4.1 Financing for TB prevention, diagnostic and treatment services

Draft! Prepared 2025-04-13 using country-reported data snapshot files from 29 July 2024!

Progress in reducing the burden of tuberculosis (TB) disease requires adequate funding sustained over many years. The World Health Organization (WHO) began annual monitoring of funding for TB prevention, diagnostic and treatment services, based on data reported by national TB programmes (NTPs) in annual rounds of global TB data collection, in 2002. Findings have been published in global TB reports and peer-reviewed publications (1–3). Recognizing that not all international donor funding for TB is captured in the data reported to WHO, each year WHO complements its analysis of data reported by NTPs with an assessment of international donor funding for TB using donor reports to the Organisation for Economic Co-operation and Development (see Section 4.2). Since 2005, funding for TB research has been monitored by the Treatment Action Group, with findings published in an annual report (4).

At the second United Nations (UN) high-level meeting on TB in September 2023, Member States committed to mobilizing at least US$ 22 billion per year for TB prevention, diagnostic and treatment services by 2027, and US$ 35 billion per year by 2030; a target of US$ 5 billion per year by 2027 was set for investment in TB research (5). These targets were based on estimates of resource needs set out in the latest Global Plan to End TB produced by the Stop TB Partnership (6).

Funding available for TB prevention, diagnostic and treatment services

Data about funding available for TB prevention, diagnostic and treatment services by major category of expenditure and source of funding in the 9-year period 2015–2023 have been reported to WHO by 132 low and middle-income countries (LMICs) (Fig. 4.1.1). These countries accounted for 99% of reported TB cases globally in 2023.

Fig. 4.1.1 The 132 low- and middle-income countriesa included in WHO analyses of TB financing, 2015–2023

Map of countries included in the analysis of TB financing

a In the most recent classification of countries by income group published by the World Bank (7), the Russian Federation was categorized as a high-income country. The country was included in all analyses because it was an upper-middle-income country for most of the period 2015–2023, it is in WHO’s list of high burden countries for drug-resistant TB and is one of the three countries in WHO’s list of global TB watchlist countries (having been in WHO’s list of high TB burden countries until 2020). For more details about WHO’s lists of high burden countries for TB, drug-resistant TB and TB/HIV, see Annex 3 of the core report document.


Funding available for TB prevention, diagnostic and treatment services in LMICs falls far short of the global targets set at the 2023 UN high-level meeting, and has fallen since 2019. In 2023, the total funding available in LMICs was US$ 5.7 billion, equivalent to only 26% of the target of reaching US$ 22 billion by 2027. This level of funding in LMICs in 2023 was also lower than that the approximately US$ 6.0 billion that was available in each of the previous 3 years (2020–2022) (Fig. 4.1.2).

Fig. 4.1.2 Funding available for TB prevention, diagnostic and treatment services in 132 low- and middle-income countries by source,a,b,c 2015–2023, compared with the 2027 global target set at the 2023 UN high-level meeting on TB

a Values for 2015–2022 are higher than those shown in the Global Tuberculosis Report 2023, since they have been inflated (for comparability with data for 2023) to constant US$ values for 2023.
b The 132 countries accounted for 99% of the global number of notified cases of TB in 2023. In a small number of countries (seven countries in 2023, which accounted for 0.52% of the number of TB cases notified globally), TB funding data for 2023 were not reported to WHO and funding amounts could not be estimated from available data. For these countries, only the estimated financial costs associated with inpatient and outpatient treatment were included.
c In the most recent classification of countries by income group published by the World Bank (7), the Russian Federation was categorized as a high-income country. The country was included in all analyses because it was an upper-middle-income country for most of the period 2015–2023, it is in WHO’s list of high burden countries for drug-resistant TB and is one of the three countries in WHO’s list of global TB watchlist countries (having been in WHO’s list of high TB burden countries until 2020). For more details about WHO’s lists of high burden countries for TB, drug-resistant TB and TB/HIV, see Annex 3 of the core report document.


Explanations for the decline in the total amount of available funding for TB between 2019 and 2020–2021 include reductions in the global number of people reported as diagnosed with TB in 2020 and 2021, compared with 2019 (Section 2); changes to models of service delivery (e.g. fewer visits to health facilities and more reliance on remote support during treatment); and reallocation of resources to the COVID-19 response. While 2022–2023 saw an impressive rebound and further increase in the number of people newly diagnosed and notified with TB (Fig. 2.1.1 in Section 2.1), there was no comparable rebound in the total funding available for TB service delivery. Instead, there was a decrease in the total funding available between 2022 (US$ 6.0 billion) and 2023 (US$ 5.7 billion); this was largely the result of reductions in domestic funding in the BRICS (Brazil, the Russian Federation, India, China, South Africa) group of countries, particularly in the Russian Federation (Fig. 4.1.3). Overall, international donor funding for LMICs has remained stable, at around US$ 1.2 billion per year.

Throughout the period 2015–2023, funding available by source shows a relatively consistent pattern in terms of the amounts and relative contributions from domestic and international donor sources (Fig. 4.1.2). In 2023, 80% of the funding available for TB prevention, diagnostic and treatment services was from domestic sources, similar to previous years. From 2019 to 2022, there was a decline in available funding from domestic sources (US$ 1.2 billion) and a very slight increase in funding provided by international donors (US$ 0.10 billion).

The main source of international donor funding for TB is The Global Fund (8). Its share of the total amount of international donor funding reported by NTPs to WHO was 76% in 2023. Section 4.2 provides a more comprehensive analysis, including additional funding that is not channeled through NTPs. Key findings include that the United States Government (USG) is the largest contributor of funding to The Global Fund and also the largest bilateral donor for TB; overall, it contributes about 50% of international donor funding for TB.

Aggregate figures for the shares of funding from domestic and international sources in LMICs are strongly influenced by the BRICS group of countries (Fig. 4.1.3). In combination, BRICS accounted for US$ 2.8 billion (63%) of the total of US$ 4.5 billion in 2023 that was provided from domestic sources. Overall, 97% of available funding in BRICS and all funding in Brazil, China and the Russian Federation in 2023 was from domestic sources. In other LMICs, international donor funding remains crucial. For example, in 2023 such funding accounted for 54% of the funding available in the 26 high TB burden and two global TB watchlist countries (Cambodia and Zimbabwe) outside BRICS, and 62% of the funding available in low-income countries (LICs).

Fig. 4.1.3 Funding available for TB prevention, diagnostic and treatment services from domestic sources and international donors in nine country groups, 2015–2023

BRICS: Brazil, the Russian Federation, India, China, South Africa.
a The two global TB watchlist countries included are Cambodia and Zimbabwe.
b Asia includes the WHO regions of South-East Asia and the Western Pacific.
c “Other regions” consists of three WHO regions: the Eastern Mediterranean Region, the European Region and the Region of the Americas.


Bangladesh, Brazil, India, Mongolia, the Philippines and Sierra Leone are examples of high TB burden countries that have increased domestic funding specifically allocated to NTPs in recent years (Fig. 4.1.4). There were also substantial increases up to 2019 in China and in 2023 in Lesotho. Domestic funding has risen in one of the global TB watchlist countries: Cambodia.

Fig. 4.1.4 Funding availablea for TB prevention, diagnostic and treatment services in the 30 high TB burden countries and three global TB watchlist countries,b based on NTP reported data, disaggregated by source of funding, 2015–2023

a Domestic funding in this graphic is based on data reported by NTPs, which typically do not include the financial costs associated with inpatient and outpatient care required during TB treatment.
b The three global TB watchlist countries are Cambodia, the Russian Federation and Zimbabwe (Annex 3) of the core report document.


Since 2017, the funding available for diagnosis and treatment of drug-susceptible TB has fallen slightly (Fig. 4.1.5). Funding available for treatment and management of drug-resistant TB increased from 2015–2022, but then declined in 2023; this pattern is largely explained by trends in the BRICS group of countries (Fig. 4.1.6).

Fig. 4.1.5 Funding available for TB prevention, diagnostic and treatment services in total and by category of expenditure in 132 low- and middle-income countries,a 2015–2023

a The 132 countries accounted for 99% of the global number of notified cases of TB in 2023. In the most recent classification of countries by income group published by the World Bank (7), the Russian Federation was categorized as a high-income country. The country was included in all analyses because it was an upper-middle-income country for most of the period 2015–2023, it is in WHO’s list of high burden countries for drug-resistant TB and is one of the three countries in WHO’s list of global TB watchlist countries (having been in WHO’s list of high TB burden countries until 2020). For more details about WHO’s lists of high burden countries for TB, drug-resistant TB and TB/HIV, see Annex 3 of the core report document.
b The category of drug-susceptible TB includes funding reported by NTPs for the following items: laboratory equipment and supplies; anti-TB drugs; programme management (including staff and activities); operational research and surveys; patient support; and miscellaneous items. It also includes WHO estimates of funding for inpatient and outpatient care for people treated for drug-susceptible TB, which are based on WHO estimates of the unit costs of bed-days and visits combined with the average number of outpatient visits and bed-days per TB patient as reported by NTPs.
c The category of drug-resistant TB includes funding reported by NTPs for the following items: anti-TB drugs required for treatment of multidrug and rifampicin-resistant TB (MDR/RR-TB, which includes people with pre-extensively drug-resistant TB and extensively drug-resistant TB, XDR-TB); any programme management (staff and activity) costs specifically required for the provision of care to people with drug-resistant TB; and WHO estimates of funding for inpatient and outpatient care. The categories for which funding is reported to WHO do not allow for funding for the diagnosis of drug-resistant TB specifically to be distinguished. In data analysis, the category of laboratory supplies and equipment is allocated to drug-susceptible TB. Rapid tests recommended by WHO can detect TB and RR-TB simultaneously.
d Data for TB preventive treatment (drugs only) are only available from 2019 onwards.


Fig. 4.1.6 Funding available for drug-susceptible TB and drug-resistant TB in three country groups, 2015–2023

BRICS: Brazil, the Russian Federation, India, China, South Africa.
a The two global TB watchlist countries included are Cambodia and Zimbabwe.
b The category of drug-susceptible TB includes funding reported by NTPs for the following items: laboratory equipment and supplies; anti-TB drugs; programme management (including staff and activities); operational research and surveys; patient support; and miscellaneous items. It also includes WHO estimates of funding for inpatient and outpatient care for people treated for drug-susceptible TB, which are based on WHO estimates of the unit costs of bed-days and visits combined with the average number of outpatient visits and bed-days per TB patient as reported by NTPs.
c The category of drug-resistant TB includes funding reported by NTPs for the following items: anti-TB drugs required for treatment of multidrug and rifampicin-resistant TB (MDR/RR-TB, which includes people with pre-extensively drug-resistant TB and extensively drug-resistant TB, XDR-TB); any programme management (staff and activity) costs specifically required for the provision of care to people with drug-resistant TB; and WHO estimates of funding for inpatient and outpatient care. The categories for which funding is reported to WHO do not allow for funding for the diagnosis of drug-resistant TB specifically to be distinguished. In data analysis, the category of laboratory supplies and equipment is allocated to drug-susceptible TB. Rapid tests recommended by WHO can detect TB and RR-TB simultaneously.


Funding gaps for implementation of national strategic plans for TB

Data about required budgets and expected funding for the implementation of national strategic plans for TB, and associated sources of funding, are reported to WHO by NTPs as part of WHO’s annual rounds of global TB data collection. Funding gaps, as identified by NTPs, were estimated based on the difference between the required budget that was reported and the expected level of funding that was reported.

In 2024, 60 of the 132 LMICs reported that funding was not sufficient for full implementation of their national strategic plans for TB (Fig. 4.1.7).

Fig. 4.1.7 The 132 low- and middle-income countriesa that did and did not report funding gaps for full implementation of their national strategic plans for TB in 2024

Map showing which countries reported funding gap

a The 132 countries accounted for 99% of the global number of notified cases of TB in 2023. In the most recent classification of countries by income group published by the World Bank (7), the Russian Federation was categorized as a high-income country. The country was included in all analyses because it was an upper-middle-income country for most of the period 2015–2023, it is in WHO’s list of high burden countries for drug-resistant TB and is one of the three countries in WHO’s list of global TB watchlist countries (having been in WHO’s list of high TB burden countries until 2020). For more details about WHO’s lists of high burden countries for TB, drug-resistant TB and TB/HIV, see Annex 3 of the core report document.


The combined total of the funding gaps reported by 60 countries for 2024 amounted to US$ 1.7 billion. The largest gaps were reported by countries in the African and South-East Asia regions. Of the 26 LICs, 17 (65%) reported funding gaps that amounted to US$ 206 million in 2024 (Fig. 4.1.8).

Fig. 4.1.8 Gaps between the funding required for national strategic plans for TB and the expected level of funding as reported by national TB programmes,a by income group and by WHO region, 2015–2024

a In 2024, 60 low- and middle-income countries reported insufficient funding for full implementation of their national strategic plans for TB.


Focusing on data from the 30 high TB burden countries and three global TB watchlist countries, Indonesia (US$ 294 million), Bangladesh (US$ 289 million), Nigeria (US$ 230 million), Viet Nam (US$ 138 million) and Kenya (US$ 121 million) reported the largest funding gaps (Fig. 4.1.9).

Fig. 4.1.9 Sources of fundinga and funding gaps reported for the TB-specific budgets included in national strategic plans for TB in the 30 high TB burden countries and three global TB watchlist countries,b 2024c



a Domestic funding in this graphic is based on data reported by NTPs, which typically do not include the financial costs associated with inpatient and outpatient care required during TB treatment.
b The three global TB watchlist countries are Cambodia, the Russian Federation and Zimbabwe (Annex 3) of the core report document.
c Three countries i.e the Democratic People’s Republic of Korea, Papua New Guinea and Sierra Leone had not reported budget data for 2024 to WHO at the time the data snapshot for this webpage was taken (29 July 2024).
d Upper middle-income countries include one high-income country: the Russian Federation.


The Stop TB Partnership’s Global Plan to End TB (the Global Plan) for 2023–2030 estimated global funding needs of US$ 15–32 billion per year in LMICs. The estimated funding needs for 2024 were US$ 17 billion, of which US$ 2.1 billion was in LICs, US$ 9.7 billion was in lower-middle-income countries and US$ 5.3 billion was in upper-middle-income countries per year (6).

Overall, the total required budget reported by the 60 countries represented only 43% of the estimated needs in the Global Plan for LMICs in 2024 (Fig. 4.1.10). A likely explanation is that national strategic plans for TB are much less ambitious (in scale and scope) than the Global Plan. National plans will be influenced by known resource constraints, in terms of the funding available domestically and from international sources.

As an example, the reported funding gap in LICs (US$ 0.21 billion) is only around 12% of the gap (US$ 1.7 billion) between the estimated needs in the Global Plan for LICs (US$ 2.1 billion) and their expected level of funding in 2024 (US$ 0.37 billion) (6).

Fig. 4.1.10 Gaps between the funding required for national strategic plans for TB as reported by NTPsa and the estimated funding needs in the Global Plan, by income group and WHO region, 2024

a The Global Plan estimates include the financial costs associated with inpatient and outpatient care required during TB treatment, which are not typically included in data reported by NTPs. For comparability purposes, the estimated financial costs associated with inpatient and outpatient treatment were added to the required budgets and expected funding reported by NTPs, using the latest available information (2023). See Box 4.1 for the methods used to develop these estimates.


Increases in both domestic and international funding for TB are urgently required. Variation in the share of funding from domestic sources within a given income group suggests that there is scope to increase domestic funding in some high TB burden and global TB watchlist countries. Allocations by The Global Fund and its major donor (the US government, which is also the leading bilateral donor for TB) are currently the dominant influences on international donor funding for TB (see also Section 4.2 of this report).

Estimated cost per person treated for TB

The median cost per person treated for TB in 2023, from a provider perspective, was US$ 783 for drug-susceptible TB (Fig. 4.1.11).

Fig. 4.1.11 Estimated cost per person treated for drug-susceptible TBa compared with GDP per capita in 119 countries,b 2023

Red dots indicate the 30 high TB burden and three global TB watchlist countries, blue dots indicate other countries; the size of each dot is proportional to the number of national notifications of drug-susceptible TB in 2023.

a The following costs are included: laboratory equipment and supplies; anti-TB drugs; programme management (including staff and activities); operational research and surveys; patient support; miscellaneous items; inpatient and outpatient care.
b Limited to countries with at least 100 persons on first-line treatment in 2023, that reported funding and utilisation data to WHO.


The median cost per person treated for drug-resistant TB, from a provider perspective, was US$ 4877 in 2023 (Fig. 4.1.12). These amounts include all of the provider costs associated with treatment and TB programme-related costs.

Fig. 4.1.12 Estimated cost per person treated for drug-resistant TBa compared with GDP per capita in 89 countries,b 2023

Red dots indicate the 30 high MDR/RR-TB burden countries, blue dots indicate other countries; the size of each dot is proportional to the number of national notifications of drug-resistant TB in 2023.

MDR/RR-TB: multidrug/rifampicin resistant-TB.
a The following costs are included: anti-TB drugs; programme management (staff and activity) costs specifically required for the provision of care to people with drug-resistant TB; inpatient and outpatient care.
b Limited to countries with at least 20 persons on second-line treatment in 2023, that reported funding and utilisation data to WHO.


Estimates of the costs incurred by people with TB and their households during diagnosis and treatment are available from national surveys (Section 5.2).

Further details about funding for TB prevention, diagnostic and treatment services are available in online country profiles and the Global Tuberculosis Report mobile app. Methods for data collection and analysis are summarized below (Box 4.1).


Box 4.1

Methods used to compile, review, validate and analyse financial data reported to WHO

WHO began monitoring government and international donor financing for TB prevention, diagnostic and treatment services in 2002. All data are stored in the WHO global TB database. The standard methods used to compile, review, validate and analyse these data are described in detail in a technical appendix; this box provides a summary.

The methods used to systematically review and validate data have remained consistent since 2002. They include routine checks for plausibility and consistency, and discussions with country respondents to resolve queries. In reviewing and validating data, particular attention has always been given to high TB burden countries.

Missing data are handled as follows:

Trend data are shown in constant (as opposed to current) 2023 US dollars. In other words, funding amounts are shown in real terms, after adjustment for inflation. Figures and tables that show data for 2023 only are labelled as current 2023 US dollars.

Note: Data sources for Fig 4.1.2–4.1.12: Data reported by NTPs and estimates produced by the WHO Global Tuberculosis Programme. The data sources, boundaries, accounting rules, and estimation methods used in this report are different from those of the System of Health Accounts 2011 (SHA2011). The TB funding data reported here are thus not comparable with the disease expenditure data, including for TB, that are reported in WHO’s Global Health Expenditure Database.

References

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  2. Floyd K, Pantoja A, Dye C. Financing tuberculosis control: the role of a global financial monitoring system. Bull World Health Organ. 2007;85(5):334–40 (https://www.ncbi.nlm.nih.gov/pubmed/17639216).

  3. Su Y, Garcia Baena I, Harle AC, Crosby SW, Micah AE, Siroka A et al. Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000-17: a financial modelling study. Lancet Infect Dis. 2020;20:929-42. (https://pubmed.ncbi.nlm.nih.gov/32334658/).

  4. Treatment Action Group, Stop TB Partnership. Tuberculosis research funding trends 2005–2021. New York: Treatment Action Group; 2022 (https://www.treatmentactiongroup.org/wp-content/uploads/2022/12/tb_funding_2022.pdf).

  5. Political declaration of the high-level meeting of the General Assembly on the fight against tuberculosis. New York: United Nations; 2023 (https://www.un.org/pga/77/wp-content/uploads/sites/105/2023/09/TB-Final-Text.pdf).

  6. The Global Plan to End TB, 2023–2030. Geneva: Stop TB Partnership; 2022 (https://www.stoptb.org/global-plan-to-end-tb/global-plan-to-end-tb-2023-2030).

  7. World Bank Country and Lending Groups. New York: World Bank; 2024 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups).

  8. The Global Fund; Geneva: (https://www.theglobalfund.org/en/).