The missing link: Unravelling household welfare dynamics in tuberculosis-affected families – a West Java case study

The objective of this study is to investigate the welfare dynamics of households affected by tuberculosis in West Java, Indonesia. Since the inception of the WHO's End TB era in 2015, there has been a growing body of evidence concerning social protection for tuberculosis. However, most of these initiatives have been heavily state-centric, focusing on short-term risk mitigation for single individuals in hoping for improving adherence, and thus exempting families in the process. On this account, given the absence of formal state protection and the high reliance on family and community support in Indonesia, it has become imperative to also consider the impact of TB from a family perspective. To address this gap, this study adopts an informal social protection framework to map out the various actors and their roles within the TB welfare ecosystem. Additionally, the study investigates the most commonly used coping strategies by families and explores the potential implications of these strategies. From the fieldwork it reveals that three major actors are involved in providing welfare for TB patients: the family (immediate and extended), the community (Puskesmas and CBO), and the state (through the family). Among these actors, the family serves as the primary safety net for most TB patients. Moreover, the coping strategy frequently employed involves kinship claims through intra-household labour substitution. A deeper look into this particular strategy reveals TB renders a significant shift in the division of labour within households, with women often taking on the role of shock absorber.