Transcript WTBD2004 16 Consolidate, sustain and advance achievements

National Tuberculosis Programme
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53 million
676,577 sq km (75/sq km)
A major public health problem
ARI 1.66% (1972), 1.5% (1994)
162/100,000 est. incidence (WHO
report 2003, Global TB control)
About 85,000 new cases of TB per
year Half of them being infectious.
Estimated 100/100,000 population is
all smear positive TB cases (1994)
Estimated 75/100,000 population is
new smear positive TB cases (1994)
HIV sero-prevalence among TB
patients – 4.5% (1995-1997)
MDR-TB among new sear positive
cases 1.25% institutional based
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(1994-1995)
ORGANIZATION SET-UP OF
NATIONAL TUBERCULOSIS PROGRAMME OF MYANMAR
HEALTH MINISTER
DEPUTY HEALTH MINISTER
DIRECTOR GENERAL
DY. DIRECTOR GENERAL
(Medical Care)
Director
(Med. Care)
Director
(Lab.)
Director
(Nursing)
DY. DIRECTOR GENERAL
(Public Health/Disease Control)
Director
(Planning)
S/DTB O
DTB O
S TB O
D TB O
Yangon
Mandalay
Kachin
Magway Shan(S)
Chin (S) Kayah
Ayeyarwaddy
No. of districts with TB team = 43 / 63
No. of townships with TB team = 58/324
No. of townships with TB staff = 46 / 324
Director
(Occupational
Health)
Deputy Director
(TB Control)
DTBO = Divisional TB Officer
STBO = State TB Officer
DTB O
Director
(Disease
Control)
Director
(Admin)
S TB O
Mon
Kayin
D TB O
S TB O
S/D TB O
Bago
Rakhine
Sagaing
Chin(N)
Director
(Food &
Drug)0
Director
(Public
Health)
3 Assistant Directors
(TB Control)
D TB O
Tanintharyi
S TB O
S TB O
Shan(N)
Shan(E)
State / Divisions #
District
Township
RHC
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Central Supervisory Committee for
Prevention and Control of TB
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•
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Chairman
Vice Chairman Members
-
Minister for Health
Deputy Minister for Health
Director of Medical Service
Ministry of Defense
Director Generals from
Ministry of Health
Directors from Dept. of Health,
Dept. of Medical Science,
Presidents of Local NGOs,
and other officials from National
TB Programme
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History of National TB Programme Myanmar
1966
NTP implementation started.
1978
NTP was integrated to Basic Health Services
under PHC programme
1994
NTP introduced 18 SCC Townships.
1997
DOTS strategy has been introduced.
Oct’ 2003
324 townships DOTS covered (Total coverage)
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DOTS COVERED TOWNSHIPS
(1994-2003)
350
324
310
300
231
Townships
250
259
168
200
144
153
153
153
1995
1996
1997
1998
150
100
50
18
0
1994
1999
2000
2001
2002
2003
Year
Existing DOTS Townships
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DOTS coverage in Myanmar
100%
80%
60%
%
40%
20%
0%
1994 1999 2000 2001 2002 2003
DOTS covered pop:
DOTS covered tsps
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DOTS Progress Towards Targets
100
Target
90
2002
80
1999
TSR(%)
70
2000
2001
60
50
40
30
20
10
0
0
20
40
CDR(%)
60
80
100
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Government contribution
Year
1995-96
1996-97
1997-98
1998-99
1999-2000
2000-2001
2001-2002
2002-2003
Regular
Budget
Drugs
Total
13,771
14,527
16,017
18,777
20,509
62,747
68,470
74,349
782
1,614
5,000
19,600
25,000
30,000
35,000
35,000
14,493
16,141
21,017
38,377
45,509
92,747
103,470
109,349
(Kyats in thousands)
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Partnerships
1. Existing partners and their contribution
Partners
Contribution
WHO:
Technical training / local abroad, IEC materials, drugs and lab. supplies
UNDP
TB drugs for 11 townships (up to 2002)
JICA
for training and training materials for 48 townships in 3 divisions (Mandalay,
Sagaing and Magway divisions)
GDF
Will support for three years now, receiving Second year support
JATA
6 townships , for training,
UNHCR
2 townships in Rakhine State for TB drugs and lab reagents
AZG
2 townships in Kachin State for drugs and lab. activities
IUATLD
3 cars and lab. equipment
2. Collaborative activities with
- National AIDS Programme
- Private sector (GP)
- Other public sector (Ministry of Labour - Social Security Board, Ministry
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of Industry, Myanmar Railway) and local NGOs (MMCWA, MMA)
Progress made in 2001- 2003
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100% DOTS coverage (324 townships) achieved in 2003 from 259
townships in 2001.
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Additional TB diagnostic and treatment centres were opened in
Yangon in 2001 and in Mandalay in 2002.
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More IEC materials and health talks among community and Cooperation with other sectors – NAP/ private public partnership /
NGOs / Social Security Board / Ministry of Industry/Myanmar
Railways
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Resource mobilization: situation, allocation, availability at start of
proposed activities, GDF supply started form end of 2001.
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Capacity building: refresher training, training for new recruit,
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international training to all health staffs, NGOs, private sector.
Progress made in 2001- 2003
contd.
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Myanmar-Thai border TB/HIV collaboration is strengthened.
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Treatment guideline for TB/HIV co-infection is developed in 2003.
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Operational research are doing in collaboration with TDR, DMR and
NTP in area of drug resistance TB, Fixed Dose Combination Drugs,
assessment of community involvement in DOTS implementation.
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NTP, Myanmar will be supported 17 million for 5 years for GFATM.
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Vehicles, lab. equipments supported from IUATLD.
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Strengthening of manpower – 1 created post of Sr. Consultant
Microbiologist, 2 created Assistant Directors for central level and
4 State/Divisional TB Officers for state/divisional level.
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Programme treatment policy changed form fully intermitted
regimen to daily regimen using with 4 - Fixed Dose Combination
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Progress in Laboratory
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(120) Binocular Microscopes are distributed during the
year 2001-2003.
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Received Microscopes and laboratory equipment from
(IUATLD) for strengthening of National TB Reference
Laboratory and network.
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Laboratory Quality Control System covered all
State/Divisions with concordance over 90%.
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Lot Quality Assurance System (LQAS) has been
introduced at state/divisional level in 2002 onward.
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Resources required for 1 year
Budget Head
Planned Cost
Available
Expected
Funding
Gap
(GFATM)
Human Resource
489,867
270,000
219867
-
2,367,000
-
1,971,000
396,000
422,500
50000
292,500
80,000
Commodities / Products
1,140,661
32660
1,064,661
43,340
Drugs
1,033,850
625333
-
408,517
Monitoring & Evaluation
201,050
77,300
121,900
1,850
Administrative
215,480
-
215,480
-
Other (Research)
331,100
-
331,100
-
6,201,508
1,055,293
4,216,508
929,707
Infrastructure/ Equipment
Training / Planning
Total
Available = Government + WHO +GDF
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Constraints
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Low community awareness about TB and facilities available for
diagnosis and treatment
Lack of transport and insufficient skilled staff at all levels for key
activities
Drug supplies are partially secured up to 2010 with the support of
GDF and GFATM
Availability of low quality anti-TB drugs leading to Multi-Drug
Resistant TB
Data management – delay in flow of data due to manual
management.
Co-infection with HIV
Weak co-operation with private sector in case finding and proper
referral
Floating population
Different geographic terrain and language barrier
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Future Plan
Train programme staffs and improve infrastructure at central and
peripheral levels for better programme management and training of
laboratory staffs and provide adequate microscopes to ensure an
effective and quality assured laboratory network.
Develop a strategy for an effective IEC campaign.
Establishment of microscopy centre at station health units to achieve
the strategy of microscopy centre for 1/50,000 population.
Exploring of alternative source of assistance and potential partners for
secured drug supplies.
Installation of user friendly computerized data management system and
facilitated reporting via fax or e-mail.
Scale up existing collaborative activities: TB-HIV projects etc. and
scaling up of existing Public-Private Partnership, and develop a referral
system for whole country in 2004.
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