Transcript Myanmar - ELF and STH PM 2382014

Progress report:
the National LF and STH programme
in MYANMAR
Dr. Ni Ni Aye,
Program Manager (ELF)
LF and STH program Mangers Meeting,Jakarta
(23-24 sept,2014)
Background Information
• Geography and Population
– Total population – 51419420 (2014
Census)
– Ecological zones - Myanmar ,the largest
country in mainland in South East Asia
with a total land area of 676,578 square
kilometer
• Political & Health Administrative
Divisions:
- First level (7 States and 7 Regions)
- Second level (69 Districts, 330
townships, 82 sub townships and 396
towns)
- Third level (3045 wards, 13267 village
tracts and 67285 Villages)
Historical Perspective
• 1877 - First case of elephantiasis -Indian man, Thayet tsp
• 1956 - Dr Nandy, a surgeon of RGH – found out the relation
between hydrocoele and presence of Mf
• 1959, Municipal Council of Rangoon - Anti- filarial campaign -
vector control.
• 1960 -Division of Health Dep; - NMBS & treatment of (+)ve cases.
• 1962-1965, Filariasis Research project (WHO)in Rangoon
• 1966-69 Pilot vector control programme - using 50% EC fenthion
larvicide in 16 tsp; of Rangoon by health department.
• 1970 -(D.O.H )Directorate of Health - Filariasis control project -
Historical Perspective (Cont;)
• 1978 - integrated with Malaria, DHF and J-B Encephalitis control
Programme into VBDC Program
• 1983, Culex larval control was stopped because of vector
resistant to insecticide, although case finding with NMBS and
treatment of positive cases •
2001, the Global Strategy for Elimination of Lymphatic
Filariasis (ELF) has been adopted.
National programme overview
Indicator
LF
Year of inception of the national
programme
2000
Target date for elimination
2020
Name of administrative unit for
implementation of PC
Total # administrative units requiring
PC at the start of the programme
Total population requiring PC in the
country
District
45
Total pop in endemic IUs
(40,014,402)
STH
2003
District
67
Sum of preSAC & SAC
requiring PC (14,634,198)
PC Programme Financing
• Contributors to the 2013 programme costs
(and rough estimate of contributions by each
if available):
Contributor
National government
Funding (US$)
Travel allowance
Sub-national government
Internal donors
External donors (GNNTD)
Transport cost for drug
Others (WHO)
Others (JICA)
7500
IEC
27000
PC programme achievements 2013
Targeted
#
administrative
units for PC
MDA2 (DEC + ALB)
# people
#
administrative
units for PC
# people
36
35488298
36
30313249
T3 (ALB/MBD) for STH 1st round
67
3151312
67
2790809
T3 (ALB/MBD) for STH 2nd round
67
12745578
67
Activities
PC
Achieved
Indicator
M&E
MMDP
12018002
Targeted
Achieved
Total # sentinel and spot check sites surveyed (LF)
13
13
Total # sentinel sites surveyed (STH)
8
0
Total # IUs where stopping-MDA TAS implemented (LF)
0
0
Total # IUs which passed TAS and stopped MDA (LF)
0
0
Total # IUs where surveillance TAS implemented (LF)
3
0
# IUs where hydrocele surgeries performed
65
65
# IUs where lymphedema and ADLA management provided
45
45
Progress Towards LF Elimination
Started MDA
96%
≥5 MDA
rounds
42%
Surveillance
post-MDA
7%
MMDP access
42%
0%
20%
40%
60%
80%
100%
Definitions
Started MDA
≥5 MDA rounds
Surveillance
MMDP access
Progress Towards LF Elimination
16%
14.7%
14%
12%
10%
8%
5.6%
6%
4%
2%
0.6%
0%
Baseline (2001)
Mid-term (2007)
Pre-TAS(2014)
Progress Towards STH scale up
*Coverage =
Progress Towards STH scale up
*Coverage =
PC coverage, 2013
PC type
MDA2 (DEC + ALB)
T3 (ALB/MBD) for STH 1st
round
T3 (ALB/MBD) for STH 2nd
round
# administrative
# administrative
units with
units receiving
reported coverage
PC
above target*
# administrative
units where
coverage was
verified**
36
36
36
67
67
67
67
67
67
*65% for LF and 75% for STH
**reported coverage was verified by coverage survey or similar independent activity
Impacts of MDA in Sentinel Sites (LF)
# SS/SC sites
Sentinel Sites
<1% mf
Sentinel Sites
≥1% mf
Spot Check
sites
<1% mf
Spot Check
sites
≥1% mf
Baseline surveys
41
28
42
31
Latest surveys
(post-MDA)
59
10
55
9
PC Monitoring and Evaluation
Describe how coverage is monitored
• Post MDA survey,
• Area coverage survey,
• Pop coverage
SAE protocol (Severely affected Event)
Detection, Management , Reporting
For <5 children and the ones who has problem to swallow the drug
- Tablets should be crushed and given with sufficient water to
prevent choking
To exclude those people
- who were taking other drugs for treatment of other
diseases from MDA
- who were suffering from other chronic diseases like, TB,
Hypertension, Heart / renal / liver diseases (with evidence of
taking treatment from any health facility)
- who were ill or bed ridden during the time of MDA
- < 2 year age group and pregnant women from MDA
LF Transmission Assessment Survey to stop MDA
#
# administrative units currently eligible for surveys to stop mass treatment 5
# administrative units where surveys to stop mass treatment were
conducted
# administrative units where criteria was passed and mass treatment
stopped
• Justification for stopping MDA without TAS in the above IU s
• Integrated assessment of STH considered?
0
LF Transmission Assessment: Forecasting
Year
Number of IUs to
be covered
TAS1 TAS2 TAS3
2014
2
2015
12
2016
4
2017
2018
22
2019
2
2020
Total number of
EUs
ICT/LF ST
Required*
5
1600*5
12
1800*12
2
6
1800*6
12
12
1800*12
4
26
1800*26
2
1800*2
24
1800*24
3
24
*sum of the total sample size required for each EU assessed;
Integrated Vector Management (LF)
• Describe any activities targeted to control LF
vectors (including those conducted by other
programmes)
• Training, Entomology survey (Malaria ,JE and DHF)
• Describe monitoring and evaluation of such
activities
LF MMDP – Strategy
LF
National policy exist?
Morbidity Mx as in strategy
Organizational placement within the government
(who is responsible?)
National ELF program PM is
responsible
How integrated with the health service?
National LF programme and
Public health division at
various level
Training of service providers conducted (by who?
How frequent?)
RO and TL from Reginal VBDC
team are already trained and
they give training to VBDC staff
and BHS annually before MDA
conduct.
Patient mobilization and registration (by who?
How?)
VBDC staff register patient
who come to VBDC clinic
LF MMDP – monitoring and evaluation
LF
Describe how MMDP services are currently
monitored and reported to the national
programme
Monitored at regional level and
reported to National program ,but it
need to be strengthen
How is “access” determined?
Determined by Regional RO and TL as
clinically and also mf positive cases.
Is there any quality assessment of provided
services?
Not yet, need to be done quality
assessment
Best Practices
• Describe interventions and/or M&E activities that worked
well
i.
ii.
iii.
iv.
Integrated activities with STH program ,Nutrition program
,Basic Health under umbrella of DOH
Disease-specific activities – as VBDC include malaria ,DHF
,Chikungunya and JE diseases, So that manpower work
together for all diseases.
Voluntarily participated – VHW as drug distributors are
voluntarily participate and BHS monitor them at grass root
level
In spite of no incentives- incentive like materials can not be
given since MDA was conducted , most of VHW are still
participating during MDA. It is most important weakness to
raise drug coverage. It must be fulfil by all partners as well as
by goverment.
Issue and Challenges during the preparation of
MDA in 2013
• Micro-planning- Region and State ,Township
• population register were distributed all Tsps ,but it
were not enough and copied during population data
collection
• Due to planned for MDA in 2012 training for TMO and
SMO and VBDC staff were trained since early month of
2012, but late arrival of DEC ,we could not conduct MDA
in 2012
• BHS guide line for MDA were distributed to all BHS
before MDA start
• Some of the trained TMO and BHS transfer to non LF
endemic township
Issue and Challenges during the preparation of
MDA in 2013
• distribution of drug and IEC and arrived to RHC before
MDA started
• Transportation cost of Drug and IEC were borne by ELF
porgram with the support of GNNTD, WHO and
government
• Drug distribution Team were not well formed in some
of the township both existing and New IU
• Distribution of pamphlet were not received by each
household before MDA
• Advoccay on MDA at central ,State/region and township
level
Issue and Challenges during MDA in
2013
• No death due to drug, only one child death due to
chocking of drug in 2013
• Deaths case were reported during MDA are co
incidental death during MDA conducted
• Most s/e are Dizziness, Head ache ,vomiting
• MDA was implemented during I week without
discontinuation even rumors on MDA
• Although some of township has low population
coverage of ingestion of drug ,more than 65 % of
coverage was achieve in district
During the implementation of MDA
• Drug distributers team could not explain about drug
and about LF to household member.
• They left drug for some person who were not at home
and they marked as ingested drug
• People were not ready to ingest drug because they did
not know that drug distributor will come and
• people refused to ingest when they heard rumors on SE
of drug starting 2days of implementation
• weak supervision and monitoring during MDA by central
, Regional and state ,even in Township level
after the implementation of MDA
• Post MDA survey were mainly done by central and
some TMOs
• But weak supervision and monitoring post/after MDA
by central , Regional and state ,even in Township level
• Post MDA survey did not conduct in every township
• Still rumors came out even after the MDA was
finished in some state and Region especially Thai
border
Issues and challenges
• Out of 45 Endemic Districts (IU), Myanmar has covered 43 IU
from 2001-2013
• Within 13 years, 3 IUs have reached the elimination target,
• Now 36 out of 43 IU was conducted in 2013
• only new 21 district could be started MDA in 2013 (2 IU from
Kachin state left)
• Total pop 35.3 M were covered,85% of total pop ,90.9 % of
eligible pop in 2013
• Previously the main threat of the program is availability of
DEC and late arrival of DEC.
• Integrated NTD of Joint request for Preventive chemotherapy,
it will be regular availability of drug of LF and STH
Availability of resources
• Now DEC tablets are donated through WHO & Albendazole is
donated by the GSK company,
• IUs of high baseline Mf rate may need more rounds of MDA which
in turn need more resource
• WHO (2014-2015 )RB –10800 USD only
• No external or internal financial support previously
• Funding from GNNTD support 35000 US$ for operational cost in
2011 ,27000 US$ will support for operational cost for
implementation of MDA (2013)
• Government support – in terms of staff, salary, traveling
allowances, warehouses, transportation cost at township level and
provision of IEC ,training cost for BHS and VHW will be supported
in 2014 ( request budget for MDA to government- 400,000 USD
• CNTD will support for TAS in 2014 and find to continue support
for more activities.
Budget for NTD control and elimination in
Myanmar (2010-2014)
Activities
Coordination and
training
Mapping
Drug distribution
Social mobilization
Monitoring and
evaluation
Morbidity control
Total (USD)
Year 1
Year 2
Year 3
Year 4
Year 5
5-Year Total
$702,240
$0
$263,000
$199,030
$350,000
$0
$263,000
$199,030
$350,000
$0
$263,000
$199,030
$350,000
$0
$263,000
$199,030
$350,000
$0
$263,000
$199,030
$2,102,240
$0
$1,315,000
$995,150
$328,636
$10,500
$1,503,406
$60,836
$3,500
$876,366
$417,636
$3,500
$1,233,166
$19,136
$3,500
$834,666
$680,636
$3,500
$1,496,166
$1,506,880
$24,500
$5,943,770
Myanmar’s national NTD program aims to treat 41 million people for at
least one NTD at an estimated cost of less than US$0.04 per person per
year, underscoring the cost-effectiveness of NTD control and
elimination programs.
30
Programme Plan
2014 target
#
administrative
units for PC
MDA2 (DEC + ALB)
# people
#
administrative
units for PC
# people
36
37.7 M
40
40563359
T3 (ALB/MBD) for STH 1st round
69
12037657
69
11223182
T3 (ALB/MBD) for STH 2nd round
42
3282274
42
1277045
Activities
PC
2015 target
Activities
2014 Target
2015 Target
# districts/IUs where coverage surveys are planned
for any PC diseases
36 IU/205 tsp
40
# IUs where pre-TAS sentinel site and spot checks
planned (LF)
6 IU
12
# IUs where TAS for stopping MDA is planned (LF)
5 IU
10
# IUs where MMDP is to be evaluated (LF)
2IU
10 IU
# IUs where surveillance activities are to be carried
out (LF)
3 IU
5 IU
MMDP
# IUs where MMDP services newly initiated (LF)
10 IU
10 IU
IVM
# IUs where IVM coordinated to target LF vectors
10IU
10IU
M&E
# IUs where STH survey integrated with LF TAS
planned
PC medicine request for 2015
required
ALB (LF)
ALB (STH)
MBD
DEC
40563359
2554090
101408398
40563359
2554090
101408398
in stock
in pipeline
requested to WHO
requested to
MDP (IVM) or ITI (AZI)
Procured from other
sources
(source, # tablets and
target age group)
Thank You for Attention