1. 1 National Tuberculosis Programme

2. 2 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 (1994-1995)

3. 3 O RGANIZATION S ET-UP OF N ATIONAL T UBERCULOSIS P ROGRAMME OF M YANMAR HEALTH MINISTER DEPUTY HEALTH MINISTER DIRECTOR GENERAL DY. DIRECTOR GENERAL (Medical Care) DY. DIRECTOR GENERAL (Public Health/Disease Control) Director (Med. Care) Director (Lab.) Director (Nursing) Director (Planning) Director (Admin) Director (Disease Control) Director (Public Health) Director (Food & Drug)0 Deputy Director (TB Control) 3 Assistant Directors (TB Control) S/DTB OS TB OD TB OS TB O D TB OS TB OS/D TB OD TB O S TB O YangonMandalay Kachin Shan(S) Kayah Ayeyar- waddy Mon Kayin BagoRakhineSagaing Chin(N) Tanin- tharyi State / Divisions # DistrictTownshipRHC DTB O Shan(N) Magway Chin (S) DTB O S TB O Shan(E) DTBO = Divisional TB Officer STBO = State TB Officer Director (Occupational Health) No. of districts with TB team = 43 / 63 No. of townships with TB team = 58/324 No. of townships with TB staff = 46 / 324

4. 4 Central Supervisory Committee for Prevention and Control of TB Chairman -Minister for Health Vice Chairman- Deputy Minister for Health Members -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 4

5. 5 1966NTP implementation started. 1978NTP was integrated to Basic Health Services under PHC programme 1994NTP introduced 18 SCC Townships. 1997DOTS strategy has been introduced. Oct’ 2003 324 townships DOTS covered (Total coverage) 6 History of National TB Programme Myanmar

6. 6 DOTS COVERED TOWNSHIPS (1994-2003) 310 259 324

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8. 8 DOTS Progress Towards Targets Target

9. 9 Government contribution YearRegular Budget DrugsTotal 1995-96 1996-97 1997-98 1998-99 1999-2000 2000-2001 2001-2002 2002-2003 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 14,493 16,141 21,017 38,377 45,509 92,747 103,470 109,349 (Kyats in thousands)

10. 10 Partnerships PartnersContribution WHO:Technical training / local abroad, IEC materials, drugs and lab. supplies UNDPTB drugs for 11 townships (up to 2002) JICA for training and training materials for 48 townships in 3 divisions (Mandalay, Sagaing and Magway divisions) GDFWill support for three years now, receiving Second year support JATA6 townships, for training, UNHCR2 townships in Rakhine State for TB drugs and lab reagents AZG2 townships in Kachin State for drugs and lab. activities IUATLD3 cars and lab. equipment 1. Existing partners and their contribution 2. Collaborative activities with -National AIDS Programme - Private sector (GP) - Other public sector (Ministry of Labour - Social Security Board, Ministry of Industry, Myanmar Railway) and local NGOs (MMCWA, MMA)

11. 11 100% DOTS coverage (324 townships) achieved in 2003 from 259 townships in 2001. Additional TB diagnostic and treatment centres were opened in Yangon in 2001 and in Mandalay in 2002. More IEC materials and health talks among community and Co- operation with other sectors – NAP/ private public partnership / NGOs / Social Security Board / Ministry of Industry/Myanmar Railways Resource mobilization: situation, allocation, availability at start of proposed activities, GDF supply started form end of 2001 . Capacity building: refresher training, training for new recruit, international training to all health staffs, NGOs, private sector. Progress made in 2001- 2003

12. 12 Progress made in 2001- 2003 contd. Myanmar-Thai border TB/HIV collaboration is strengthened. Treatment guideline for TB/HIV co-infection is developed in 2003. 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. NTP, Myanmar will be supported 17 million for 5 years for GFATM. Vehicles, lab. equipments supported from IUATLD. 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. Programme treatment policy changed form fully intermitted regimen to daily regimen using with 4 - Fixed Dose Combination (4FDC)

13. 13 Progress in Laboratory (120) Binocular Microscopes are distributed during the year 2001-2003. Received Microscopes and laboratory equipment from (IUATLD) for strengthening of National TB Reference Laboratory and network. Laboratory Quality Control System covered all State/Divisions with concordance over 90%. Lot Quality Assurance System (LQAS) has been introduced at state/divisional level in 2002 onward.

14. 14 Resources required for 1 year Budget HeadPlanned CostAvailableExpected (GFATM) Funding Gap Human Resource 489,867270,000219867- Infrastructure/ Equipment 2,367,000-1,971,000396,000 Training / Planning 422,50050000292,50080,000 Commodities / Products 1,140,661326601,064,66143,340 Drugs 1,033,850625333-408,517 Monitoring & Evaluation 201,05077,300121,9001,850 Administrative 215,480- - Other (Research) 331,100- - Total 6,201,5081,055,2934,216,508929,707 Available = Government + WHO +GDF

15. 15  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 Constraints

16. 16 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. Future Plan

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