Planning in line with the Stop TB Strategy and the Global Plan to Stop TB, Dr Win Maung Programme Manager National Tuberculosis Programme Ministry of Health, Myanmar

Myanmar is among the 22 countries globally with the highest burden of TB. NTP detected TB cases in 2005 HIV prevalence in the general population estimated at 1.3%; HIV-prevalence among adult TB patients estimated as 7.1% nation-wide survey of DR: 4% and 15.5% MDR among new and previously treated TB patients respectively Thailand China India Bangladesh Laos Population : ~51,4 million Low Income Level General background

Progress in TB control in Myanmar, CDR from 70% (2002) to 95% (2005)* TSR stabilized at 82% and rose to 84%(2005) Total DOTS coverage in Myanmar achieved in 2003 CDR from 70% (2002) to 95% (2005)* TSR stabilized at 82% and rose to 84%(2005) Total DOTS coverage in Myanmar achieved in 2003 * Denominator of CDR is based on 1972 and 1994 TB prevalence survey

Progress in TB control Decentralizing of sputum smear microscopy and sputum collection points Establishment of NTRL PPM Pilot sites with NGO Start of GDF support 2002 and 2004 External Review Mission Start of EQA for laboratory First nationwide DRS Decentralizing of sputum smear microscopy and sputum collection points Establishment of NTRL PPM Pilot sites with NGO Start of GDF support 2002 and 2004 External Review Mission Start of EQA for laboratory First nationwide DRS

Progress in TB control yrs National Strategic Plan PPM operational guidelines published TBHIV treatment guidelines published GFATM grant implemented 5 yrs National Strategic Plan PPM operational guidelines published TBHIV treatment guidelines published GFATM grant implemented GDF awarded NTP with 2nd 3 yrs grant (till 2008) Integrated HIV Care (IHC) for TBHIV patients (WHO, IUATLD) 2 additional TBHIV pilot sites established TBHIV Surveillance in 5 sites Integrated HIV Care (IHC) for TBHIV patients (WHO, IUATLD) 2 additional TBHIV pilot sites established TBHIV Surveillance in 5 sites 3 TBHIV Pilot sites May 2005-June 2006

New 3 Disease Fund established to fight TB, HIV/AIDS and malaria: 99,5 million $ for 5 years HRD Plan launched TBHIV Initiative officially launched DR TB Committee established to developed national guidelines Private GPs trained by NTP, MMA, JICA and PSI on PPM DOTS Establishment of EQA LQAS quality control of AFB slide Approval of Fidelis Project Annual GDF Review New 3 Disease Fund established to fight TB, HIV/AIDS and malaria: 99,5 million $ for 5 years HRD Plan launched TBHIV Initiative officially launched DR TB Committee established to developed national guidelines Private GPs trained by NTP, MMA, JICA and PSI on PPM DOTS Establishment of EQA LQAS quality control of AFB slide Approval of Fidelis Project Annual GDF Review Progress in TB control 2006 TB prevalence survey in Yangon division finalized: 1/4 patients under Rx by private GPs 76% of S+ are “unknown new” TB prevalence survey in Yangon division finalized: 1/4 patients under Rx by private GPs 76% of S+ are “unknown new” Staff trained in 2006

Planning for TB control for , 5-years National Strategic Plan for TB control ( ) 2.Development of a 3-year operational plan 2006/7– 2008/9, based on the National Strategic Plan includes the Bridge Fund proposal designed to help mobilize funding from new "3 Disease Fund“ includes activities implemented by NTP and activities implemented by 11 partners all work to develop this plan facilitated by use of new WHO tool, which is designed to help planning and budgeting in line with the Global Plan and Stop TB Strategy at country level

Budget for operational plan, all activities Plan and budget mainly focus on component 1, but increasing emphasis on components 2 and 5 in Component 1 work in progress

Funding and funding gaps for operational plan Year 2 and 3 only JATA/JICA/WHO/GDF/IUATLD have funds available This figure include all the partners: National and International NGOs IUATLD/JICA/JATA Fidelis/Italian Gov GDF/WHO/3DF work in progress

Major planned activities and challenges Stop TB Strategy component Major activities plannedChallenges High quality DOTS expansion/ enhancement Decentralize DOTS to rural health centres Revise National TB guidelines Mobile teams for remote and hard to reach areas Childhood TB guidelines Access of patients to DOTS services Resources mobilization for 1st- line drugs for 2008 after GDF grant expires

Major planned activities and challenges Stop TB Strategy component Major activities plannedChallenges TB/HIV, MDR-TB, other challenges Scale-up collaborative TB/HIV preventive and control activities TBHIV and MDR TB Guidelines Integration of TB and HIV surveillance GLC application for MDR-TB project Establishment of DST capacity at sub-national level 2 nd National DRS Relatively high DR level Limited capacity to diagnose and manage MDR- TB

Major planned activities and challenges Stop TB Strategy component Major activities plannedChallenges Health systems strengthening Training courses for health staff at all levels, including leadership, logistic management, budget and planning 2007 External Review Mission Limited HR with necessary competencies at peripheral level Engage all care providers Scaling-up PPM-DOTS activities including integration of major public hospitals and prisons Maintain quality during scale-up of PPM DOTS Activities N. GPs N. Private Lab HF N. Hospitals#253 N. Townships covered

Stop TB Strategy component Major activities plannedChallenges Empowering people with TB and communities Enable and promote research Major planned activities and challenges KAP survey Develop ACSM strategy Implementation of Fidelis Project for hard to reach population National prevalence survey Maintaining partnerships with researchers/academic institutions Expand self-income generation programmes Scale-up community care strategy Improving community awareness of TB

Comprehensive and easy to use Requirement and gap can easily be identified Each figure is directly linked with funding, gaps and graphs Can give WHO report in time Promote standardized approach by all partners for development of joint operational plan and/or major finding proposals Comprehensive and easy to use Requirement and gap can easily be identified Each figure is directly linked with funding, gaps and graphs Can give WHO report in time Promote standardized approach by all partners for development of joint operational plan and/or major finding proposals Myanmar experience with WHO planning and budget tool In future Easy to update/revise data (e.g. from year to year) Data are entered in Excel and calculations are automatically updated when data are changed Useful when funding is delayed and activities postponed Excel budget sheet

Conclusions Urgent additional resource mobilization is necessary to build upon the 3 Diseases Fund mechanism (supported by DIFID, EC, AusAID, Norway, Sweden and Netherlands Gov) to fully cover the programme needs 1. Stop TB Partnership in Myanmar is moving towards Global TB Control targets despite limited resources and thanks to High political commitment Dedicated staff Strong community support Excellent coordination with the partners Continuous WHO technical assistance 1. Stop TB Partnership in Myanmar is moving towards Global TB Control targets despite limited resources and thanks to High political commitment Dedicated staff Strong community support Excellent coordination with the partners Continuous WHO technical assistance