MYANMAR: Funding, access challenges to TB treatment
Outside the TB centre in Yangon
YANGON, 3 December 2010 (IRIN) - Access to health services remains a challenge for tuberculosis (TB) patients in rural Myanmar.
"There is a need to improve case-finding because some areas are hard to reach," Eva Nathanson, technical officer for the World Health Organization (WHO), told IRIN in the Burmese former capital of Yangon. "More patients need to be found so that they can get treatment."
According to government figures, 1.5 percent of the country's 53 million people are infected with the TB bacilli annually.
Myanmar has the 19th highest TB burden in the world, according to the WHO
While this common and often deadly infectious disease ranks as a priority alongside malaria and HIV/AIDS in Myanmar's national health plan, sputum smear microscopy (tissue sample analysis) and chest X-ray services are not easily accessible.
"There is only one microscopy centre per 150,000 people, which is far from the international standard of one per 100,000 people," said one health worker, who asked not to be identified.
There are also only two laboratories performing culture and drug susceptibility testing (DST) for the entire population, against the international standard of one reference laboratory per five million people, the same person said.
Lack of information
The recommended strategy for the detection and cure of TB is the directly observed treatment short course (DOTS
), whereby the patient is monitored to ensure they take their medication regularly, in the right combination, and for the full duration of the treatment.
However, in many affected communities, patients do not complete the treatment.
Aung Kyaw Linn, senior programme manager of the Social Franchising Department of Population Services International (PSI) in Myanmar, cites a "lack of knowledge on consequences of treatment interruption" as the primary reason for incomplete treatment regimes.
One of the consequences when patients fail to take their drugs exactly as prescribed is the development of a multi-drug resistant (MDR-TB) strain, which is immune to standard frontline drugs, more expensive, and harder to cure.
With an estimated 4,800 MDR-TB cases in 2009
, Myanmar's National Tuberculosis Program and Médecins Sans Frontières (Holland), with technical assistance from the WHO, began a two-year DOTS-Plus pilot project in July 2009, which aims to provide 275 MDR-TB patients with TB treatment in Yangon and Mandalay.
"NTP has a plan to expand treating MDR-TB patients early next year," said Myo Zaw, a national consultant with WHO.
Health agencies, however, emphasize that a long-term financial commitment to the first-line anti-TB drugs has to be secured.
According to the country's Five Year National Strategic Plan for Tuberculosis Control (2011-2015), the total cost for TB control was calculated at US$160 million.
"Any interruption in the first-line anti-TB drug supply would be devastating for the TB patients and would lead to increased suffering of patients, an increase in the number of avoidable deaths and lead to the development of multi-drug resistant TB," warned one international healthcare NGO worker.