Planning in line with the Stop TB Strategy Planning in line with the Stop TB Strategy and the Global Plan to Stop TB, 2006-2015and the Global Plan to Stop TB, 2006-2015

Dr Win MaungDr Win Maung

Programme Manager Programme Manager National Tuberculosis ProgrammeNational Tuberculosis Programme

Ministry of Health, MyanmarMinistry of Health, Myanmar

Myanmar is among the 22

countries globally with the

highest burden of TB.

NTP detected 107.991 TB cases in 2005NTP detected 107.991 TB cases in 2005

HIV prevalence in the general population estimated at 1.3%; HIV-prevalence among adult TB patients estimated as 7.1%

HIV prevalence in the general population estimated at 1.3%; HIV-prevalence among adult TB patients estimated as 7.1%

2002-2003 nation-wide survey of DR: 4% and 15.5% MDR among new and previously treated TB patients respectively

2002-2003 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 millionPopulation : ~51,4 million

Low Income LevelLow Income Level

General backgroundGeneral background

Progress in TB control in Myanmar, Progress in TB control in Myanmar, 1994-20051994-2005

33%

44%

55%

66%70%

74%

83%

95%

78%82% 81% 82% 82% 82% 81%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1994 1999 2000 2001 2002 2003 2004 2005

Case detection rate(New)Cure rateTreatment success rate

33%

44%

55%

66%70%

74%

83%

95%

78%82% 81% 82% 82% 82% 81%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1994 1999 2000 2001 2002 2003 2004 2005

Case detection rate(New)Cure rateTreatment success rate

• 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 2001-2004Progress in TB control 2001-2004

• 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 2005Progress in TB control 2005• 5 yrs National Strategic Plan 2006-2010 • PPM operational guidelines published• TBHIV treatment guidelines published• GFATM grant implemented

• 5 yrs National Strategic Plan 2006-2010 • PPM operational guidelines published• TBHIV treatment guidelines published• GFATM grant implemented

GDF awarded NTP with 2nd 3 yrs grant (till 2008)

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

34

25

52

15

62

32

0 10 20 30 40 50 60 70

TB casesundertaking

VCCT

HIV+ amongTB patients

Taunggyi Myitkyina Mandalay

34

25

52

15

62

32

0 10 20 30 40 50 60 70

TB casesundertaking

VCCT

HIV+ amongTB patients

Taunggyi Myitkyina Mandalay

3 TBHIV Pilot sitesMay 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 2006Progress 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”

17%

81%7%

46% BHS

TMO/TB Coord

DOT Prov

Lab techn

17%

81%7%

46% BHS

TMO/TB Coord

DOT Prov

Lab techn

Staff trained in 2006

Planning for TB control for 2006-2010Planning for TB control for 2006-2010

1. 2005, 5-years National Strategic Plan for TB control (2006-2010)

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 activitiesBudget for operational plan, all activities

Plan and budget mainly focus on component 1, but increasing emphasis on components 2 and 5 in 2007-2008

0

2

4

6

8

10

12

14

16

18

2006/2007 2007/2008 2008/2009

US

$ m

illi

on

sFirst-line drugs NTP staff Prog mngt/supervision

Training Lab supplies, equipment MDR-TB, TB/HIV

PPM and PAL CTBC and ACSM TA, M&E and OR

Co

mp

on

ent

1

work in progress

Funding and funding gaps for operational planFunding and funding gaps for operational plan

7,5 3,9 3,3

14,110,25,5

0

2

4

6

8

10

12

14

16

18

20

year 1 year 2 year 3

US

$m

illi

on

s

financial gap

fund availbale

7,5 3,9 3,3

14,110,25,5

0

2

4

6

8

10

12

14

16

18

20

year 1 year 2 year 3

US

$m

illi

on

s

financial gap

fund availbale

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 challengesMajor planned activities and challenges

Stop TB Strategy component

Major activities planned Challenges

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 challengesMajor planned activities and challengesStop TB Strategy component

Major activities planned Challenges

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• 2nd National DRS

• Relatively high DR level • Limited capacity to diagnose and manage MDR-TB

Major planned activities and challengesMajor planned activities and challenges

Stop TB Strategy component

Major activities planned Challenges

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 2005 2006 2007 2008

N. GPs 238 432 395 405

N. Private Lab HF 35 30 25 30

N. Hospitals # 2 5 3

N. Townships covered

63 24 15 15

Stop TB Strategy component

Major activities planned Challenges

Empowering people with TB and communities

Enable and promote research

Major planned activities and challengesMajor 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 experienceMyanmar experience with WHO planning and budget tool with WHO planning and budget tool

In futureIn 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

Fiscal Year 2006Expected number of ss+ patients to be treated 33,418Expected number of ss-/EP patients to be treated 41,642

Expected FundingBudget

RequiredGovernment Loans GFATM Other Grants Gap

First-line drugs 5,566,860$ 55,542$ -$ 20,000$ 3,592,277$ 1,899,040$ NTP staff 3,509,037$ 383,441$ -$ 262,418$ 150,600$ 2,712,578$ Routine programme management, supervision activities, drug management and training

3,093,875$ 55,606$ -$ 647,748$ 356,057$ 2,034,464$

Laboratory supplies and equipment 1,432,153$ -$ -$ 741,135$ 65,951$ 625,067$ PPM and PAL 453,553$ -$ -$ 970$ 80,295$ 372,288$ Collabortive TB/HIV activities 386,681$ -$ -$ 15,000$ 107,500$ 264,181$ MDR-TB 16,400$ -$ -$ -$ -$ 16,400$ ACSM and CTBC 1,690,424$ -$ -$ 67,638$ 700,683$ 906,723$ TA 23,000$ -$ -$ -$ -$ 23,000$ M&E 169,225$ -$ -$ 94,000$ 32,000$ 43,225$ OR 5,000$ -$ -$ -$ 4,500$ 500$ Total Budget 16,346,207$ 494,589$ -$ 1,848,909$ 5,089,863$ 8,897,466$

Fiscal Year 2006Expected number of ss+ patients to be treated 33,418Expected number of ss-/EP patients to be treated 41,642

Expected FundingBudget

RequiredGovernment Loans GFATM Other Grants Gap

First-line drugs 5,566,860$ 55,542$ -$ 20,000$ 3,592,277$ 1,899,040$ NTP staff 3,509,037$ 383,441$ -$ 262,418$ 150,600$ 2,712,578$ Routine programme management, supervision activities, drug management and training

3,093,875$ 55,606$ -$ 647,748$ 356,057$ 2,034,464$

Laboratory supplies and equipment 1,432,153$ -$ -$ 741,135$ 65,951$ 625,067$ PPM and PAL 453,553$ -$ -$ 970$ 80,295$ 372,288$ Collabortive TB/HIV activities 386,681$ -$ -$ 15,000$ 107,500$ 264,181$ MDR-TB 16,400$ -$ -$ -$ -$ 16,400$ ACSM and CTBC 1,690,424$ -$ -$ 67,638$ 700,683$ 906,723$ TA 23,000$ -$ -$ -$ -$ 23,000$ M&E 169,225$ -$ -$ 94,000$ 32,000$ 43,225$ OR 5,000$ -$ -$ -$ 4,500$ 500$ Total Budget 16,346,207$ 494,589$ -$ 1,848,909$ 5,089,863$ 8,897,466$

Excel budget sheet

ConclusionsConclusions

2.2. 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

2.2. 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