Tuberculosis (TB) is a communicable disease transmitted through air droplets. The disease still remains a leading cause of mortality in some countries including my country, Myanmar. Therefore, TB has been a prioritized public health problem. Following the strategies of World Health Organization (WHO), National tuberculosis program (NTP) has led the TB control activities to fight against this preventable and manageable communicable disease across the country.
Since 2011, NTP increasingly engaged with international non-governmental organizations (INGOs) to provide community based tuberculosis care (CBTC). CBTC refers to TB control services provided to TB patients through the community health volunteers. It aims to improve TB case finding in the community to get early and prompt diagnosis and treatment.
But as a researcher, I realized that organizations approach the provision of CBTC in different ways and I was interested in how effective they are. To answer those questions, my research team and I reviewed the program data from the NTP and four INGOs, who had implemented CBTC in 23 townships in the country in 2013–2014.
From each INGOS’ reports, we extracted information on its approach and key activities; the number of presumptive TB cases referred and undergoing TB testing; and the number of patients diagnosed with TB and their treatment outcomes. The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships.
During 2013 and 2014, a total of 21,995 presumptive TB cases were referred for TB diagnosis, with 7,383 (34%) new TB cases diagnosed and almost all (98%) successfully treated.
What we found was that the INGOs implemented CBTC in challenging contexts, targeting migrants, post-conflict areas, the urban poor, and other vulnerable populations in Myanmar. One of the big differences between the INGOs was their recruitment of community volunteers. Two organizations recruited community volunteers via existing community health volunteers or health structures, one via existing community leaderships, and one directly involved TB infected/affected individuals.
We also found that the ways they appreciated the effort of volunteers were not the same. Two INGOs compensated volunteers via performance-based financing, and two provided financial and in-kind initiatives.
During 2013 and 2014, a total of 21,995 presumptive TB cases were referred for TB diagnosis, with 7,383 (34%) new TB cases diagnosed and almost all (98%) successfully treated. The four INGOs contributed to the detection of, on average, 36% (7,383/20,663) of the total new TB cases in their respective townships.
WHO aims to achieve ambitious increases in TB case detection and reductions in TB-associated deaths according to THE END TB STRATEGY 2016-2035 with the vision “A world free of TB: Zero deaths, disease and suffering due to TB”.
There is a long way to go for my country to achieve this vision. In order to ensure sustainability of INGO activities and to ease handovers, we would like to recommend that open and transparent discussions between INGOs, local NGOs, and national TB programs should be organized from the onset.