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Viewing cable 07RANGOON134, BURMA'S TB PROGRAM: SOME PROGRESS, LOOMING PROBLEMS

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Reference ID Created Released Classification Origin
07RANGOON134 2007-02-08 09:20 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Rangoon
VZCZCXRO1559
OO RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHGO #0134/01 0390920
ZNR UUUUU ZZH
O 080920Z FEB 07
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC IMMEDIATE 5689
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1317
RUEHBY/AMEMBASSY CANBERRA 0150
RUEHKA/AMEMBASSY DHAKA 4463
RUEHLO/AMEMBASSY LONDON 1911
RUEHNE/AMEMBASSY NEW DELHI 3729
RUEHUL/AMEMBASSY SEOUL 7248
RUEHTC/AMEMBASSY THE HAGUE 0598
RUEHKO/AMEMBASSY TOKYO 4822
RUEHCI/AMCONSUL CALCUTTA 1043
RUEHCN/AMCONSUL CHENGDU 1042
RUDKIA/AMCONSUL CHIANG MAI 0832
RUEATRS/DEPT OF TREASURY WASHDC
RUEHGV/USMISSION GENEVA 3034
RHEHNSC/NSC WASHDC
RUEKJCS/SECDEF WASHDC
RUEKJCS/JOINT STAFF WASHDC
RUCNDT/USMISSION USUN NEW YORK 0685
RUEHBS/USEU BRUSSELS
UNCLAS SECTION 01 OF 03 RANGOON 000134 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS; PACOM FOR FPA 
 
E.O. 12958: N/A 
TAGS: PGOV SOCI TBIO BM
SUBJECT: BURMA'S TB PROGRAM: SOME PROGRESS, LOOMING PROBLEMS 
 
 
RANGOON 00000134  001.2 OF 003 
 
 
1. (U) Members of a World Health Organization (WHO) 
monitoring mission reported that, though progress has been 
made, serious problems loom in Burma's ability to identify 
and treat TB patients.  Of primary concern are: the rising 
funding gap, impending drug shortage, increasing rate of 
HIV-infected TB patients, rising TB death rates, lack of 
standardized treatment regimes, and the increase of 
multi-drug resistant TB.  WHO mission members provided the 
Minister of Health a list of recommended actions, and called 
upon donors and the 3D Fund to address problem areas.  3D 
Fund reps cautioned against expectations that 3D funding 
could cover all the gaps.  Private sector doctors also make 
an important contribution, but without substantial new 
resources, the TB threat in Burma will multiply over the new 
few years.  End summary. 
 
Positive Highlights 
------------------- 
2. (U) On February 2, WHO sponsored a briefing for the 
diplomatic corps, INGOs, and local medical organizations on 
the results of its biannual National TB Program monitoring 
mission.  WHO Mission members expressed satisfaction with the 
access and cooperation they received from the GOB during the 
two-week visit.  The final report will not be available until 
the GOB has given its approval.  The mission identified the 
following strengths in Burma's TB program: 
 
-- Non-governmental actors: Many INGOs, including PSI, CARE, 
Pact, World Vision, and AZG provide high quality services for 
the detection and treatment of TB around the country.  Many 
private General Practitioners also provide TB care, and 
mission members said public/private partnerships work well. 
 
-- Labs: Quality of diagnosis in labs is very good. 
 
-- Government support: GOB contribution to the TB program has 
risen over the past few years (comment: albeit from miniscule 
amounts. End comment.) 
 
-- Drug Supply: Until now, the drug supply from the Global TB 
Drug Facility has been adequate, with no shortages.  The WHO 
mission expressed concern at an impending cutoff of global 
drug supply, with no resources yet identified to pay for 
imports of drugs after 2007. 
 
Looming Problems 
---------------- 
3. (U) Mission representatives also noted that serious 
problems exist and more loom in the near future, including: 
 
-- Inadequate data: TB case notifications by medical 
professionals have risen steeply since 1999.  The high 
percentage rates the GOB has reported for detection and 
successful treatment of TB were called into question, 
however, when the mission found prevalence rates 300% higher 
than assumed during a quick survey in Rangoon.  The mission 
noted that, since the true number of cases is not known, 
Burma's strong performance scores relative to its neighbors 
were questionable. 
 
-- Rising funding gap: The current funding gap of $5 million 
in the national program will rise to over $15 million by 
2009.  The drugs are expensive, and supplies after 2007 will 
be cut off as the global supply program expires.  Future 
spending is needed to strengthen the weak supervision of the 
program around the country and to train more technicians and 
physicians. 
 
-- Rise in HIV co-infection and TB deaths: The rate of HIV 
co-infection has risen from 4.5% in 1997 to 7.1% in 2005. 
 
RANGOON 00000134  002.2 OF 003 
 
 
The death rate from TB has risen to 5.5%.  HIV infection is 
one reason for rising mortality rates. 
 
-- Treatment regimes not standardized, late case diagnosis: 
The medical system frequently diagnoses TB in its later 
stages, making treatment more difficult.  Also, many 
different treatment regimes are available domestically, 
offering consumers confusing and sometimes ineffectual 
choices. 
 
-- The rate of multi-drug resistant TB (MDR-TB) is rising, 
and high numbers of patients in the border areas do not take 
the full course of treatment. 
 
-- Inadequate program supervision is exacerbated by poor 
infrastructure in rural areas. 
 
4. (U) Mission representatives reported that they met the 
Minister of Health on February 1, and made the following 
recommendations: address the looming drug shortage; enhance 
division/district/township level coordination; develop human 
resource capabilities, especially among lab technicians; plan 
and implement a TB/HIV-AIDS workshop; bring more medical 
specialists and General Practitioners into TB care; and 
resume border health programs to strengthen surveillance of 
HIV/TB and MDR-TB cases. The WHO mission representative said 
she hoped donors, including the 3D Fund, would help support 
these recommendations, and would expand Three Diseases Fund 
(3D Fund) programs, now restricted to the township level, to 
division and central levels as well. 
 
3DF Cannot Step In 
------------------ 
5.  (U) The 3D Fund representative from the EC, Dr. Anne 
Harmer, responded that the current funding level of 
approximately US$100 million over five years is not adequate 
to cover additional programs and that, in fact, the 3D Fund 
is seeking additional donors.  The Fund plans to implement 
programs in 325 townships, and cannot expand its coverage to 
the district or central levels.  Harmer relayed that 3D Fund 
donors already face many problems including: the under-funded 
human resources system; poor infrastructure; lack of 
coordination; and insufficient capacity at the township 
level.  She added that the Fund must still develop systems 
for cash management, monitoring, evaluation, and procurement. 
 She also noted delays caused by insufficient UN capacity. 
 
Private Sector Engagement Shows Promise 
--------------------------------------- 
6. (U) Most TB treatment is performed by government 
physicians, hospitals, and health centers.  The UN and INGOs 
now work primarily with the government health system, but 
also provide some support to the private sector. Since 2004, 
Population Services International (PSI) has trained over 300 
private doctors with existing clinics to provide TB treatment 
to low-income communities.  Their treatment success rate is 
one of the highest in the region at 83%, with only a 4% 
default rate.  PSI operates a quality assurance program, and 
collects and analyzes key TB-related data.  According to 
figures in the national TB Plan, the private clinics that 
receive assistance from PSI contributed almost 12% of the 
estimated detection rate. 
 
7. (SBU) Comment: The WHO presentation made clear that no one 
knows the true scope of the problem in Burma and that, 
without substantial resources - financial, human and 
technical - TB, including multi-drug resistant strains, has 
the potential to expand rapidly in the next two to three 
years.  WHO and 3D officials would welcome technical 
assistance from the US Centers for Disease Control in 
 
RANGOON 00000134  003.2 OF 003 
 
 
designing an effective TB control program for Burma.  In the 
meantime we will continue to work with WHO to urge the GOB to 
increase its own funding and improve access for other 
humanitarian providers.  End comment. 
VILLAROSA