Action Plan Good Health Situation of Population in Capital of Myanmar Yangon Division By DR MYA THIDA AYE.

Action Plan

Good Health Situation of Population in Capital of Myanmar

Yangon Division

By

DR MYA THIDA AYE

5

KACHINSTATE

SHAN(N)

SAGAINGDIVISION

CHINSTATE

RAKHINESTATE

MANDALAYDIVISION

MAGWEDIVISION

BAGODIVISION

AYARWADDYDIVISION

YANGONDIVISION

KAYINSTATE

KAYAHSTATE

MONSTATE

TANINTHARYIDIVISION

Map of Myanmar, Map of Myanmar, State / Divisional TB CentersState / Divisional TB Centers

SHAN(S)SHAN(E)

LAOS

CHINA

INDIA

BANGLADESH

MandalayMandalay Division2.

Chin State

SittweRakhineState8.

BagoBagoDivision7.

KayinState

MawlamyineMon State6.

PatheinAyeyarwadyDivision5.

TaunggyiShan (South)4.

KayahState

MyintkyinaKachinState

KyaingtonShan (East)13

LashioShan (North)12.

MyeikTanintharyiDivision11.

MagwayMagwayDivision10.

MonywaSagaingDivision9.

3.

YangonYangon Division1.

TB Centers State/DivisionsS/D TB O

No. of districts with TB team = 45 / 63No. of townships with TB team = 56/324 No. of townships with TB staff = 46 / 324

Yangon Division (Geography)• Area -3927.1468 sq mile• Population -6293,724 • Districts - 4 Doctor population -1:11636

• Townships -45 Nurses population -1:8863• Wards -603 Midwive population -1:3412• Village -2124• Village tracts -634• Urban household -507829• Rural household -1805314

Epidemiology of TB

• ARI 1.66% (1972)• 1.5% (1994)• 154/100,000 ARI est.incidence(WHO 2004)• About 85,000 new cases of TB/year• HIV sero +ve among TB -4.5%(1995-1997)• MDR TB among new ss+ve cases & previously

treated cases :4%&15.5% respectively(2002-2003 country wide survey)

History of NTP

• NTP started 1966• Integrated with PHC 1978• Replaced with SCC 1994• Adopted DOTS 1997• Covered 100%DOTS 2003

DOTS COVERED TOWNSHIPSDOTS COVERED TOWNSHIPS(1994-2003)(1994-2003)

18

144 153 153 153168

231

0

36

72

108

144

180

216

252

288

324

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

To

wn

sh

ips

Existing DOTS Townships

310

259

324

Treatment outcome of new SS(+)cases (Yangon Division) (2004)

• New SS(+cases) 7377• CDR 156%• Cured 67%• Completion rate 8%• Defaulter rate 13%• Death rate 4%• Failure rate 3%• Estimated NSS(+) 4720

Situation analysis

• Stakeholder analysis(catetorisation)

• The beneficiaries are :peoples in the city.program manager;patients;• Health workers• Potential opponents :uncooperative health staff• Implementing agencies:government.ministry of health,Division of • Health,NGOS,DOTS providers,supervisors,health workers,health

voluntiers• Decision maker:government,ministery of health,division of health,• Program manager,TB coordinator,patients• Funding agencies:Government,Global fund,WHO,JATA,JICA,

High defaulter rate Failure to do sputum check up at the end of 6 month treatment

High death rate

Weak defaulter tracing

Weak supervision of healthstaff

Lack of staff

Low Cure Rate

Poor health situation of the population

Patients misunderstanding on length of treatment

Insufficient explanation about TB treatment by health

center staff

Health staffs are not giving much attention to TB services

Patient has lack of Knowledge about Treatment of TB

Patient does not have sufficient

health education

TB/HIV co-infection

Poor collaboration and implementation

between NTP & NAP

No proper budget allocated

Health staff does not talk

about the treatment of TB

completely

PROBLEM ANALYSIS

Problem analysis

• Problem tree• The core problem in Yangon Division is (Low cure rate) and the

causes of its problem are:• 1.High defaulter rate :which is due to• weak defaulter tracing• patients' misunderstanding of length of treatment of TB• 2.Failure to do sputum check up at the end of 6 month treatment• Because of lack of health knowledge about treatment of TB• 3.High death rate :because of TB/HIV co infection

• The effect of low cure rate lead to increase transmission of infection• In the community and then lead to• Poor health situation of the population.

Low defaulter rate Routine sputum check up at the end of 6 month treatment Low death rate

defaulter tracing is improved

Good supervision of health

staff

Sufficient staff

High Cure Rate

Good health situation of the population

Patients knowledge on length of

treatmentIs improved

sufficient explanation about TB treatment

by health center staff

Health staffs give much attention to improve TB services

Patient have moreKnowledge about Treatment of TB

Patient have sufficient health

education

Reduced TB/HIV

co-infection

Good collaboration and implementation

between NTP & NAP

proper budget allocated

Health staff talk About the treatment

Of TB completely

OBJECTIVE ANALYSIS

High defaulter rate(1)

Weak defaulter tracing

Weak supervisionof health staff

Lack of staff

Patients misunderstandingOf length of treatment

Insufficient explanation aboutTB treatment by health center

staff

Health staff are not giving much Attention to TB services

Poor health situation of the population

Low cure rate

High defaulter rateFailure to do sputum checkUp at the end of 6 month High death rate

Lack of health knowledgeAbout treatment of TB

Patient does not have Sufficient health education

Low defaulter rate(1)

defaulter tracingimproved

Good supervisionof health staff

Sufficient staff

Patients knowledge onlength of treatment is improved

sufficient explanation aboutTB treatment by health center

staff

Health staff give much Attention to improve TB services

Good health situation of the population

High cure rate

Low defaulter rateRoutine sputum check

Up at the end of 6 month Low death rate

Patients have more knowledgeAbout treatment of TB

Patient have Sufficient health education

Project selection

approach Defaulter tracing

Health education

TB/HIVcolloboration

Feasibility 4 4 3

Sustainability 4 4 3

Cost benefit 4 4 4

Availableresources

5 4 3

17 16 13

Project Design Matrix.

• PROJECT NAME: “Improvement of health situation of population in capital of Myanmar.

• DURATION: April 2006- April 2009.• TARGET AREA: Yangon Division.

TARGET GROUP:New sputum smear (+)ve TB patients.

Narrative Summarya Objectively Verifiable Indicators

Means of Verification

Important Assumptions

Overall Goal: To achieve good health situation of population in capital of Myanmar.

Annual risk of infectionIs reduced from 1.5% to.8% by the end of March 2009.

Annual ReportsCohort Analysis Health Indicators

government will permit to continue the project.

Project Purpose: To increase the

cure rate.

1.Cure rate is increasedfrom 67%to 85%in the end of March ,2009.

Township TB register, Quarterly Assessment register,Annual report of NTP.

Political commitment at Divisional level continue.

PROJECT DESIGN MATRIX.

Outputs1.Defaulter rate is decreased.

2.Patients”sputum check up at the end of 6 month treatment is increased.

1.Health workers defaultertracing is improved from30%to 60% by the end of 2000 March.

1.Follow up sputum check up increased from 20%to50% by 2009.

1.Quarterly reports from TB registers and treatment outcome.2.Laboratory reportand NTP annual report.

1.External support by JATA.2.Government commitment.3.Trained health workers continued their work.

Activities: 1- Organize a workshop for

health workers.1-2 Conduct advocacy

meeting with stakeholders.

1-3 Conduct group discussions with mothers group, local leaders.

1-4 Provide health education to TB patients and to their families.

2- Plan for training programme for the health workers.

2-1 Conduct trainings for all health staff.

2-2 Distribute training materials.

3- Quarterly assessment and meeting of the TB officers.

Inputs:NTP Staff FacilitatorsPrinter materials.Meeting places.Training materials.Global fundIEC materials

Preconditions:Acceptance of the project by the authorities of Ministry of Health.Acceptance of the project by the authorities of Division of Health.Allowance of budget for activities proposal.Good attitude of Divisional Coordinators.Active participation of Stakeholders.Active participation of Community leaders.

Health facilities in Yangon Division• 1.Central hospitals 14• 2.200 beded hospitals 2• 3.150 beded hospitals 2• 4.100 beded hospital 1• 5.50 beded hospital 7• 6.25 beded hospital 11• 7.16 beded hospital 6• 8.station hospital 25• 9.primary T/S H C 28• 10.secondary 21• 10.RHC 77• 11.sub RHC 338• 12.MCH clinics 21• 13.school H clinics 21• 14.General practice 1553