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Khan MS, Schwanke-Khilji S, Yoong J, Tun ZM, Watson S, Coker RJ. Large funding inflows, limited local capacity and emerging disease control priorities: a situational assessment of tuberculosis control in Myanmar. Health Policy Plan 2018; 32:i22-i31. [PMID: 29028226 DOI: 10.1093/heapol/czx062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/13/2022] Open
Abstract
There are numerous challenges in planning and implementing effective disease control programmes in Myanmar, which is undergoing internal political and economic transformations whilst experiencing massive inflows of external funding. The objective of our study-involving key informant discussions, participant observations and linked literature reviews-was to analyse how tuberculosis (TB) control strategies in Myanmar are influenced by the broader political, economic, epidemiological and health systems context using the Systemic Rapid Assessment conceptual and analytical framework. Our findings indicate that the substantial influx of donor funding, in the order of one billion dollars over a 5-year period, may be too rapid for the country's infrastructure to effectively utilize. TB control strategies thus far have tended to favour medical or technological approaches rather than infrastructure development, and appear to be driven more by perceived urgency to 'do something' rather informed by evidence of cost-effectiveness and sustainable long-term impact. Progress has been made towards ambitious targets for scaling up treatment of drug-resistant TB, although there are concerns about ensuring quality of care. We also find substantial disparities in health and funding allocation between regions and ethnic groups, which are related to the political context and health system infrastructure. Our situational assessment of emerging TB control strategies in this transitioning health system indicates that large investments by international donors may be pushing Myanmar to scale up TB and drug-resistant TB services too quickly, without due consideration given to the health system (service delivery infrastructure, human resource capacity, quality of care, equity) and epidemiological (evidence of effectiveness of interventions, prevention of new cases) context.
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Affiliation(s)
- Mishal S Khan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sara Schwanke-Khilji
- Division of Hospital Medicine, Oregon Health and Science University, Oregon, USA
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Zaw Myo Tun
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | | | - Richard James Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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