Different challenges, different approaches and related expenditures of community-based tuberculosis activities by international non-governmental organizations in Myanmar.
BACKGROUND
International non-governmental organizations (INGOs) have been implementing community-based tuberculosis (TB) care (CBTBC) in Myanmar since 2011. Although the National TB Programme (NTP) ultimately plans to take over CBTBC, there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs.


METHODS
This was a descriptive study using routinely-collected programmatic and financial data from four INGOs during 2013 and 2014, adjusted for inflation. Data analysis was performed from the provider perspective. Costs for sputum examination were not included as it was provided free of charge by NTP. We calculated the average cost per year of each programme and cost per patient completing treatment.


RESULTS
Four INGOs assisted the NTP by providing CBTBC in areas where access to TB services was challenging. Each INGO faced different issues in their contexts and responded with a diversity of strategies. The total costs ranged from US$ 140 754 to US$ 550 221 during the study period. The cost per patient completing treatment ranged from US$ 215 to US$ 1 076 for new cases and US$ 354 to US$ 1 215 for retreatment cases, depending on the targeted area and the package of services offered. One INGO appeared less costly, more sustainable and patient oriented than others.


CONCLUSIONS
This study revealed a wide variety of models of care and associated costs for implementing CBTBC in diverse and challenging populations and contexts in Myanmar. Consequently, we recommend a more comprehensive evaluation, including development of a cost model, to estimate the costs of scaling up CBTBC country-wide, and cost-effectiveness studies, to best inform the NTP as it prepares to takeover CBTBC activities from INGOs. While awaiting evidence from these studies, model of CBTBC that have higher sustainability potential and allocate more resources to patient-centered care should be given priority support.
Department of Medical Research, Ministry of Health and Sports, No 5, Ziwaka Road, Dagon Township, 11191, Yangon, Myanmar. waiwai.han84@gmail.com.
Wai Wai
http://orcid.org/0000-0001-5546-4265
WW
Han
Department of Medical Research, Ministry of Health and Sports, No 5, Ziwaka Road, Dagon Township, 11191, Yangon, Myanmar.
Saw
S
Saw
Médecins sans Frontières, Operational Research Unit, Luxembourg city, Luxembourg.
Petros
P
Isaakidis
Médecins sans Frontières, Operational Research Unit, Luxembourg city, Luxembourg.
Mohammed
M
Khogali
Médecins sans Frontières, Operational Research Unit, Luxembourg city, Luxembourg.
Anthony
A
Reid
Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.|National Tuberculosis Programme, Hanoi, Vietnam.
Nguyen
N
Hoa
Department of Medical Research, Ministry of Health and Sports, No 5, Ziwaka Road, Dagon Township, 11191, Yangon, Myanmar.
Ko Ko
KK
Zaw
National Tuberculosis Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
Si Thu
ST
Aung
D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003150:Community Health Workers / Q000191:economics; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007390:International Agencies / Q000191:economics / Q000458:organization & administration; D002052:Myanmar / Q000453:epidemiology; D009938:Organizations / Q000191:economics / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000191:economics; D019233:Retreatment / Q000191:economics; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000628:therapy*
Budget allocation; Cost; Operational research; Sustainability