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

3. 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

4. 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)

5. History of NTP NTP started 1966 Integrated with PHC 1978 Replaced with SCC 1994 Adopted DOTS 1997 Covered 100%DOTS 2003

6. DOTS COVERED TOWNSHIPS (1994-2003) DOTS COVERED TOWNSHIPS (1994-2003) 310 259 324

7. 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

8. 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,

9. 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 health staff 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

10. 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.

11. 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 treatment Is improved sufficient explanation about TB treatment by health center staff Health staffs give much attention to improve TB services Patient have more Knowledge 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

12. High defaulter rate(1) Weak defaulter tracing Weak supervision of health staff Lack of staff Patients misunderstanding Of length of treatment Insufficient explanation about TB treatment by health center staff Health staff are not giving much Attention to TB services

13. Poor health situation of the population Low cure rate High defaulter rate Failure to do sputum check Up at the end of 6 month High death rate Lack of health knowledge About treatment of TB Patient does not have Sufficient health education

14. Low defaulter rate(1) defaulter tracing improved Good supervision of health staff Sufficient staff Patients knowledge on length of treatment is improved sufficient explanation about TB treatment by health center staff Health staff give much Attention to improve TB services

15. Good health situation of the population High cure rate Low defaulter rate Routine sputum check Up at the end of 6 month Low death rate Patients have more knowledge About treatment of TB Patient have Sufficient health education

16. Project selection approachDefaulter tracing Health education TB/HIV colloboration Feasibility443 Sustainability443 Cost benefit444 Available resources 543 171613

17. 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.

18. Narrative SummaryaObjectively Verifiable Indicators Means of Verification Important Assumptions Overall Goal: To achieve good health situation of population in capital of Myanmar. Annual risk of infection Is reduced from 1.5% to.8% by the end of March 2009.  Annual Reports  Cohort Analysis  Health Indicators government will permit to continue the project. Project Purpose: To increase the cure rate. 1.Cure rate is increased from 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.

19. Outputs 1.Defaulter rate is decreased. 2.Patients”sputum check up at the end of 6 month treatment is increased. 1.Health workers defaulter tracing is improved from 30%to 60% by the end of 2000 March. 1.Follow up sputum check up increased from 20%to 50% by 2009. 1.Quarterly reports from TB registers and treatment outcome. 2.Laboratory report and 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  Facilitators  Printer materials.  Meeting places.  Training materials.  Global fund  IEC 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.

21. 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