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Ingenious Bonus System to Fight TB in Burma

  • Moe Htun
  • Zaw Win

The number of TB cases has been increasing in Burma. In its annual report - World Health Organization Report 2005 released on March 24 - the U.N. agency said the total number of reported TB cases in Burma increased from less than 15,000 in 1998 to more than 75,000 in 2003.

However, Dr. Tin Soe, a Burmese physician now working as Public Health Department director of the U.S. Marshall Islands in the Pacific Ocean, said an increase in the population, the lack of an effective public education program, poverty and non-adherence to the doctors' instructions have led to a greater incidence of tuberculosis in Burma, where an estimated 400,000 people are infected.

In order to fight TB in Burma, Malteser, a Germany-based aid organization, has been carrying out a health care project called "Ingenious Bonus System to Fight TB in Myanmar" in Maungdaw Township in western Burma Rakhine state since 2003.

Andre Stulz, Malteser country coordinator in Burma, said 666 TB cases were detected in the area, where the total population is 460,000. He said the three-stage project included detection of TB cases, hospitalization and monitoring the TB treatment, which requires taking of antibiotics over a period of six to eight months.

He said most TB patients fail to complete the treatment because of the side effects of the antibiotics and economic stress.

"... because he has to go to monthly visits to the hospital, where he will also get the drug ration for the next month. He has to pay a maximum of $4 to travel to the hospital and if you think that the income of 85% of all the families we worked with are less than $1.10 per day. This should last for 6 persons. So imagine how important this is he has to spend $4 per day to travel to the hospital," he said.

Mr. Stulz said Malteser has developed an ingenious system to fight TB effectively by providing an incentive to both patients and health workers to finish the course. Under the project, those who continue long treatment will be awarded with food items for themselves and their families.

"The client… one of the problems is that the travel expenditure. That means we pay them for the transport two times, one at the beginning for the half of the period and the other half in the end. And we provide them supplementary food. That means they get rations for the treatment for 6 months. and this ration is half of the beginning and half of the middle of the treatment," he said.

Malteser also gives bonuses to the community health workers who ensure successful treatment. Mr. Stulz said this project is beneficial to both patients and government health providers.

He has seen patients' adherence to the treatment was very high and the hand-in-hand co-operation between Malteser and the government health providers is very rewarding.

He said, "They have limited capacity to go outside of the hospital. So they are happy that the NGOs do the outreach work because it is expensive in logistics, transport and reachability access is very difficulty in this area. But the hospital tries to provide us with sufficient drugs in time, sufficient diagnostic skills and all these kinds of things."

Because of the ingenious project 89% of TB patients have fully recovered in 2004. Mr. Stulz pointed out that long-term commitment, established trust and sufficient momentum are required to be effective in combating TB.

He hoped to expand the ingenious bonus project to fight TB in other parts of Burma.

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