PSI and Tuberculosis Service Delivery

Humble Beginnings- The Myanmar Model

In 2004, PSI launched its first TB social franchising program to provide high quality TB diagnosis and treatment services to low income communities in Myanmar. Through this innovative public private mix (PPM) program, private general practitioners participating in PSI Myanmar’s Sun Quality Health (SQH) network are trained in TB symptomatic screening, diagnosis and treatment. SQH providers screen clients presenting with cough for TB symptoms, and then refer all TB suspects for sputum smear microscopy for bacteriological confirmation of active TB disease. Patients diagnosed with active TB disease receive anti-TB treatment, directly observed therapy short-course (DOTS).

PSI Myanmar treatment supporters follow-up with patients through-out their treatment to encourage adherence, as well as trace clients who default on their treatment and trace cohabitating contacts of sputum smear positive pulmonary TB patients so that they too can be screened for TB and receive treatment as indicated. The quality of the DOTS services provided by SQH providers is regularly monitored by trained PSI Myanmar quality assurance officers. PSI Myanmar uses mass media and community outreach activities to increase community awareness of TB and the availability of quality DOTS services at SQH clinics.

To date, over 415 private providers have been trained in over 90 townships in 10 of Myanmar’s 14 states and divisions, supported by 86 private labs. Over 60,600 clients have been tested for TB and more than 28,690 have been placed on treatment, including 12,899 (45%) infectious active pulmonary TB cases (Category 1). The program has a treatment success rate of 83% among new smear positive cases, and contributes 10% of the national case detection rate. External evaluations have commended the program for increasing equitable access to quality TB services to the poor, as more than 65% of patients come from the lowest 2 socio-economic groups. PSI Myanmar’s TB program was recently recognized by USAID and WHO Stop TB Department as a best practice for community based approach TB programming and a model for engaging private providers in quality TB care.

PSI recognizes the link between TB and HIV, and has integrated symptomatic TB screening at all of its voluntary counseling and testing (VCT) sites in Myanmar, South Africa, Zimbabwe, Zambia, and Namibia. As part of their routine counseling, VCT counselors use a questionnaire to identify TB suspects who are then referred to DOTS services. In South Africa and Zimbabwe, PSI also provides HIV counseling and testing services at public sector TB clinics.

PSI has also designed and implemented several effective TB communication campaigns in Kenya, India, Laos, Pakistan, Romania, and Myanmar. Key messages seek to increase care seeking behaviors, reduce stigma around TB and DOTS treatment, and increase patients’ and providers’ belief that TB can be effectively cured. In Kenya, PSI developed and executed a mass media campaign encouraging people with signs of tuberculosis to seek treatment at public health facilities. The campaign was very successful, reaching over 72% of Kenyans and significantly raising general population knowledge levels about TB and where TB services can be found. The campaign was well liked, and was non-stigmatizing to those who had TB. In India, PSI supported the Revised National Tuberculosis Control Programme (RNTCP) to develop a variety of mid-media materials to promote World TB Day 2008, as well as advocacy materials to encourage private sector awareness and involvement in TB control.

TB publications and useful resources