National Workshop on Adopting and Adapting the International Standards for TB Care (ISTC) in Myanmar

4 – 5 March 2009

The Ministry of Health, Myanmar, in collaboration with WHO Country Office Myanmar  organized the National Workshop on Adopting and Adapting the International Standards for TB Care in Myanmar at Traders’ Hotel, 4-5 March 2009. The workshop was financially supported by the United States Agency for International Development and WHO.

The country’s highest level medical professionals attended, namely Professors/ Heads of Medicine, Surgery, Obstetric and Gynaecology, Paediatric, Respiratory Medicine, Orthopaedic surgery, Universities of Medicine and Defense Service Medical Academy, the Myanmar Medical Association, other related Ministries (Railway, Labour, Home Affairs), representatives of Medical Superintendents, Township Medical Officers, National TB Programme (NTP), the US Embassy, International Non Governmental Organizations, the Japan International Cooperation Agency, and the 3 Diseases Fund. 

Research in Myanmar, and globally, demonstrated that a large proportion of TB patients are diagnosed and treated outside the National TB Programme: either in the private sector or in public sector but not related to the National TB Programme (for example in specialist hospitals, and Ministries other than Health including prisons). Importantly, this research also confirmed that the diagnostic and treatment protocols used by the specialists are often sub-standard, paving the way to create drug resistance.

These findings clearly highlight the need to urgently scale up TB control efforts by strengthening the collaboration with not only the general practitioners but also specialists/ private practitioners and medical institutes and other Ministries.  To this effect, the global Stop TB partnership developed the International Standards of TB care.

Since then, many countries have adopted the International Standards of TB care or ISTC, using the ISTC to unite public and private sectors in providing a uniformly accepted level of care for all patients with, or suspected of having, TB by describing the essential elements of TB care that should be available everywhere. Importantly, the ISTC also present a core for medical and nursing school curricula and for continuing medical education.

The main facilitator of the workshop was Professor Phillip Hopewell, Professor of Medicine, University of California, American Thoracic Society. The chair was Professor Tin Maung Cho, retired Professor/Head of Respiratory Medicine and co-chair Professor Aye Maung Han, Rector of University of Medicine (1), Yangon.

The National TB Programme had performed an assessment survey before the workshop in selected public and private facilities to assess the situation on TB practices. This survey would then be the baseline to measure impact after the introduction of the ISTC in the same selected facilities.

There are (17) International Standards for TB Care (6 Standards for Diagnosis, 9 Standards for Treatment and 2 Standards for Public Health Responsibilities). The individual standards were discussed and modifications were proposed in the working groups needed for Myanmar context.

The Indonesian experiences on uses of ISTC was also shared by two leading pulmonologists from Faculty of Medicine University of Indonesia where the ISTC were successfully rolled out aligning the specialists with the National TB Programme.

The approaches for dissemination and uses of ISTC in Myanmar context were thoroughly discussed in group and plenary and made the following recommendations:

     Given that there was minimal need for adaptation identified by the Workshop the Ministry of Health should endorse ISTC together with an annex stating the points for adaptation for the Myanmar context.

     The NTP should advocate to the MOH to officially launch ISTC during the upcoming World TB Day activities on March 24, 2009.

     The Ministry of Health should establish an ISTC Task Force that includes the relevant stakeholders. 

     The NTP, in collaboration with relevant partners should develop a work plan for implementation, and monitoring and evaluation of the ISTC in Myanmar.

     Based on the above work plan, a resource mobilization plan should be presented to relevant donors such as the GFATM (round 9), USAID, and UNITAID.

     The Myanmar Medical Association should endorse the ISTC based upon the adoption of the ISTC with the limited adaptations for the Myanmar context developed in the National Workshop on the ISTC.

The consensus of the workshop for the next step is to establish an ISTC Task Force and develop draft work plan by June, 2009.