结核病（TB）是一种通过空气液滴传播的传染病。在我的国家，包括缅甸在内的某些国家，这种疾病仍然是死亡的主要原因。因此，结核病一直是一个优先的公共卫生问题。遵循世界卫生组织（WHO）的策略，国家结核病计划（NTP）导致结核病控制活动与全国可预防且可管理的传染病作斗争。
Since 2011, NTP increasingly engaged with international non-governmental organizations (INGOs) to provide community based tuberculosis care (CBTC). CBTC refers to TB control services provided to TB patients through the community health volunteers. It aims to improve TB case finding in the community to get early and prompt diagnosis and treatment.
但是，作为一名研究人员，我意识到组织以不同的方式处理CBTC，我对它们的效果感兴趣。为了回答这些问题，我和我的研究团队审查了NTP的计划数据和四个INGO，他们于2013 - 2014年在该国23个乡镇实施了CBTC。
From each INGOS’ reports, we extracted information on its approach and key activities; the number of presumptive TB cases referred and undergoing TB testing; and the number of patients diagnosed with TB and their treatment outcomes. The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships.
During 2013 and 2014, a total of 21,995 presumptive TB cases were referred for TB diagnosis, with 7,383 (34%) new TB cases diagnosed and almost all (98%) successfully treated.
What we found was that the INGOs implemented CBTC in challenging contexts, targeting migrants, post-conflict areas, the urban poor, and other vulnerable populations in Myanmar. One of the big differences between the INGOs was their recruitment of community volunteers. Two organizations recruited community volunteers via existing community health volunteers or health structures, one via existing community leaderships, and one directly involved TB infected/affected individuals.
We also found that the ways they appreciated the effort of volunteers were not the same. Two INGOs compensated volunteers via performance-based financing, and two provided financial and in-kind initiatives.
During 2013 and 2014, a total of 21,995 presumptive TB cases were referred for TB diagnosis, with 7,383 (34%) new TB cases diagnosed and almost all (98%) successfully treated. The four INGOs contributed to the detection of, on average, 36% (7,383/20,663) of the total new TB cases in their respective townships.
WHO aims to achieve ambitious increases in TB case detection and reductions in TB-associated deaths according toTHE END TB STRATEGY 2016-2035with the vision “A world free of TB: Zero deaths, disease and suffering due to TB”.
There is a long way to go for my country to achieve this vision. In order to ensure sustainability of INGO activities and to ease handovers, we would like to recommend that open and transparent discussions between INGOs, local NGOs, and national TB programs should be organized from the onset.
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