Community Empowerment in TB Control Activities: Support of International Non-Governmental Organizations to National Tuberculosis Programme in Kayah and Mon States in 2012

Le Le Win, Saw Saw, Yin Thet Nu Oo, Thandar Lwin & Tin MiMi Khine

Special Issue May 2020

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During 2011, National Tuberculosis Pro-gramme (NTP) of Myanmar performed TB control activities by collaborating with five international non-governmental organizations (INGOs) through various approaches inclu-ding community empowerment.¹ Those INGOs involving in TB programme trained the local people as community volunteers for control activities in their respective target township to sustain its achievement of case detection rate and treatment success rate. Till 2011, existing situation of these activities had not been assessed and this study attempted to assess the situation of involvement of community volunteers in TB control activities by INGOs.

A cross-sectional study design was con-ducted during 2012 in Loikaw Township, Kayah State and Mudon Township, Mon State. These townships were chosen purposely since there was only one INGO implementing TB control activities in one township-World Vision Myanmar at Loikaw and International Organization for Migration (IOM) at Mudon, respectively. The aims of both organizations were more or less the same as follows:^{2, 3}

·      do not treat patients

·      help patients preventing from TB

·      get treatment, i.e., provided free by NTP

·      provide care and free support to patients

·      provide some incentives to volunteers,
but not very much that could deviate volunteer concept

The study involved 54 volunteers for face-to-face interview and 58 respondents (i.e., TB patients, public health staff and responsible person from the organizations) for in-depth interview (IDI) and key informant interview (KII). Ethical approval was obtained from Ethical Review Committee, Department of Medical Research (Lower Myanmar). With the consent, the interviews were conducted by trained interviewers and IDIs and KIIs by core research team members with the pre-tested research tools. After getting permission, discussions of IDIs and KIIs were tape-recorded, transcribed, translated and analysed manually. For respondents who could not speak Myanmar language, the local residents, who were not staff of the organization acted as interpreters.

Since the study did not aim to evaluate and compare the activities of the organizations, and to respect anonymity, only coded alphabets were used-Organization ‘A’ and ‘B’, respectively.There was not much difference in characteristics of the volunteers of both organizations, except their livelihood and years of working at the respective organization (Table 1).

Almost all volunteers from both organi-zations involved actively in case detection, providing Direct Observed Treatment (DOT) to patients, getting sputum results and health messages dissemination (Figure 1).

Table 1. Salient characteristics of the volunteers

Fig. 1. Reported activities done by volunteers for persons affected with TB

During last one year before data collection period, volunteers referred more TB suspected patients than contacts (maximum 55 and 90 TB suspected patients vs. maximum 34 and 10 contacts from the organization, respectively). They were well recognized, accepted and heavily depended by community. During treatment course, patients received care and free supports from organization through volunteers. Midwives were rarely contacted by patients because of engaging with their routine duties, midwives could not spare time for accompanying patients to TB centre, sending sputum cups and getting sputum results and unaffordable for transportation expense. Minor degree of weak collaboration between midwives and volunteers at township level was observed.

The following expressions of some respon-dents supported these findings.

She (volunteer) brought me my medicines. During the period of treatment, I went there (TB department) 4 times for medicines. For sputum test, she gave me 3 cups and she took them to the city. While taking the medicines, she (volunteer) came to my house 1 to 2 times a month to check whether I took the medicines and to see my condition, particularly on the day of sputum testing and marked in the books.

(A 44-year-oldmale patient)

Majority of the people afraid to go to city and talk with strangers. They used to rely on us when they need to go to hospital. But when we found a suspected case, mostly we didn’t have time to go to township TB unit together with the patient. We can’t pay money for transportation of the patient either. And we know that if we send the patient to the volunteer, he or she would get help from the organization and also receive supports and money. If we found the cases and treated them, they (patients) won’t get any support. They (volunteers) would help the patient till the treatment is completed. So we sent the patients to them. Afterwards, the volunteers reported us the number of patients they referred to TB unit.

(A midwife with 15 years of service)

Since we had done for years, there are not much new TB cases in our area. We then decided to define villages with such situation as Phase II. We didn’t aim to totally withdraw the project from the area. Instead, we will include new villages into the project. Because in other adjacent villages, which are not under existing project, have many cases exist. (But the respondent did not remember the exact number of cases)

(An organization staff with 5 years of service)

Findings revealed that volunteers contributed to NTP in raising community awareness, case detection, treatment completion and treatment success to considerable extent. It also indicated the possibility to utilize trained volunteers by the respective Township Health Department once the INGOs would pull out someday. Even there were good examples of voluntary free services rendered to TB patients, this condition was questionable for sustainability of these voluntary activities if the external support discontinued. Infor-mation from this study would help health system in developing policy on communityvolunteers’involvement in TB control and strengthening partnership with NTP.

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The authors declare that they have no competing interests

1. Department of Health. Annual Report of National Tuberculosis Programme2010.Ministry of Health, Myanmar. October, 2011.

2. Personal communication with the responsible person from the central and township level of World Vision Myanmar.

3. Personal communication with the responsible person from the central and township level of International Organization for Migration (IOM).