Large funding inflows, limited local capacity and emerging disease control priorities: a situational assessment of tuberculosis control in Myanmar
Large funding inflows, limited local capacity and emerging disease control priorities: a situational assessment of tuberculosis control in Myanmar
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DOI：
10.1093/heapol/czx062
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发表时间：
2017-10-01
影响因子：
3.2
通讯作者：
Coker, Richard James
中科院分区：
文献类型：
--
作者：
Khan, Mishal S.;Schwanke-Khilji, Sara;Coker, Richard James
在缅甸规划和实施有效的疾病控制方案方面存在许多挑战，缅甸正在经历内部政治和经济转型，同时经历大量外部资金流入。我们研究的目的--包括关键知情人讨论、参与者观察和相关文献综述--是使用系统性快速评估概念和分析框架，分析缅甸结核病（TB）控制战略如何受到更广泛的政治、经济、流行病学和卫生系统背景的影响。我们的调查结果表明，捐助资金的大量涌入，在五年期间达到10亿美元左右，可能过于迅速，使该国的基础设施无法有效利用。到目前为止，结核病控制战略往往倾向于采用医疗或技术方法，而不是基础设施的发展，而且似乎更多地受到“做点什么”的紧迫感的驱动，而不是受到成本效益和可持续长期影响的证据的影响。在实现扩大耐药结核病治疗规模的宏伟目标方面取得了进展，尽管在确保护理质量方面存在关切。我们还发现，地区和民族之间的健康和资金分配存在很大差异，这与政治背景和卫生系统基础设施有关。我们对这一转型中的卫生系统中新出现的结核病控制战略的情况评估表明，国际捐助者的大量投资可能会推动缅甸过快地扩大结核病和耐药结核病服务，而没有适当考虑卫生系统（提供服务的基础设施、人力资源能力、护理质量、公平）和流行病学（干预措施有效性的证据，预防新病例）背景。
There are numerous challenges in planning and implementing effective disease control programmes in Myanmar, which is undergoing internal political and economic transformations whilst experiencing massive inflows of external funding. The objective of our study-involving key informant discussions, participant observations and linked literature reviews-was to analyse how tuberculosis (TB) control strategies in Myanmar are influenced by the broader political, economic, epidemiological and health systems context using the Systemic Rapid Assessment conceptual and analytical framework. Our findings indicate that the substantial influx of donor funding, in the order of one billion dollars over a 5-year period, may be too rapid for the country's infrastructure to effectively utilize. TB control strategies thus far have tended to favour medical or technological approaches rather than infrastructure development, and appear to be driven more by perceived urgency to 'do something' rather informed by evidence of cost-effectiveness and sustainable long-term impact. Progress has been made towards ambitious targets for scaling up treatment of drug-resistant TB, although there are concerns about ensuring quality of care. We also find substantial disparities in health and funding allocation between regions and ethnic groups, which are related to the political context and health system infrastructure. Our situational assessment of emerging TB control strategies in this transitioning health system indicates that large investments by international donors may be pushing Myanmar to scale up TB and drug-resistant TB services too quickly, without due consideration given to the health system (service delivery infrastructure, human resource capacity, quality of care, equity) and epidemiological (evidence of effectiveness of interventions, prevention of new cases) context.