WHO initiative ensures access to CXR services with minimum Out of Pocket Expenditure during crisis in Yangon

Due to unprecedented crisis in Myanmar, access to TB services has been seriously disrupted. TB case notification for all forms of TB, DR-TB, Childhood-TB and TB-HIV cases have decreased by more than 80 percent from January to June 2021 compared to the same period of time during 2020. Similar trend was observed in Yangon which is home to 12 percent of population, 25 percent of all cases of TB and 47 percent of Drug Resistant TB of Myanmar. 

Major public health service outlets were also closed post February 2021, and WHO Myanmar worked closely with I/NGOs, Public-Private Mix and Private Sector to avail TB services to people of Yangon. A major cost for the people at Private Sector was US 10/ CXR diagnosis which was unaffordable to many. WHO in Myanmar stepped up to the challenge to design an intervention possible in the context. 

The intervention consisted of identification of quality CXR service providers as per recommendation of the TB experts from Yangon, WHO hired a “Contractual Partner” to coordinate with the identified service providers. The offer was CXR testing without cost to Presumptive TB or during follow up tests.  Contractual Partner then reimburses USD 10/CXR to facilities conducting the X-ray based on verification of document submitted. WHO examines the claims on case - by - case basis as per its norms, standards and processes before further disbursement to contractual partners. 

As of 14 October 2021, 16 townships are covered through the approach. CXR images and readings are sent to referring doctors, hand carried by the cases or sent electronically. As part of the package, detail teleconsultations between medical doctors and TB cases start. Treatment compliance is attempted through VAD (Video Assisted DOTS). The DOTS center further inform the Community-based TB Partners (Myanmar Health Assistant Association and Myanmar Medical Association MA) who support active TB case findings and community referral. 

Various challenges are being encountered while implementing the project. These include risks during travel to health facility, transportation limitation, temporary closure of some selected private CXR facilities, banking disruptions and risk of COVID-19 to service providers. 

Despite of these challenges, till 30 September, a total of 1289 Chest X-rays were taken at contracted private facilities. Saving of US 10 at the time of crisis per person would help meet other family requirements especially during a time when family income is minimum ever.