Success of border-based health programs

Case study: expansion of the BPHWT

The BPHWT faces a number of challenges in carrying out its work. Security risks and the junta’s ‘four-cuts’ policy restrict travel, which hinders healthcare service provision in the field as well as the attendance of training sessions by BPHWT workers. Data records, training materials and supplies are sometimes lost when workers are forced to flee an attack, or are confiscated by the military. Some health workers have been arrested and even killed. For example:

The SPDC attacked a village in Du Playa when they heard the BP team was treating villagers. The team and villagers fled to the jungle, one of the men taking care of BP security was shot in the shoulder. Later when it was safe to return, they discovered the house they had been treating patients in was burnt to the ground. (BPHWT 2001)

Despite these challenges, however, the BPHWT provides an indispensable service to IDPs in eastern Burma and has continued to grow. Through collaboration and mutual support from other border-based groups, the BPHWT has expanded greatly since 1998. In 1998, there were 32 BPHWTs; in 2007, 76 teams were working in 17 areas. The BPHWT now works in Karen, Karenni, Mon and Shan States in eastern Burma, as well as cooperating in an integrated program in Chin State and a pilot program in Arakan (Rakhine) State. The total number of cases treated by BPHWT medics in 2006 was 71 789 (BPHWT 2006). The TBA program has grown extensively, from 55 trained TBAs in 2000 to 725 in 17 areas in 2007. An essential part of this program is the repeated follow-up training provided to TBAs trained by the BPHWT. TBAs supported by the BPHWT receive biannual training to improve skills, receive new knowledge regarding health interventions and discuss improvements to the program. This continued support and regular contact with TBAs supports the quality of the program and builds up TBA skills over time (see Table 12.1 on the growth of the BPHWT).

Table 12.1 BPHWT: number of teams and intended target population

Year

Number of BPHWT teams

Number of TBAs

Target population of IDPs

1998

32

-

-

1999

-

-

-

2000

56

55

100 000

2001

60

200

120 000

2002

70

200

140 000

2003

70

200

140 000

2004

70

230

140 000

2005

70

460

140 000

2006

76

720

150 000

2007

76

720

150 000

Sources: BPHWT annual reports and six-monthly reports, 1998–2007.

Case study: KDHW Malaria Control Program

The KDHW launched a Malaria Control Program (MCP) in 2003. Administered and managed from Thailand, the program consists of a team of medics, the members of which live and work in communities within Burma where they provide care. They return to Thailand every six months for refresher training, to restock supplies and share data. The MCP has grown extensively since 2003, with 50 medics and a network of village health workers providing malaria-control services to 40 859 people in 53 areas in Karen State (Table 12.2).

Table 12.2 KDHW MCP program expansion
 

2003

2004

2005

2006

2007

Areas covered

4

5

17

36

53

Households

398

554

2041

5800

7501

Population

1868

3460

9798

31 646

40 859

The KDHW MCP conducts malaria-prevention education activities, vector control through insecticide-treated mosquito nets, early diagnosis with Paracheck diagnostic tests and Artesunate combination therapy for treatment. In addition, it includes ‘directly observed therapy’ for Artesunate combination therapy treatment and biannual population screening and treatment. Finally, MCP medics promote community participation by relying on the volunteer health workers that they recruit and train to conduct house visits to monitor mosquito-net use and provide education.

The KDHW MCP has shown enormous success since its inception in 2003. Approximately 90 per cent of people in the target area sleep under insecticide-treated nets every night and 95 per cent of those diagnosed with malaria have completed directly observed therapy. As illustrated in Figure 12.1, the prevalence of Plasmodium falciparum (Pf) malaria has decreased in each target area since inception of the MCP. The program also serves as a platform from which to gather essential data from the target population. For example, between 2002 and 2006, the KDHW MCP network and members of the GHAP conducted an extensive study on the prevalence of Pf malaria in Karen State (BPHWT 2006).

Figure 12.1 Pf malaria prevalence by term (KDHW MCP)
Figure 12.1 Pf malaria prevalence by term (KDHW MCP)