THREE DISEASES FUND OMITS PRIVATE SECTOR TREATMENT

UNCLAS SECTION 01 OF 02 RANGOON 000588 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS; PACOM FOR FPA E.O. 12958: N/A TAGS: ECON EAID TBIO PGOV BM SUBJECT: THREE DISEASES FUND OMITS PRIVATE SECTOR TREATMENT OF TB REF: RANGOON 0419 RANGOON 00000588 001.2 OF 002 ¶1. (SBU) Summary: Population Services International (PSI) did not receive funding from the Three Diseases Fund (3DF) to continue its effective TB treatment program in Burma. The 3DF instead chose to support the TB programs of the World Health Organization and the Myanmar Medical Association (MMA). The MMA, a local professional association, will use the funds to refer patients to the public health sector, while PSI's program would have treated 33,000 patients through its chain of already successful private clinics over a three year period. PSI representatives attribute the decision primarily to a preference by Fund consultants to build the capacity of the public sector. We should consider adding funding for TB in Burma to show the viability of private delivery. End summary. PSI LOSES FUNDING -------------- ¶2. (U) On June 15, 2007, PSI Country Director John Hetherington and Communications Manager Sam Conner briefed Charge on the results of the 3DF's first round of funding for TB. The 3DF was established by Australia, the EC, the Netherlands, Norway, Sweden, and the UK to support activities in Burma's national programs for malaria, TB and HIV/AIDS. A board, made up of donor representatives and regional health experts approved the first round of grants for projects to begin in 2007 (reftel). The 3DF Board did not approve PSI's $2 million, three-year TB proposal, which would have continued treatment of TB patients through its network of private health clinics. PSI estimated that 85% of the 33,000 low income patients it would treat if funded could die, and each patient could infect up to ten additional people with TB. ¶3. (SBU) Hetherington attributed the 3DF Board's decision to a number of factors, including the incorrect perception that PSI's clinics compete with government clinics, time constraints that prevented the Board from a thorough analysis of proposals, and the Board's assumption that PSI could easily find other sources of funding. He also said that the Board may have wanted to show support for at least one government body, and therefore decided to award the money to the MMA, to build its capacity in setting up a referral service. Hetherington predicted that the 3DF would not meet its goals of reducing TB morbidity, mortality and transmission. The 3DF had originally committed to support existing programs and has agreed to fund all of the other existing TB programs, just not PSI. RUSHED PROCESS LED TO UNINTENDED RESULTS -------------- ¶4. (SBU) Hetherington said he believed the rushed process was the source for a number of unintended actions. One Board member told him that they had only 24 hours to review and approve all the proposals recommended by a panel. He told us that a Board member privately admitted to him that the Board mistakenly approved $450,000 less than it intended for PSI's HIV/AIDS program, but could not take corrective action. Hetherington acknowledged that PSI might receive funding in March from the 3DF's 2008 round. ¶5. (SBU) The 2002-2003 Nationwide Drug Resistance Survey showed 4% multi-drug resistant TB among new patients and 15.5% among previously-treated patients. More recent information indicates that number has grown. The clinics RANGOON 00000588 002 OF 002 supported by PSI in seven states and divisions handled 11% of the 2005 TB caseload. Excluding drugs, PSI's cost is $40 per patient treated, compared with the public health sector's $117. PSI's TB funding will end in March 2008. Hetherington predicted that existing donors will put all their funding into the 3DF, and cease all direct bilateral support of INGOs for malaria, TB and HIV/AIDS projects. The U.S. is currently the only donor that funds a PSI health project - in HIV/AIDS - outside of the 3DF. ¶6. (SBU) Comment: 3DF's start-up delays and decision making process have been, as one UN rep admitted, "messy." The donors wanted to get projects going on the ground as quickly as possible and planned to iron out difficulties as they arose. The Board's decision not to fund PSI may have been a conscious effort to build capacity in the public health sector, which is the preferred practice of 3DF donors. PSI has proven its network of private clinics can effectively deliver quality health care to those most in need. The United States already supports PSI's HIV/AIDS projects. Post has repeatedly requested additional funding for TB and malaria. Our funds could support already proven projects that demonstrate the effectiveness of humanitarian assistance delivered by private providers, as opposed to Burmese government entities being supported by other donors. End comment. VILLAROSA