3D FUND ANNUAL REVIEW SHOWS POSITIVE RESULTS, IDENTIFIES CHALLENGES

UNCLAS SECTION 01 OF 06 RANGOON 000308



SIPDIS



SENSITIVE



SIPDIS



DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD

DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART;

OES/IHA/DSINGER AND NCOMELLA

DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL

CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN

USDA FOR OSEC AND APHIS

USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG

USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM

DOD FOR OSD/ISA/AP FOR LEW STERN

PARIS FOR FAS/AG MINISTER COUNSELOR/OIE

ROME FOR FAO

BANGKOK FOR REO OFFICE, USAID/RDMA HEALTH OFFICE - JMACARTHUR,

CBOWES

PACOM FOR FPA



E.O. 12958:N/A

TAGS: ECON, TBIO, EAID, SOCI, PGOV, AMED, BM

SUBJ: 3D FUND ANNUAL REVIEW SHOWS POSITIVE RESULTS, IDENTIFIES

CHALLENGES



REF: A) RANGOON 096 B) 07 RANGOON 744 C) RANGOON 278 D) RANGOON



279 E) 07 RANGOON 634



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1. (SBU) Summary. The 3 Diseases Fund (3DF),the largest single

health donor in Burma, recently completed its first year in

operation. During the first annual review meeting, April 1-2,

donors, implementing partners, and GOB officials highlighted how the

3DF's assistance addressed Burma's health concerns in the areas of

HIV/AIDS, malaria, and tuberculosis, as well as identified

challenges to the prevention and provision of services for these

diseases. First year successes included: expansion of national

programs for all three diseases, increased number of NGOs providing

anti-retroviral treatments (ART) for HIV/AIDS patients, improved

coordination between implementing partners and township level health

officers, expansion of the public-private treatment for TB, and

provision and treatment of more than 100,000 long-lasting bed nets,

among others. In addition to expounding the success of 3DF

programs, donors and implementing partners also identified future

challenges that must be overcome to ensure successful development of

Burma's health programs. The 3DF will examine its current funding

priorities to determine whether it should reallocate funds from

HIV/AIDS programs to TB and malaria; implementing partners will

improve data collection and collaboration with the Ministry of

Health (MOH) and NGOs; MOH will work with 3DF to prevent multi-drug

resistant strains of TB and malaria from spreading. 3DF partners

urged other donors to provide more humanitarian assistance to Burma,

noting that funding gaps in the national programs may pose regional

problems as Burma's disease incidence crosses its borders. End

Summary.



Promoting Health Under the 3D Fund

--------------



2. (SBU) A consortium of six donors - Australia, the European

Commission, the Netherlands, Norway, Sweden, and the United Kingdom

- established the Three Diseases Fund (3DF) in 2006 to reduce the

burden of morbidity and mortality for HIV/AIDS, malaria, and

tuberculosis (TB) in Burma and to cover the gap left by the pull out

of the Global Fund in 2005 (Ref A). To date, donors have pledged

$104 million over five years to assist national health programs at

the township level, and have disbursed more than $23 million to 26

implementing partners during the first year. According to Mark

Canning, British Ambassador and 3D Fund Board Chair, the 3D Fund's

implementing partners, which include UN organizations, international

NGOs, and local NGOS, use the funds to support 38 different projects

in more than 300 townships throughout Burma.



3. (SBU) The 3DF plans to expand its program in 2008 by giving



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small grants, up to $100,000, to local NGOs for small scale health

projects, 3DF Manager Mikko Lainejoki announced during the annual

review. The 3DF had planned to launch its small grants program by

March 2008, but faced difficulties identifying local partners and

establishing fund flow mechanisms, and determining how best to

monitor and evaluate the activities (to be reported septel).

Lainejoki told the Fund Board that the 3DF has resolved these issues

and will provide up to $1 million in small grants to local NGOs by

July.



Combating HIV/AIDS

--------------



4. (SBU) The 3DF, working closely with implementing partners, the

Ministry of Health (MOH),and the National HIV/AIDS Program (NAP),

have made progress in addressing HIV/AIDS in Burma, NAP Program

Manager Dr. Min Thwe explained. The number of HIV/AIDS cases in

Burma has dropped during the past three years, MOH officials

emphasized. According to MOH studies, while the number of most at

risk populations increased, the overall prevalence rate was 0.67

percent in 2007, showing a leveling off of new HIV/AIDS cases. In

2005, UN figures showed an HIV/AIDS prevalence rate of 1.3 percent

of the general population (Ref B). While the prevalence rate

decreased from 2005 levels, UN officials noted that it was due

primarily to the use of a new formula to determine prevalence, and

only secondarily to the increasing number of HIV positive patients'

deaths.



5. (SBU) In 2007, the NAP established and implemented its

operational plan, determined priority townships in Burma for ART

treatment, and mapped vulnerable populations. The NAP also provided

more than 30 million condoms free-of-charge in 2007. According to

the Ministry of Health, the GOB's highest priority is to reduce

HIV-related risk and vulnerability among targeted populations, such

as female sex workers and their male clients, men who have sex with

men, drug users, and families of HIV/AIDS patients. In 2008, the

NAP, which has a limited budget of approximately $250,000, plans to

expand its treatment program, allocating 60 percent of its budget

for ARTs and care and support. Because the national HIV/AIDS

prevalence rate is less than 1 percent, the NAP will gradually

reduce its budget for awareness raising, instead relying on NGOs to

conduct educational outreach and behavior change programs. In 2008,

the NAP hopes to improve coordination with the 3DF implementing

partners to reduce the spread of HIV/AIDS, including collaboration

on HIV/AIDS data collection, further cooperation on monitoring and

evaluation, and expanding treatment for PLHAs.



6. (SBU) While the NAP is active in more than 100 townships around



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Burma, the majority of HIV/AIDS treatment and prevention activities

are conducted by NGOs, most of which receive support from the 3D

Fund, PSI Deputy Director Habibur Rahmen explained. Ten 3DF

partners work on HIV/AIDS activities in 93 townships. While their

activities vary, most conduct home-based care; provide

socio-economic, psycho-social, and nutritional support to people

living with HIV/AIDS (PLHAs); and give medical support, including

ARTs. Currently, 10,882 people receive ARTs, which accounts for

less than 20 percent of Burma's HIV positive population.

MSF-Holland Country Director Frank Smithuis commented that while

ARTs are expensive, the cost of providing care with ARTs and without

is the same. Those HIV/AIDS patients who do not receive ARTs often

need food support and treatment for other diseases, which costs more

than providing ARTs, he explained. He expressed concern that more

NGOs and donors were not doing enough to help the Burmese people,

letting politics get in the way of providing humanitarian assistance

to the truly needy. He encouraged donors and NGOs to increase

funding for Burma, noting that NGOs have successfully worked in

Burma with small budgets, particularly in the health sector.



Lauding the National TB Program

--------------



7. (SBU) Tuberculosis (TB) is a major public health concern in

Burma and the WHO classifies Burma as one of 22 TB high-burden

countries in the world. While the true prevalence of TB in Burma

remains unknown, the WHO estimates that more than 40 percent of

Burma's population is infected with TB (Refs C and D). The National

TB Program (NTP) plans to conduct a prevalence study in 2008, if

funds permit, to determine the true disease burden, NTP Manager Dr.

Win Maung told the Fund Board. Despite not knowing the true

incident rate, the MOH and WHO claim that the NTP has achieved WHO

TB targets, detecting 86 percent of new TB cases and successfully

treating 85 percent of cases. NGOs questioned the validity of these

numbers, arguing that without knowing the true burden of the

disease, it was impossible to know whether the NTP has detected 86

percent of the cases, Dr. Nyo Nyo Mint of PSI stated.



8. (SBU) In 2007, the 3DF, working through the WHO, successfully

strengthened the NTP's capacity at the township level, WHO TB

Officer Dr. Hans Kluge explained. The NTP, the strongest of the

GOB's national programs, will focus on improving its treatment of TB

cases in 2008, particularly of multi-drug resistant TB (MDR-TB) and

HIV-TB co-infection cases. Due to funding gaps, the NTP continues

to rely on the private sector to assist with TB detection,

surveillance, and treatment. The 3DF, which funds 10 partners for

TB, has successfully conducted community outreach activities in more

than 141 townships and supported the Public-Private Mix (PPM) DOTS



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program, which encourages coordination between the NTP and private

clinics for the treatment of TB. 3DF officials lauded the PPM

program, noting that PSI and Myanmar Medical Association (MMA)

clinics detected more than 10,000 new TB cases in 2007. PSI

detected 95 percent of these new cases, and provides TB treatment to

more than 10 percent of Burma's TB cases. During the meeting, PSI

officials pointed out that because the 3DF did not extend TB funding

to PSI past March 31, 2008, (it provided the funding to MMA instead)

PSI might to have to halt its TB services in 2009. Some

participants questioned whether the 3DF and NTP would be able to

successfully treat TB nationwide if PSI stopped its TB program.



Malaria

--------------



9. (SBU) Malaria continues to be a significant health problem in

Burma, with more than 650,000 cases reported in 2006. 285 of

Burma's 324 townships are high-risk malaria areas, with 29 percent

of the population living in malaria-risk areas, WHO Malaria Officer

Dr. Leonard Ortega declared. However, the GOB allocates

approximately $150,000 for malaria programs each year, 95 percent of

which is spent on salaries and operational costs (Ref E). Despite

the high prevalence of malaria, both morbidity and mortality rates

for malaria have decreased during the past five years, now at 9.6 of

1000 people and 2.9 of 100,000 people respectively. The National

Malaria Program (NMP) expects to reduce both morbidity and mortality

rates to 6.0 and 2.5 by 2010, NMP Manager Dr. Than Win explained.



10. (SBU) 3DF partners acknowledge that Burma's malaria incidence

may be up to three times MOH figures, and informed the Fund Board

that the best way to reduce the number of malaria cases was to

increase educational awareness and provide long-lasting treated bed

nets to families in need. Only five percent of Burma's population

own and use bed nets, most of which are untreated, Birke Herzbroch

of Malteser explained. To successfully combat malaria, 3DF partners

and the NMP must provide more than 4 million bed nets as quickly as

possible. 3DF partners in 2007 provided more than 36,000 bed nets

to vulnerable populations and treated more than 57,000 bed nets with

long-lasting insecticide. Partners also established 14 mobile

clinics to treat malaria, trained more than 362 health care

providers, and procured malaria drugs for private and NMP clinics.

In 2008, the National Malaria Program and 3DF partners plan to

distribute additional bed nets, procure more than 2.4 million

chloroquine tablets to treat malaria, and increase the number of

outreach programs.



Identifying Future Challenges

--------------



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11. (SBU) In addition to highlighting the positive steps taken by

the 3DF, Board Members, MOH Officials, implementing partners, and

donors identified challenges that both the 3DF and GOB must overcome

to successfully promote health programs and services while reducing

the burden of disease in Burma.



--Funding Gaps: The 3DF is the largest donor in Burma's health

sector, providing $23 million this year, substantially more than the

GOB gives to national programs and NGOs. However, 3DF funding alone

is not enough, Board members and donors emphasized, highlighting

funding gaps for all three national programs. Some of the gaps

include lack of funding for drug treatment protocols for HIV/AIDS,

TB, and malaria; no assistance for coordination of information

gathering and analysis; and less funding for monitoring and

evaluation of programs. Not only should other donors provide more

humanitarian assistance to help Burma's needy, but the GOB should

substantially increase the amount going to health programs, Board

members declared. The high rate of HIV/AIDS, TB, and malaria

prevalence in Burma is not just Burma's problem, they noted. As

more Burmese flee the country, looking for jobs or an escape from

persecution, they bring their diseases with them, making regional

outbreaks of MDR-TB and malaria likely.



--Reviewing Funding Priorities: 3DF members noted that the current

3DF budget is split 60-20-20 between HIV/AIDS, TB, and malaria. Due

to the lower prevalence rate of HIV/AIDS and the higher rates of TB

and malaria infections, some NGOs questioned the 3DF's budget

priorities. Mikko Lainejoki acknowledged the discrepancy, noting

that the 3DF would be reviewing disease burden and treatment

information to determine how best to allocate funds for future

years.



--Securing MOUs with the Government/Monitoring and Evaluation

issues: Many of the implementing partners stressed that the GOB's

policy of only issuing one-year MOUs for NGOs posed a significant

challenge. Almost immediately after signing the MOU, NGOs must

begin negotiations for next year's document, they complained.

Additionally, they questioned GOB restrictions on NGO travel, noting

that travel was vital to properly monitor and evaluate programs.

MOH officials responded that NGOs that asked for permission well in

advance were able to travel. In 2007, the MOH granted travel

permission 444 times; through March 2008, the MOH had already issued

travel permits for 303 trips. MOH officials noted, however, that

NGOs should only travel to areas covered by their MOU - if they

wanted to travel to a new area or start a program in a new area,

travel permits might be delayed.





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--Multi-drug resistance for TB and malaria: Participants

highlighted that the availability of inferior TB and malaria drugs

on the market, coupled by patients defaulting on their medicines,

led to higher rates of multi-drug resistant diseases in Burma. NGOs

and 3DF members stressed the need to improve basic health services

and monitoring to ensure that patients completed their drug

protocols. Additionally, they called on the MOH to work with the

Burmese Food and Drug Administration to ensure that drugs available

on the local market were safe.



--Need for Improved Data Collection: Several members of the Board

stressed that NGOs and the MOH needed to improve their data

collection techniques and share information. Without accurate

information at the beginning of the project, it is impossible to

determine success overall, they noted. Many NGOs collect data on

their own, but either do not share it or lack the manpower to

analyze it properly. NGOs pledged to improve data collection and

cooperation with other NGOs during 2008.



Comment

--------------



12. (SBU) Burma's national disease programs - the NAP, the NTP, and

the NMP - provide solid, albeit inconsistent, health care treatment

for Burmese throughout the country. The 3DF and its donors believe

the best way to reach Burma's needy populations is to work through

the existing structures, strengthening the capacity of township

level health providers so they can better detect and treat diseases.

The Ministry of Health, which is woefully underfunded and receives

a budget of less than 1 percent of Burma's GDP annually, cannot do

this alone and must rely on the assistance of donors to supplement

its programs. The 3DF, like most donors, refuses to provide money

directly to the GOB and instead works through 26 implementing

partners to establish a public-private partnership for health

services and education. The 3DF cannot address Burma's health needs

on its own, with minimal financial support from the regime.

Additional humanitarian assistance helps the Burmese people who

should not have to suffer for their terrible government. Assistance

not only will help the Burmese people survive, but will halt the

spread of these highly infectious diseases to the rest of the world.





VILLAROSA