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DE RUEHGO #0308/01 1231032
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O 021032Z MAY 08 ZDK TO ALL
FM AMEMBASSY RANGOON
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RUCNASE/ASEAN MEMBER COLLECTIVE
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RUCLRFA/USDA WASHDC
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RHEHNSC/NSC WASHDC
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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 
 
RANGOON 00000308  001.6 OF 006 
 
 
¶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 
 
RANGOON 00000308  002.4 OF 006 
 
 
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 
 
RANGOON 00000308  003.4 OF 006 
 
 
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 
 
RANGOON 00000308  004.4 OF 006 
 
 
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 
----------------------------- 
 
RANGOON 00000308  005.4 OF 006 
 
 
 
¶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. 
 
 
RANGOON 00000308  006.4 OF 006 
 
 
--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