Khan Mishal S, Schwanke Khilji Sara U, Saw Saw, Coker Richard J
Communicable Diseases Policy Research Group, Department of Global Health and Development London School of Hygiene & Tropical Medicine, London, UK
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Health Policy Plan. 2017 Feb;32(1):102-109. doi: 10.1093/heapol/czw077. Epub 2016 Jun 21.
Myanmar represents an extreme example of the difficulties in optimally allocating resources for maximum public health benefit, on the basis of limited information. At the recent Myanmar Health Forum 'Investing in Health' much of the discussion revolved around what to invest in, how health systems could be strengthened, and what research and capacity building areas the international donor community should prioritise for support. Funding for infectious disease control, particularly HIV and tuberculosis, is being channelled to the country at an unprecedented rate, but very little research has been conducted in recent years, and existing information has not yet been synthesised. This paper presents findings of the first systematic literature review on tuberculosis control and the health system in Myanmar, with the aim of informing the development of optimal research priorities and strategies. Medline and grey literature were searched for relevant papers. Inclusion criteria and analyses were structured to capture data on the Myanmar health system, healthcare delivery, financing, tuberculosis control indicators and information systems. A total of 77 papers were included in the analysis. The results indicate that there has been a large increase in the number of peer-reviewed articles published on tuberculosis in Myanmar over the past decade, although the absolute number of studies remains small. We identified several areas in which evidence to inform policy and resource allocation decisions is lacking, including research focused on rural and/or vulnerable populations, analyses of risk factors for TB and drug resistance that can inform prevention strategies and economic analyses for optimising resource allocation. The gaps in research to inform policy identified through this study may be relevant to other low resource settings with extremely limited research capacity.
缅甸是一个极端的例子，说明在信息有限的情况下，为实现最大公共卫生效益而优化资源分配存在困难。在最近举行的缅甸健康论坛“投资健康”上，大部分讨论都围绕着投资方向、如何加强卫生系统，以及国际捐助界应优先支持哪些研究和能力建设领域展开。用于传染病控制，特别是艾滋病毒和结核病控制的资金正以前所未有的速度流入该国，但近年来开展的研究很少，现有信息也尚未进行综合分析。本文介绍了关于缅甸结核病控制和卫生系统的首次系统文献综述的结果，旨在为制定最佳研究重点和战略提供参考。通过检索医学文献数据库（Medline）和灰色文献来查找相关论文。纳入标准和分析结构旨在获取有关缅甸卫生系统、医疗服务提供、融资、结核病控制指标和信息系统的数据。共有77篇论文纳入分析。结果表明，在过去十年中，缅甸发表的关于结核病的同行评审文章数量大幅增加，尽管研究的绝对数量仍然很少。我们确定了几个缺乏为政策和资源分配决策提供依据的证据的领域，包括针对农村和/或弱势群体的研究、可用于指导预防策略的结核病和耐药性风险因素分析，以及优化资源分配的经济分析。通过本研究确定的政策研究差距可能与其他研究能力极其有限的低资源环境相关。
