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[dashboard:where_we_work]YANGON, Myanmar — In the densely populated industrial township of Hlaing Thar Yar, Yangon, tuberculosis (TB) continues to spread quietly among communities where crowded living conditions and high mobility increase the risk of transmission.For many residents, daily life is shaped by long working hours, financial pressure, and limited access to health care. In this environment, even a persistent cough can go unchecked until the disease progresses.For U Maung Si, 72, early intervention made a critical difference.“I began experiencing a persistent cough,” he said. “A health volunteer encouraged me to get checked, and I was supported to go to a clinic for an X-ray screening.”The results revealed a small lesion in his lungs, and he was diagnosed early and started treatment promptly.“I was very worried I might transmit the disease to my family,” he said. “But I feel relieved and happy that I did not pass it on.”   Despite such successes, health providers say that fragmented service delivery remains a major challenge. Dr Phyo Thiha Tun, who works at a TB clinic receiving referrals from across the township, says many patients are lost along the referral pathway.“We screen suspected patients here, send sputum samples to another facility, and then refer confirmed cases to the township TB center for treatment initiation,” he said. “During these steps, some patients are lost to follow-up.”In Hlaing Thar Yar, where many residents are migrant factory workers, the risk of TB transmission is heightened.“Overcrowded living conditions make TB transmission very easy. When we lose track of suspected TB patients during the referral process, the risk of further transmission in the community becomes even higher.”   Caption: U Maung Si and other TB patients at the local TB clinic in Hlaing Tar Yar Township. Photo: © WHO MyanmarFor TB treatment, returning for follow-up or completing referrals is important. Financial hardship is a key reason why patients are lost to follow-up. Another is difficulty to take time off to complete visits to the clinic as it may jeopardize their income. In many cases, patients also require a family member or companion to accompany them, doubling the time away from work and resulting in additional loss of daily income for already vulnerable households.“Most of our patients are migrant workers,” Dr Phyo explained. “They struggle with transport costs and cannot always afford repeated visits.”“Even when we provide travel assistance, rising transport costs make it insufficient,” he added.As a result, a number of patients are lost during referral — a gap that directly affects treatment success.   Community health volunteers play a critical role in bridging these gaps and connecting communities with essential TB services.“I am San Thida, a community health volunteer with MHAA,” she said. “We identify suspected TB patients, raise awareness, and support them to access diagnosis and treatment.”Through community outreach, awareness of TB has improved, and more people are now self-referring for care.“When we find suspected cases, we refer them to free TB clinics,” she said. “We also support transport costs during treatment, recognizing that travel expenses can be a significant barrier for patients who already face financial hardship and risk losing income when seeking care.”However, she noted that financial barriers remain a major challenge for many families. Across interviews, one message emerges clearly: TB control in high-risk areas depends not only on effective diagnosis and treatment, but also on ensuring that services are accessible and designed around the realities faced by patients. Dr Phyo believes a more integrated model could transform outcomes.“If mass screening and a one-stop TB service could be established in high-risk areas, it would significantly improve early detection and treatment success,” he said.At present, patients often move between multiple facilities, from screening to laboratory testing to treatment initiation.“This multi-step process sometimes leads to loss of patients during referral,” he explained. “A one-stop service would reduce these gaps.”These system gaps are further compounded by the realities many patients face. For providers and community workers alike, TB is not only a medical challenge, but also a systems issue shaped by mobility, poverty, and barriers to access.“Many patients are migrant workers who travel back to their hometowns,” Dr Phyo said. “Without continuity of care, they may unknowingly transmit TB further.”In this context, strengthening integrated, locally accessible services is not only critical for improving individual treatment outcomes, but it is also essential for reducing transmission across communities and regions. What is unfolding in Hlaing Thar Yar is not an isolated challenge; it reflects a broader reality in high-burden, high-mobility settings where fragmented health systems continue to hinder effective TB control.For patients navigating multiple referrals, long travel distances, and financial constraints, gaps in the system can mean the difference between completing treatment and being lost to follow-up.“A one-stop service would reduce these gaps and help us keep patients in care,” Dr Phyo said. “It would make diagnosis and treatment much more accessible for those who need it most.”In communities where TB can spread easily but access to care remains limited, strengthening integrated, patient-centered services is essential—not only to improve outcomes for individuals, but also to break the chain of transmission.As Dr Phyo emphasizes, “If we can bring services together and closer to the community, we can detect TB earlier, treat it effectively, and prevent it from spreading further.”In the effort to end TB, ensuring that every patient can access timely diagnosis and treatment, and is not lost follow-up may be the most critical step of all. *This story was originally published on the WHO website on 8 July 2026.