Existing Mechanisms, Gaps and Priorities Areas for development in

Health Sector Myanmar

Dr. Nilar Tin

Deputy Director General (Public Health)

Department of Health

Ministry of Health Minister for Health

TEXT TEXT

Deputy Minister

Dept of Medical Research

LM

Dept of Medical Research

CM

Dept of Medical Research

UM

Dept of Medical Science

Dept of Traditional Medicine

National Health Policy National Health Committee Health Legislations National Health Plan Myanmar Health Vision 2030 Rural Health Development Plan ASEAN /Regional/ Global Millennium Development Goals

Deputy Minister

Dept of

Health

Dept of Health

Planning

UN Agencies, Bilateral, INGOs, …

Other Ministries National NGOs, Private Sector,

CBOs…..

Department of Traditional Medicine

Department of Medical Research (Central)

Department of Medical Research (Upper)

Department of Medical Research (Lower)

Department of Health Planning

THE REPUBLIC OF THE UNION OF MYANMAR

NHP M & E Committee

Ministry of Health

Department of Medical Science

Department of Health

State/Regional Government

1. Ministries 2.MWAF 3. MMCWA

4. MRCS 5. MMA 6. MDA 7. MNMA 8. MHAA 9. Traditional Medicine Practitioners Association 10. Religious Organization

CABINET

District Authority

Township Authority

Ward/ Village

Authority

State/Region Health Committee

District Health Committee

Township

Health Committee

Ward/ Village Tract Health Committee

State/Region Health Department

District Health Department

Township Health Department

Station Hospital

Rural Health Center

Village Volunteers

National Health Committee

Township Health System (330 townships) Township Medical Officer

Medical Care Public Health

Disease Control

Administration Cooperation

T/S & Station Hospital

Inpatients/ Outpatients

wards OT/

Labor room

Lab/ Radiology

Medical Store

Urban Health Center

Malaria Team

Office Local

Authority/ Other Depts MCH

Leprosy team Dispensary

NGO- INGO

National NGO

School Health TB team

RHCs/ Sub-RHCs

VHWs

HIV/STD

COMMUNITY

Township Health

Committee

Health Indicators

s/n Indicators Source/year

1 Life expectancy at birth

65.1 (male)

70.5 (female)

(Statistical Year Book 2009) 2008

2 Infant Mortality Rate

(per 1000 live births)

37.5 Multiple Indicator Cluster Survey 2009-

2010

3 Under 5 Mortality Rate

(per 1000 live births)

46.1 Multiple Indicator Cluster Survey 2009-

2010 4 Maternal Mortality Ratio

(per 100,000 live births)

240 UN Interagency 2010

5 Delivery by Skilled Birth Attendants 64.8 HMIS

6 HIV/AIDS prevalence rate

0.61 Estimated by NAP and partners, 2010

7

TB Prevalence

(per 100,000 population)

525

Nationwide TB Prevalence survey 2010

8

Malaria Prevalence

(per 1000 population)

11.7

VBDC Report , 2010

GAPS in Health Systems Accessibility

of Service

Availability of resources

Quality Care at hospitals/labs

HRH Lack of integration

HMIS

Financing

Recommendations of Universal Health Coverage Meeting July, 2012

Supply Side Systems Strengthening-PHC

Priority activities for accessibility of services-integrated service What will be done when Expected o/p By whom

• Comprehensive Health Planning system Integrated health services through Essential Package of services (MNCH + EPI + Nutrition + Environmental Sanitation + CDC+ NCD) to reach HTR areas at township level Coordinated Township Health Plan, Meso plans at S/R and NHP

2013 to 2015

Costed Coordinated Township Health Plans/Meso plans for S/R & leading to a costed NHP

GOM-MOH-DOH S/R Governments +Development Partners

• State and Region Health Sector Re-Development Plans, particularly in areas in conflict or post conflict States, or areas of low socio economic development

"

Supply Side Systems Strengthening

Priority activities for availability of resources What will be done when E/outputs By whom

• Supply side strengthening through flushing of Station Hospital and below with essential drugs Still need – • One standard system of procurement & distribution system, • Strengthening of infrastructure (constructing ware houses & refurbishment of main store at hospitals), • Capacity building on Supply System Management • Costing of essential drugs for further scale up

2013 to 2015

Covers 330 townships SH and below

GOM-MOH-DOH S/R Governments GOM-MOH-DOH S/R Governments +DPs +Private sector

• Provision of Transportation Means to Basic Health Staff

330 townships

GOM-MOH-DOH S/R Governments+ DPs

• Effective health promotion through provision of IEC materials/guides in different ethnic languages; and using Behavior Change Communication methods

2013 to 2015

Covers 330 townships

GOM-MOH-DOH S/R Governments +DPs

Gaps in Health Information System

Data Quality-not highly valid

Data Flow- still manual

Timeliness of data affecting

completeness of data

Strengthening Health Information System

Priority activities for strengthening information system What will be done By

when Expected outputs

By whom

• Piloting ELECTRONIC Network Information Flow System from sub RHC to RHC to Township to State/Region up to Central in (2) Townships, one in State and another in Region (Public Health Data + Hospital Data + Vital Registration)

•Capacity Building and technical and material support for making it happen

2013 to 2015

Covers (2) Townships -quality and highly valid data

GOM-MOH-DHP-DOH S/R Governments + DPs +Private sector

• Development of Information Policy on strengthening existing HMIS and including private sector information

2013 "

Gaps in HRH

Population coverage ( Std) 1MW : 4000 pop 1MW : 5 V Actual 1 MW : >5000 pop 1 MW : > 10 V Still rely on AMW/TBA for delivery in the rural remote areas

Delivery by Skilled Birth Attendants 58-64%

Lack of HRH Master Plan for recruitment

& deployment

Maternal Mortality 200/100,000 LB

Skill Mix Issues -Midwives: PHS 2 still 10:1 which has to be 1:1

Midwives lack financial support

MDG Goals

Supply side Systems Strengthening Priority activities for HRH

What will be done By when

Expected output

By whom

• Expand the number of sub Rural Health Centers through proper mapping of villages in each township; increasing more midwives and Public Health Supervisors PHS 2

2013 to 2015

Estimated 10,000 MW + 10,000 PHS2 By 3 years

GOM-MOH-DOH S/R Governments

• Site selection of already located pensioner midwife/Lady Health Visitor/HA/THN to recruit as contracted health staff ; to work under the existing TMO’s jurisdiction

2013 To 2015

Rural retention of HWF

GOM-MOH-DOH DPs

• Strengthening Infrastructure for midwives Construct new sub RHC/ refurbish old RHC Include labour room and running water for enhancing institutional delivery

2013 To 2015

Depending upon needs

GOM-MOH-DOH DPs Local Government

• Training of AMW to cover 1 AMW : 1 village (existing-20,000; required -30,000 –cost 15 million USD)

2013-2015

65,000 AMW GOM-MOH-DOH DPs Local Government

Supply side Systems Strengthening Priority activities for HRH continued:

What will be done By when

Expected output By whom

• Implementation of National HRH Master Plan (Draft) • HRH Policy Formulation including strategy for community based health workers (e.g. volunteers)

2013 To 2016

- Focal HRH Unit -Health Personal Information System

-Develop L&M systems to strengthen planning & management of HRH at all levels -Tools for projection of health staff, production & recruitment -Policy & regulations for staff remuneration -Institutional quality standards -Improved competence of health staff

GOM-MOH-DMS/DOH/DHP Other Ministries DPs Stakeholders

Health Financing Initiatives

Priority activities for accessibility of services-demand side financing What will be done when E O By whom

• Demand side financing- Maternal and Child Voucher scheme- Feasibility study already conducted in one township • Guidelines, trial and scale up of voucher scheme

2013 to 2015

50 -100 twps

GOM-MOH-DOH/DHP +DPs

• Hospital Equity Fund for poor mothers and children for emergency hospital care • Guidelines, trial and scale up of HEF (be implemented in 180 townships by 2015 )

2013 to 2015

150 twps

GOM-MOH-DOH/DHP S/R Governments + DPs + Local NGOs/CBOs

• Community Based Health Protection scheme piloted in one township • Guidelines, trial and scale up of CBHP scheme

2013 to 2015

50-100 twps

GOM-MOH-DHP/DOH + DPs + Community

Longer term- • Costed plan for Universal Health Coverage linked to financing plan • Expanding government HE • Working with DPs to ensure coordination of other resources through costed sector plan and budget (with different ways of financing) • Clear financing for health sector including Expanding social health insurance (SSB) & Private Health Insurance

GOM-MOH-DHP/DOH S/R Governments + DPs + Community + Private Sector

Gaps identified in Health Systems

Gaps in Quality Hospital Services

Need of high standard quality hospital services

Need of high standard imaging services

Need of high standard blood centers

Need of high standard laboratory services

Need of high quality FDA labs

Strengthening Medical Care & Support Services Priority activities for high standard medical care services

What will be done By when

Expected outputs By whom

• Strengthening Hospital Infrastructure/ Laboratory/ Imaging Procedures

2013 to --

5-10 International Standard Hospitals/Labs/ Imaging Centers

Investments Joint venture/ Public-Private

• Pharmaceutical Factories 5-10 Pharmaceutical, Vaccine and Traditional Medicine Factories

Investments Joint venture/ Public-Private

• Development of high level blood banks 1-2 Blood Banks Investments Joint venture/ Public-Private

• Food and Drug High Standard Lab International Standard FDA Lab

Investments Joint venture/ Public-Private

Sr. Project Name 2013 2014 2015 2016 2017

1. National Nutrition Control Center * Development of Nutrition Lab

0.06

2. Expanded Program for Immunization * Vaccine Plant

15.0

3. Food and Drug Administration * High Standard Lab Development

3.4 3.4 3.4

Plan for Foreign Investment in Health Sector (US$ in million)

Sr. Project Name 2013 2014 2015 2016 2017

4. Medical Care * Construction of Quality Hospitals (Public-Private, Joint Venture, Private) * National Blood Centers plus *Construction of new Medical Sub Depot (2 in number)

3.88 2.0

3.88 2.0

3.88 2.0

5. Ambulance Services * Procurement of well- equipped ambulances (300)

0.43

0.43

0.43

Plan for Foreign Investment in Health Sector (US$ in million)

Updating overall Policies and Plans Priority activities for health sector investments

What will be done By when

Expected outputs By whom

• Building the evidence for Health Policy particularly in terms of health systems research, social research and health financing evaluations.

2013- -Provider payments -medical benefits packages -Poverty identification schemes -levels of financial risk protection

GOM-MOH-Research Institutes S/R Govts +DPs

• Reviewing current health policies • Updating overall health strategies- Costing National Health Plan, Strategic Plans for RH/WCHD/Nutrition/ TB/HIV/AIDS/ Malaria/Water & Sanitation etc.. • Updating & Strengthening National Health Laws

2013-

Updated health policies Costed Plans Updated NH Laws

GOM-MOH S/R Govts +DPs

• Improving Governance at all levels Leadership and Management Capacity

2013- Decentralization Accountability & Transparency

GOM-MOH +DPs

Enhancing Coordination & Collaboration Mechanisms

Priority activities for health sector investments What will be done By

when Expected outputs By whom

• Developing and strengthening collaborating mechanisms with donors & development partners –Expand scope of M-CCM

2013- Broader scope of CCM covering all health sector

GOM-MOH +DPs

• Regular Development Partner Forum to Map of Activities of Development Partners/DOH so as to know aid inflows, who is doing what, at where; track progress against Nay Pyi Taw accord; agree priorities

2013- Identify gaps and fill up gaps Set common performance Indicators

GOM-MOH +DPs

• The foundation of PHC system strengthening through increases in tax based financing and improved aid effectiveness

2013- -one plan -one monitoring & evaluation system -one financial management system -Efficiency/Equity

GOM-MOH +DPs

Thank You