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As a concrete result of the CCS development work
performed between January and June 2000, WHO has identified the following
priority areas for collaboration during the period of 2002-2005:
 health system;
excess burden of diseases;
women’s health / reproductive health;
child and adolescent health;
healthy environment; and
major risk factors
hazardous to health.
These areas have been selected on the basis of
information provided in a large number of reference documents and reports
(references in Annex 3), a list of selection criteria developed during the
CCS seminar, adapted from an initial WHO global list and inputs contributed
throughout the CCS seminar by the participants. (Detailed matrixes developed
for each priority area are available at the WHO-Myanmar Country Office.) The main
criteria used for the selection process were as follows:
Potential for significant change in national
burden of diseases with existing cost-effective interventions considering
local situation.
Health problems with major impact on
socioeconomic development and a disproportionate impact on the lives of the
poor.
Opportunities to reduce health inequalities
within (vulnerable groups, national races/localities) and between countries.
Comparative advantage of WHO:
particularly in relation to the production of public goods, building
consensus around policies, strategies and standards, initiating and managing
partnerships.
Major demand for WHO support based on
country's needs.
Urgent need for applicable new technologies.
Availability of support from other agencies
and partners.
Potential to strengthen development of human
resources and research.
Health System
Without a well functioning health system,
technical interventions are not likely to have a major impact on health
outcomes. The four health system functions, i.e. stewardship, health
financing, resources development and provision of health services, need to be
strengthened. Planning and coordination of external aid, health management
information system and regulation & legislation are the areas where WHO
support is expected. In the area of human resources for health, the main challenges where WHO
assistance is required, are production of human
resources, performance assessment and improving of managerial skills. WHO
will continue its support in the area of research. The strategy is
to conduct research on priority diseases and on health systems to develop and
improve the infrastructure necessary for effective health research and to
promote the utilization of research findings. WHO will also focus its assistance
in the area of traditional
medicine, especially in evaluation of cost-effectiveness of
traditional medicine interventions.
Excess Burden of
Disease
Analysis of the overall health situation suggests that communicable diseases continue
to be major public health problem and constitute a major part of the excess
burden of disease on the people, on the health services, and on the economy
of the country. Malaria is a major cause of morbidity and mortality.
Tuberculosis is one of the major public health problems in Myanmar and is considered the
second priority disease in the National Health Plan after malaria. HIV/AIDS
is a disease of national concern and occupies the third position after
malaria and tuberculosis. Leprosy and polio are on the verge of being
eliminated or eradicated and efforts must be taken to ensure that final
campaigns and interventions are completed. Dengue and dengue haemorrhagic fever is becoming an increasing problem in
the country. These diseases are considered major challenges for the
next 4-5 years period. Current available technical strategies for
communicable disease control have already been accepted and adapted to
country-specific needs. However, WHO technical support in implementing these
strategies is required. In the area of non-communicable diseases, cardiovascular diseases, cancer,
diabetes, chronic pulmonary diseases, accidents/injuries and mental health
are considered priority issues for WHO support. Surveillance of major
non-communicable diseases should be established. There is a lack of awareness
in the community about the risks of non-communicable diseases. For the
priority area of non-communicable diseases, WHO would focus its support to
advocacy and technical assistance.
Women’s Health /
Reproductive Health
Pregnancy-related deaths constitute the leading
cause of loss of healthy lives among women of reproductive age in Myanmar.
Haemorrhage, eclampsia,
obstructed labour, puerperal sepsis and unsafe
abortion are the major causes of maternal deaths. Most maternal deaths are
preventable. There is a need to equip the health system with cost-effective
reproductive health interventions such as good family planning services,
effective access to essential obstetric care including post-abortion care and
emergency obstetric care through effective community-based referral systems.
Reproductive tract infections, sexually transmitted diseases and HIV/AIDS
also appear to be among the major causes of women’s ill-health. A major issue
in women’s health is the lack of disaggregated health information by sex, age
and other relevant variables. The focus should be on institutionalizing
disaggregated data in health information system, and mainstreaming women’s
perspectives in all health policies and programmes. Violence against women is
increasingly being recognized as a public health problem. During 2002-2005, WHO’s support will be directed to technical assistance,
partnership building and joint monitoring of achievements in surveillance,
institutionalization and adaptation of WHO standards and guidelines.
Child and
Adolescent Health
Although there has been a decline in the last
decade, both infant mortality and under-5 mortality rates are still high.
Since the adolescent population constitutes 20.5 % of the total population
and their health habits set the health pattern for their entire life span,
investments in adolescent health would provide many health dividends. The
leading causes of death in under 5 children were
reported to be acute respiratory infections, diarrhoea,
malaria, dengue haemorrhagic fever and
malnutrition; deaths were mostly due to insufficient quality of care caused
by lack of diagnostic skills and inadequate recognizing of danger signs of
the disease for referral. Only 30 % of the health staff is able to give
proper management of ARI and 80 % of the training courses are not conducted
according to planned curriculum. Inadequate skills-based and participatory
training methodologies have been used, including limitations in systematic
and integrated planned training programme. The coverage of IMCI should be
expanded and the quality of training, logistics and resources including
supervision and monitoring should be strengthened. WHO’s
support during 2002-2005 would focus on the above areas. In adolescent
health, technical and advocacy support is expected in the development of
national policies and strategies to promote an integrated development of child and adolescent
health and STD/HIV together with the prevention of other risk factors.
Environmental
Health
Safe drinking water and sanitation have been identified as priority health issues
under the heading. The coverage of safe drinking water for the whole country
is currently estimated at 66 % and about 80 % for sanitation (especially
sanitary latrines). The use of polluted water and unsanitary methods of
excreta disposal by the population, combined with unhygienic practices and
unsanitary environment result in the high incidence of diseases such as diarrhoea, dysentery, cholera, typhoid, viral hepatitis,
etc. The challenges to the provision of safe drinking water include the
improvement of coverage, the monitoring of water quality as well as
information, education and communication to the public and the further
promotion of inter-sector co-ordination and collaboration. Besides increasing
coverage, the improvement in sanitation will also require information,
education and communication to the public and the promotion of inter-sector
coordination. These are identified as challenges to be addressed during
2002-2005. WHO’s support in the area of
environmental health would include technical assistance, capacity building
and partnership development.
Major Risk
Factors Hazardous for Health
Tobaccois a major risk factor for several
other non-communicable diseases such as cancer, cardiovascular diseases and
chronic respiratory disorders. Alcohol use is also a major risk for disease,
particularly in the adult male population. In 1993-1994, a survey in Myanmar
showed that 44.6 % of students aged between 10 and 20 years smoked. There is
a clear need to develop long-term, comprehensive and multi-sector policies to
stop the use of tobacco. Another challenge is to stimulate health awareness
and responsibility and to promote conditions and behaviors which favor
health. Unsafebloodis
identified as another major risk factor hazardous to health. There is a need
for resources to establish a proper quality assurance system in every level
of blood transfusion services. The third major risk factor identified is malnutrition and foodsafety. The main
challenge is the high prevalence of moderate and severe malnutrition among
children under the age of 3; high nutritional anaemia
among pregnant
women (58%), low birth weight (24%) and inadequately trained staff in the
programming and management of specific food inspection and control. During
the period 2002-2005, WHO’s support in this area
will focus on advocacy and technical support (particularly training,
information system base, setting standards and monitoring).
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