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The overall goal of the World Health Organization in Myanmar is to contribute to the improvement of
the health of the people of Myanmar.
Health development will be supported by advocating health-promoting policies
and providing technical leadership in collaboration with the government and
other national and international partners in health, in line with WHO’s core goals for health development. WHO support will
emphasize the development and adoption of policies, norms and standards to be
implemented through evidence-based technically sound interventions. WHO will
work towards more efficient and more equitable health systems.
The goal set above can effectively be achieved if an optimal mix of
partnerships in health is developed. The WHO country office is also mandated
to facilitate the exchange of experience, regionally and globally.
Key strategic directions and functions
Broadstrategic directions have been defined globally providing
the framework for WHO’s technical work:
 To reduce the excess mortality and morbidity, especially in poor and
marginalized populations
To develop health systems that improve health outcomes equitably, are
financially fair and respond to people’s legitimate demands
To promote healthy lifestyles and reduce factors of risk to human
health that arise from environmental, economic, social and behavioural causes
To develop enabling policy and institutional environments in the
health sector and promote effective health dimensions to social, economic,
environmental and development policies
The objective of the WHO’s strategy is to develop equitable, responsive and
fair financing health systems by improving the process of developing health
policy, planning, regulation and financing. WHO will work in co-operation
with other development partners and contribute to policies and programmes
addressing the needs of the poor. Priority areas of work have been set
using criteria listed in Chapter 3. WHO’s work in Myanmar
during the period 2002-2005 will therefore focus on the following six areas
of work identified as high priority:
Health systems,
Excess burden of disease,
Women’s Health/ Reproductive
Health,
Child and Adolescent Health,
Environmental Health, and
Major risk factors hazardous for
health.
In the
absence of significant bilateral and other sources of aid for health, WHO’s support in Myanmar during the 1990s has been
broad-based, covering a wide range of technical areas as well as support in
implementation. This is the result, in part, of important gaps left unfilled.
WHO’s contribution has focused on the Ministry of
Health (MoH) and consisted of technical assistance,
training, fellowships, guidelines and support for international standards as
well as supplies and equipment. This has been done through projects with
limited scope but covered a large number of health areas, with particular
attention to communicable disease control.
WHO’s
role over the last 10 years has been crucial in maintaining an inflow of
technical assistance, capacity building and training (MoH)
as well as in providing resources for disease control programmes. As long as
external support to the country remains limited and supplies in the priority
areas of work are insufficient, WHO will maintain its role in ensuring the
provision of some of these supplies and equipment, in particular for malaria,
tuberculosis, STIs and HIV/AIDS and reproductive
health.
There is a need to support the health sector in developing
responses and taking pro-active stances on issues linked to health care
delivery, health sector reform and regulation as well as poverty reduction.
Rather than support limited implementation in a range of areas, WHO’s
contribution will aim for a greater impact by a more strategic selection of
activities. This involves work along six core functions, which consist of
modes of assistance where WHO has a comparative
advantage in technical terms and areas of expertise as well as in mandate.
WHO’score functions are to:
 Catalyze change through technical and
policy support in ways that stimulate action and help to build sustainable
national capacity in the health sector
Stimulate the development and testing of
new technologies, tools and guidelines for disease control, risk reduction,
health care management and service delivery
Set, validate, monitor and pursue the
implementation of norms and standards
Articulate consistent, ethical,
evidence-based policy and advocacy positions;
Negotiate and sustain national, regional
and global partnerships
Manage information, assess trends and
compare performance of health systems; set the agenda for and stimulate
research and development;
It is clear that not all of these functions will carry the
same weight across the six priority areas in health for 2002-2005 and their
relative importance is detailed under each priority component below.
In view of the disparities and diversity throughout the
country, an important direction for WHO’s support will be the development,
when necessary, of differentiated
approaches to programming for health inurban,rural and border areas. In line with the government’s
efforts to improve access to health in border areas, highlighted by meetings
such as the Myanmar-Thailand border meeting on bilateral cooperation in
communicable disease control, held in July 2000, WHO will direct special efforts
towards supporting work in border areas.
The WHO
country office will also promote the following initiatives and provide support for
their implementation: Enhancing
Health Systems Performance (EHSPI), Roll Back Malaria (RBMI), Stop TB,
“Making Pregnancy Safer” (MPS) and Tobacco Free Initiative (TFI).
HEALTH SYSTEMS
The
objective of WHO’s strategy is to contribute to the development of equitable,
fair financing health systems which are responsive to people’s needs by
improving the process of developing health policy, planning, regulation and
financing. The central role of health in the sustainable development of Myanmar
is recognized and the MoH is committed to
strengthening the health system to respond to existing needs. An important
evolution in the country over the past eight years has been the shift towards
a market economy, reflected in the adoption of market and cost-sharing
mechanisms in the health system.
WHO will
extend support to the MoH under the functions
defining the role of a health system: 1) stewardship, 2) financing, 3)
resources development, 4) health services provision.
First, the development of national health policy
and the next five-year health plan will be supported by WHO and will cover
the process of identification of key issues across the health sector and
policy objectives as well as strategy-development. This should contribute to
a strong evidence-base for an objective-led and broad-based modernization of
the health sector. Key support will also be provided in the elaboration of a
framework, which regulates health sector activity and ensures standards,
norms and quality of care in the public and private health sector.
Second, managerial and financial capability and
capacity at all levels need to be strengthened and support for professional
training will be promoted through partnerships. The efforts of the MoH in advocating
for an increased share of government budget to the health sector will be
supported as well as more operational research on health expenditure from all
sources. Performance and impact monitoring of different financing schemes
will be an important area of WHO support as it will
provide the evidence-base that will facilitate sound policy development on
financing.
Third, WHO will advocate for improved management,
planning and distribution of resources. This will be done through the
expansion of partnerships and by strengthening information and research on
the availability, needs and use of resources, facilities and supplies.
Another major area for support will be the development of planning and
management capacity for human resources for health as well as research and
guidance on the optimal production mix and utilisation of staff, based on
needs. A review of the supply and
availability of essential drugs and consumables is necessary to plan
requirements and monitor needs and use and will also be supported.
Co-ordination in the area of essential drugs will be advocated for by WHO
which should also help to secure additional resources for essential drugs.
Fourth,
technical assistance will facilitate the definition of essential packages of
care for different levels of the health system. This will constitute
important groundwork which will help in a) the planning and allocation of
resources to ensure more equitable access to primary health care services, b)
the definition/ clarification of provider roles especially for the township
health teams.
Key directions
Research and policy support to develop a broader approach to health
involving the public and private health sector. Advocate for and support the
development of objective-led modernization of the health sector
Advocate for and strengthen the regulatory framework for health and
provide norms and standards for adaptation, both in the public and private sector
Help strengthen policy, planning and management for 1) human resources
for health, 2) drugs and consumables, 3) health facilities and equipment
Provision of health services
EXCESS BURDEN OF
DISEASES
Reducing the excess mortality and morbidity, especially in poor and
marginalized populations is one of WHO’s four
strategic directions. Major public health problems in Myanmar are malaria, still a
principal contributor to mortality, tuberculosis, HIV/AIDS and STIs which all remain priority diseases under the
National Health Plan and will benefit from a continued focus of efforts.
During
the next five years, WHO will continue to support the MoH
in designing and implementing effective and integrated communicable disease
control programmes to reduce excess mortality, morbidity and disability,
especially in populations with limited access to health services.
The outbreak early warning system, surveillance and case management for
malaria, tuberculosis, sexually transmitted infections, HIV/AIDS and other
diseases such as dengue/ dengue haemorrhagic fever will need continual
strengthening and support with increased emphasis on the broad range of
existing providers across the health sector. Leprosy control will be further
supported to achieve elimination. A crucial step will also be to ensure the
quality of diagnosis and diagnostic tools throughout the health sector by
advocating for quality assurance in testing facilities, supporting strategy
development and capacity building as well as adapting necessary tools/
guidelines and ensuring supplies and maintenance.
Although
communicable diseases currently contribute the bulk of the burden,
non-communicable diseases are on the increase and monitoring needs to be
established through surveillance. WHO will provide technical support for a
Burden of Disease (BOD) study, which will assess the relative magnitude of
communicable and non-communicable diseases in Myanmar, providing important
baseline information. WHO will also advocate for
strategy development in addressing CDs and NCDs
using the BOD study as a tool for decision-makers, particularly in the
process of prioritisation and resource allocation.
Key directions
Strengthen advocacy at the state/division level for highest priority
programmes to reach populations groups with low access to health services
Support the strengthening of integrated prevention and control efforts
for priority communicable and non communicable diseases, by encouraging a
broad participation across the health sector, especially at the district and
township levels
Advocate the targeted use of social vaccines (Insecticide-treated
mosquito nets, condoms, counselling) through appropriate partnerships at all
levels (i.e. private companies, casual sex workers, institutions)
Promote/explore modes of partnerships for the procurement of essential
supplies in the absence of major donors/contributors
Technical support will be provided along the seven main intervention
areas defined, in co-ordination with the UN theme group on HIV/AIDS and the
M.O.H.: (i) targeted condom use and reproductive
health; (ii) behavioural development and change communications; (iii)
compassion care and support for people living with AIDS; (iv) reducing the
harmful consequences of injecting drug use; (v) blood safety programme
covering remote areas and rural communities; (vi) improved multi-sector
coordination and enhancing the capacity of national NGOs and the community;
and (vii) surveillance system and research.
WOMEN'S HEALTH /
REPRODUCTIVE HEALTH
Pregnancy-related deaths continue to be a leading cause of
mortality in Myanmar
and it is widely recognized that unsafe abortions constitute a major cause of
morbidity and death among women of reproductive age. WHO’s
work in the coming period will aim to address key issues identified under
this priority area: high maternal mortality, high prevalence of unsafe
abortions, unmet demand for contraception, prevention and control of STIs, HIV/AIDS and violence against women.
A key
area for advocacy and technical support will be the development of national
policies, strategies and action plans on reproductive health that are applied
down to the district and township levels. A life cycle approach to reproductive health will be promoted as well
as the inclusion of sexually transmitted infections and HIV/AIDS prevention
and control.
WHO will
assume a leadership role in promoting and developing essential packages of
services such as an Integrated Reproductive Health Package (covering STIs as well as RTIs and birth
spacing) and standards of care for basic and essential obstetric care at
referral level. Efforts to improve knowledge,
availability and use of, prevention and contraceptive methods will be
supported and broader access to reproductive health services will be
advocated.
Basic and
essential obstetric care will be strengthened and quality of care ensured by
improving the management system, capacity of basic health staff and by
adapting existing norms, standards and guidelines especially for midwifery
practice and the integrated management of pregnancy and childbirth (IMPAC).
Partnerships will be promoted, especially for the development of clear and
targeted community messages on reproductive health care and the integrated
management of pregnancy and childbirth as well as to increase the
availability and ensure continuity of supplies for the programme.
Key directions
support the development of national policy, strategies and action
plans on reproductive health that will be applied down to the district and
township levels
leadership role in promoting essential packages of services such as an
integrated reproductive health package and standards of care for Basic
Obstetric Care & Essential Obstetric Care at referral level, in the
framework of the redefinition of essential packages of care (mentioned under
the Health Systems component)
strengthen the provision quality of care, especially at the midwife
and auxilliary midwife level through support in
capacity-building, the adaptation of guidelines and partnerships as well as
in implementing standards for practice
Support the development of an effective referral system, for provision
of essential obstetric care at referral level
CHILD AND ADOLESCENT HEALTH
The key
challenges that WHO’s work will address are the
reduction in infant and under five mortality, the expansion/strengthening of
immunization, improving the nutritional status of children under five, school
health and adolescent health. To pave the way for a more integrated approach
to women and child health development, WHO will promote the guiding
principles of the life cycle approach, throughout interventions in child and
adolescent health.
WHO will
help to redefine/clarify the roles of peripheral health workers in the
Integrated Management of Childhood Illnesses and assist in strengthening the
quality of the current training at peripheral and referral levels.
Polio
eradication will continue to be a major area of focus and like immunization
programme in general will require constant support to improve surveillance,
strengthen routine services and improve/ expand the cold chain to the rural
health centre level. Efforts will particularly emphasise polio, neonatal
tetanus and measles. WHO will also advocate and promote the provision of
booster vaccination in schools as well as school-based mass treatment for helminths at the primary level. New vaccines, such as
hepatitis B vaccine, will be introduced and vaccine administration made safer
through the use of auto-disposable syringes. Data collection for vaccine
preventable diseases will be improved.
In view
of the evolving needs and context, an important direction of WHO’s support will be reflected in the development of a
national policy and strategy on adolescent health as well as a national
programme. The definition of an integrated package of adolescent-friendly
reproductive health services will constitute a major step as well as build
capacity at national, state/division and township levels for the programming
and provision of services.
Key directions
Promote the
establishment/strengthening of a perinatal/newborn
care programme
Support the strengthening of the
Expanded Programme of Immunization and work in partnership with the Global
Alliance for Vaccines and Immunisation (GAVI)
Strengthen capacity for the
implementation of the Integrated Management of Childhood Illnesses (IMCI)
Promote and support the
development of an effective referral system for the treatment of complicated
childhood illnesses
Support the development of national policy,
strategies and action plans on adolescent health and advocate for increased
access to adolescent reproductive health services
ENVIRONMENTAL HEALTH
Under the
broad objective of promoting healthy lifestyles and reducing factors of risk
to human health that arise from environmental, economic, social and
behavioural causes, WHO support during the coming period will direct efforts
towards promoting and developing the supply of safe drinking water and
sanitation. The key directions of work in this area will be to advocate for
increased coverage of safe drinking water across Myanmar (currently 60%) with an
emphasis on quality monitoring to ensure that national standards of water
quality are met, particularly in the fast-growing cities of the country. WHO
will make support available for policy-development, planning and the use and
adaptation of current technical guidelines, norms and standards.
Support will also be provided in planning for sanitation and for the
development of long-term solutions for waste disposal in hospitals across the
sector and in cities. Support in this area will concentrate on process
development and technical inputs based on WHO’s expertise and comparative
advantage. Effective partnerships will be promoted and encouraged for
implementation purposes.
Community
education and participation are an important condition of success in these
priority areas and will be promoted by WHO through
partnerships at the community, technical and ministerial levels to increase
multi-sector participation. Effective partnerships across sectors should
contribute to improvements in both water and sanitation but will require the
development of implementation arrangements clearly defining responsibilities
down to the ward level. In order to address the re-emergence of diseases such
as dengue/dengue haemorrhagic fever, increased co-operation will be advocated
between sectors to ensure that sanitation, water supply, construction and
health are collaborating effectively to reduce hazards.
Key directions
Support the elaboration and implementation of a National Plan of
Action for Health and Environment as well as the development of policy and
planning for environmental health
Advocate for intensified efforts to increase national coverage for the
supply of safe water
Ensure the availability of technical support (assistance, guidelines,
norms and standards) for the safety of water supply and sanitation
Strengthen the planning process and development of long-term solutions
for waste-disposal in hospitals across the sector and in cities
Catalyze and support sustained multi-sector action and partnerships,
with emphasis on environmental factors contributing to the re-emergence of
diseases like dengue/dengue haemorrhagic fever and malaria
Promote the concept of Primary Environmental Care and provide relevant
support in information, education and communication
MAJOR RISK FACTORS HAZARDOUS FOR HEALTH
To more
effectively address some of the current major risks to health, the priority
areas of focus for the period 2002-2005 will cover safety of blood, the
increasing health risks linked to the use of tobacco and food safety.
In a
context of growing HIV prevalence, the establishment of a well-functioning
quality control system, screening blood for HIV and hepatitis B at every
level of the transfusion services is essential. This will be developed with
WHO support to the MoH (National Health
Laboratories and Blood Bank) in terms of policy and technical support,
guidelines and regional/global experience. To ensure the safety of blood
transfusions at the township hospital level and for essential obstetric care,
WHO will support the training of medical officers, pathologists and
laboratory technicians in transfusion medicine.
WHO has
an important role in fostering and supporting health promoting policies which
in the case of tobacco aim to protect the health of children, women and
unsuspecting consumers from the proven dangers of smoking.
Policies, which will limit the use of tobacco in public places, especially
schools, clinics and hospitals and government ministries, limit the sale of
tobacco in the proximity of such places and make compulsory the visibility of
product content, will be encouraged. School-based health programmes are an
important area of prevention work and WHO technical support may facilitate
the integration of prevention messages on the risks of tobacco and drug use
into school-health.
WHO will
make available global and regional guidelines, norms and standards on food
safety and will support the upgrading of the food safety control system.
Key directions
advocate the publication and
implementation of the National Blood Policy (in draft stage since 1998)
support technically the
establishment of a well-functioning quality control system, screening blood
at every level of the transfusion services (i.e. for hepatitis B, HIV)
provide technical support to develop the information system and
research on tobacco issues in the country including production, consumption
and tobacco advertising
strengthen the development of
policies and legislation on tobacco (advertising, use on premises, control
measures and management of risk factors)
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