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This WHO Country Cooperation Strategy (CCS) for Myanmar presents the directions and priority
areas that WHO will focus on in Myanmar during the period
2008-2011, in line with WHO global and regional policy frameworks and
following an assessment of the comparative advantage that the Organization
enjoys. The updated CCS is built on the experiences and achievements during
the period of the first CCS (2002-2005), which was reviewed during 2006-2007,
in close collaboration with the Ministry of Health and development partners,
by a team of staff members from the WHO Country Office, Regional Office for South-East Asia and headquarters.
Myanmar
is a developing nation with an estimated population of 55.4 million. Despite
a significant economic growth rate in the recent years, there are important
disparities in rural areas, where about 70% of the population resides and
which benefit much less than urban areas. Major infectious diseases are in
the list of priorities under the National Health Plan 2006-2011. Malaria is
the leading cause of reported morbidity and mortality in the country. A
majority of malaria infections are now highly resistant to commonly used
anti-malaria drugs. Myanmar
is among the 22 countries globally with the highest burdens of tuberculosis
(TB). The overall prevalence of human immunodeficiency virus (HIV) among
adults is estimated at 0.67%. The prevalence of multi-drug resistant TB
(MDR-TB) and TB-HIV co-infections are emerging problems.
The country has aligned its response with the WHO global
action plan for pandemic influenza and has been prepared for a possible
outbreak of avian and human pandemic influenza since early 2006. Myanmar has
taken steps to implement the International Health Regulations (2005), or IHR.
Dengue and dengue haemorrhagic fever (DHF) appears
to be an increasing problem with seasonal epidemics in certain parts of the
country. Leprosy, though no longer a public health problem in Myanmar,
still needs attention, for example by sustaining leprosy control activities
and providing quality leprosy services focusing on prevention of disability
and rehabilitation of persons affected by leprosy.
Noncommunicable diseases, such
as diabetes mellitus, cardiovascular diseases (including hypertension) and
cancers, are emerging as important health problems as a result of various
risk factors. Tobacco use, both by smoking and chewing, is fairly common.
Although snakebites are a major problem, it is difficult to estimate their
exact number because relatively few cases come to the hospital. Mental
illness and avoidable blindness are also emerging health issues. Official
statistics show that injuries stand first among the leading reported causes
of morbidity and third among the causes of mortality, in Myanmar.
Disasters are also a major concern. Natural disasters common in Myanmar are
floods, cyclones, storms, earthquakes and landslides. Human-induced disasters
include urban fires, which usually occur in the hot dry season. Around 80% of
the population in Myanmar have access to
improved water supply and sanitary means of excreta disposal. Malnutrition,
including micronutrient deficiencies, continues to be a public health concern
in Myanmar.
A five-year Strategic Plan for Child Health Development
(2005-2009) has been formulated. Although there has been notable improvement
in the health status of children, much more needs to be done to sustain the
gains made. Improving quality and coverage of immunization services need
special attention for protecting children from vaccine-preventable diseases.
In the aftermath of the polio outbreak reported from Maungdaw
township of Rakhine
State, sub-National Immunization Days and country-wide National Immunization
Days for poliomyelitis eradication were organized in 2007. Despite a series
of preventive campaigns, measles outbreaks still occur. Nationwide mass
measles campaigns were carried out in 2007 to reduce measles mortality.
There is little information available about the adolescent
health situation, and very few programmes
specifically address this issue. Following a recent WHO review, a five-year
Strategic Plan for Adolescent Health (2006-2010) was launched in December
2006. The estimates for the year 2000 on maternal mortality indicated a
maternal mortality ratio (MMR) of 360 per 100 000 live births. A recent study
showed a slight decrease but the MMR in rural areas was estimated to be about
2.5 times that in urban areas. It is estimated that unsafe abortions may
account for approximately half of all maternal deaths. The five-year
Strategic Plan for Reproductive Health was formulated and launched by the
Ministry of Health in 2004.
The Government of Myanmar has, as one of its social
objectives, committed itself to “the uplift of the health, fitness and
educational standards of the entire nation”1. The National Health Committee,
chaired by the Secretary of the State Peace and Development Council, is a
high-level interministerial and policy-making body
for health matters concerning the country. Health committees exist at each
administrative level, providing a mechanism for intersectoral
collaboration and coordination. Four healthrelated
medium- and long-term plans have also been developed, including the National
Health Plan (NHP) 2006-2011. NHP contains the following health system goals:
improving health, i.e. to raise average levels and reduce inequalities;
improving responsiveness to people’s expectations; and improving fairness in
the distribution of financial contributions. A number of national strategic
plans exist for particular domains such as reproductive health, child health,
adolescent health, HIV/AIDS, TB and malaria, and for water supply, sanitation
and hygiene.
The Ministry of Health is responsible for the preventive, promotive, curative and rehabilitative health services at
all levels through seven departments and hospitals and clinics at various
levels. At the township level, health services are provided by the township
hospital, station hospitals, urban and rural health centres
and sub-rural health centres. Health staff at community levels provide health services using
the primary health-care (PHC) approach with the participation of voluntary
health workers such as auxiliary midwives and community health workers. There
are competent staff members at all levels with the capacity to mobilize the
workforce and the communities for short-term, intensive campaigns. There was
also a remarkable increase in the number of various categories of the health
workforce, as many new health-related universities and training institutions
had been founded between 1988 and 2007. The public health-care system,
however, is critically under-resourced, with major problem areas concerning
issues of access and coverage. Insufficient human resources at the periphery,
paucity of drugs and lack of basic information for monitoring are critical.
Traditional medicine also plays an important role in the public health system
and is currently accorded a high profile and considerable support by the
government. Services and drugs are made available free of charge. While the
private sector has expanded rapidly and is currently estimated to provide
75%-80% of ambulatory care, private service providers have had limited
involvement in public health programmes.
The United Nations plays a major role in contributing to
health activities. The main contributors include WHO, the United Nations
Children’s Fund (UNICEF), the United Nations Development Programme
(UNDP), United Nations Population Fund (UNFPA) and the Food and Agriculture
Organization of the United Nations (FAO). WHO is currently participating in
technical partnerships through UN working groups
and. technical and strategy groups. The contribution of nongovernmental
organizations (NGOs) to the health development of the country is also
remarkable. The Ministry of Health has signed memorandums of understanding
with 31 international NGOs and 10 national NGOs on collaboration in health
development, particularly in the areas of maternal and child health, primary
health care, environmental sanitation, control of communicable diseases,
rehabilitation of the disabled and border health.
Although government health expenditures increased
three-fold between 2000-2001 and 2005-2006, the health sector is highly
under-resourced. In 2003 general government expenditures on health, as a
percentage of the total expenditures on health, was 19.4% while the remaining
80.6% was from the private sector.. External
assistance is a major source of financing in the health sector. In 2004, Myanmar received
total official development assistance (ODA) of US$ 121 million, of which
roughly 13% went to the health sector. However, very few countries are
providing direct financial support to the Government of Myanmar due to
restrictions imposed by their national governments and the European Union to
this form of assistance. Instead, development assistance to the health sector
is channeled mainly through global partnerships such as the Global TB Drug
Facility (GDF), WHO Global Malaria Programme and
the Global Alliance for Vaccines and Immunization (GAVI), and directly to
international NGOs (INGOs) and national NGOs
working in the country. One of the major challenges posed by current aid
modalities is to ensure that development assistance aligns with national programmes and policies while at the same time ensuring
that conditions imposed by donor countries are respected. Furthermore,
funding mechanisms that bypass the government and directly support INGOs and NGOs and external development partners may lead
to further weakening of a fragile health system. This may also lead to the
creation of parallel health structures and programmes
that do not necessarily follow national norms and standards.
WHO is accountable for the implementation of the
WHO-Myanmar collaborative programmes although most
of the implementation of in-country activities is undertaken by counterparts
in MoH.
National and international staff members of the WHO country office provide
technical and programme management support. When
required, staff members from the Regional Office and headquarters provide
extensive support as well.
Between 2008 and 2011, WHO will build on the work of the
2002-2005 CCS, expanding support for health development in Myanmar and moving progressively from
project to programme support.
In consideration of the health situation in Myanmar, the priorities of the
Ministry of Health and its health development partners, the Country
Cooperation Strategy for 2008-2011 outlines the following areas of priority for
WHO:
1. Improve
health system performance.
2. Reduce
excess burden of disease.
3. Improve
health conditions for mothers, children and adolescents.
In these priority areas, WHO will support the stakeholders
in accordance with its core functions. For all programmes and services, emphasis will be placed on
equity, fairness and progress towards universal access. WHO will continue to
act as the centre for information on health, providing updated information on
health development and guidelines, norms and standards.
The current organizational structure of the WHO Myanmar Country Office (WCO)
is still appropriate to cater to the needs of the Myanmar CCS 2008-2011. The organogram of the country office can always be reviewed
according to the priority issues during a particular period of a CCS. The country
team will have to be supported at the highest levels in the Ministry of
Health and in the Regional Office if WHO wishes to ensure its country programme is making the difference that it can
potentially make in Myanmar.
The WHO Representative will use all possible opportunities to communicate
about WHO’s strategic agenda in and with Myanmar
in order to mobilize and streamline more support for the health sector and
bolster the organization’s capacity to support its development.
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