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During the current and past two biennia, WHO Collaborative
Programmes in Myanmar
have embraced a broad-based approach towards meeting the national health
needs. The major thrust of WHO Collaborative Programmes
have been the priorities within the six broad areas of the National
Health Plan: (1) community health care, (2) disease control, (3) hospital
care, (4) environmental health, (5) health systems development, and (6)
organization and management. In general, these collaborative programmes are
in line with the National Health Policy (1993) and the National Health Plan
(1996-2001).
Due to the country’s limited access to external funding
sources, the number of projects supported by WHO collaborative programmes has
not been reduced; therefore, WHO’s support could not
be shifted from the “full menu approach” to a “selected priority areas
approach”. Consequently, the support provided through WHO collaborative
programmes did not fully match with the priority ranking order of the health
problems. For example, malaria stood out as the highest ranking problem in
the last five NHPlan since 1978, but malaria was ranked 5th in terms of WHO
collaborative programme under the regular budget. Similarly, tuberculosis,
the second highest ranking since 1986, is ranked 21st in WHO collaborative
programme (1994-1995) and 12th in 1996-1997. The third highest-ranking
priority (ie. HIV/AIDS, diarrhea and dysentery) ranked 16th and 24th
respectively in 1994-1995 WHO collaborative programmes.
Although spread across 40 projects or plans of action, WHO
collaborative programmes have had catalytic role in producing some
strategically important results. A paper on “Myanmar: Main Health Policy
Issues and Country Strategy”, developed by WHO ICO Mission in collaboration
with senior officials of Department of Health Planning (1997), serves as the
background paper in matters relating to future health policy and health
development in the country. Another strategic outcome was the establishment
of a WHO-Government coordination mechanism, which meets formally or
otherwise, every six months. A flexible, but strategic approach, such as this
one, has been instrumental in involving decision-making various levels in
planning and implementing WHO collaborative programmes.
Under the area of eradication
of specific communicable diseases, the successful implementation of
National Immunization Days (NIDs) and sub-national NIDs for polio eradication
have taken place and a National Certification Committee established. WHO has
also provided assistance in the implementation of multi-drug therapy (MDT)
strategy for the elimination of leprosy. The
prevalence rate has dropped from 53.4/10,000 (1987) to 2.5/10,000 by the end
of December 1998.
The prevention and
control of specific communicable diseases continues to receive support
from WHO. Efforts to reduce the dengue/DHF case
fatality rate has made continued progress with the establishment of three
dengue training wards using standard sets of equipment sent by WHO. The
control of malaria has been identified as a priority programme and is
implemented under the primary health care approach. The Roll Back Malaria
(RBM) Initiative has been endorsed and a plan of action for resource
mobilization developed with the collaboration of the MoH, WHO, UNICEF and
UNDP to support its implementation at local level. WHO has facilitated an
inter-country collaborative programme for the control of border malaria
(bilateral and multilateral approach). WHO and
UNICEF work jointly under the RBM Mekong Project with countries in the Mekong Basin to address the problem of
multidrug-resistant malaria. Tuberculosis continues to be an issue of primary
concern and control is expected to become critical as treatment compliance
fails and HIV/AIDS progresses. WHO continues rendering technical assistance in
term of expertise, training and diagnostic tools and drugs.
WHO provides technical assistance in implementation of the
comprehensive reproductive health approach, mainly capacity building in the
area of reproductive health and health
of women and children.
The government has shown high political commitment to environmental health, especially water
and sanitation. WHO continues to provide technical assistance in capacity
building for the rural water supply development programme, water analysis
laboratory, environmental engineering in sanitation and pollution control.
National figures for sanitation coverage show an increase from 45.2% (1997)
to 61.7% (1999). With the change in strategy from supply driven
donor-financing to self reliance and self help financing through social
mobilization, the construction of 2 million latrines has been completed by
the end of 2000.
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