Myanmar Dr. Nilar Tin Deputy Director General (Public Health) Department of Health

Transcription

1 Existing Mechanisms, Gaps and Priorities Areas for development in Health Sector Myanmar Dr. Nilar Tin Deputy Director General (Public Health) Department of Health

2 Ministry of Health Minister for Health Deputy Minister Deputy Minister Dept of Health Dept of Medical Science Dept of Medical Research LM Dept of Medical Research CM Dept of Medical Research UM Dept of Traditional Medicine Dept of Health Planning UN Agencies, Bilateral, INGOs, National Health Policy National Health Committee TEXT TEXT Health Legislations National Health Plan Myanmar Health Vision 2030 Rural Health Development Plan ASEAN /Regional/ Global Millennium Development Goals Other Ministries National NGOs, Private Sector, CBOs..

3 THE REPUBLIC OF THE UNION OF MYANMAR CABINET National Health Committee NHP M & E Committee Ministry of Health Department of Health Department of Medical Science Department of Health Planning Department of Medical Research (Lower) Department of Medical Research (Upper) Department of Medical Research (Central) Department of Traditional Medicine State/Regional Government District Authority Township Authority State/Region Health Committee District Health Committee Township Health Committee State/Region Health Department District Health Department Township Health Department Station Hospital 1. Ministries 2.MWAF 3. MMCWA 4. MRCS 5. MMA 6. MDA 7. MNMA 8. MHAA 9. Traditional Medicine Practitioners Association 10. Religious Organization Ward/ Village Authority Ward/ Village Tract Health Committee Rural Health Center Village Volunteers

4 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 Urban Health Center MCH School Health RHCs/ Sub- RHCs VHWs Malaria Team Leprosy team TB team HIV/STD COMMUNITY Office Dispensary Local Authority/ Other Depts NGO- INGO National NGO Township Health Committee Medical Store

5 Health Indicators s/n Indicators Source/year 1 Life expectancy at birth 65.1 (male) 70.5 (female) (Statistical Year Book 2009) Infant Mortality Rate (per 1000 live births) 3 Under 5 Mortality Rate (per 1000 live births) 4 Maternal Mortality Ratio 37.5 Multiple Indicator Cluster Survey Multiple Indicator Cluster Survey UN Interagency 2010 (per 100,000 live births) 5 Delivery by Skilled Birth Attendants 64.8 HMIS 6 HIV/AIDS prevalence rate 0.61 Estimated by NAP and partners, TB Prevalence (per 100,000 population) 525 Nationwide TB Prevalence survey 2010 Malaria Prevalence (per 1000 population) 11.7 VBDC Report, 2010

6 GAPS in Health Systems Accessibility Financing of Service Availability of resources HMIS Quality Care at hospitals/labs Lack of integration HRH

7 Recommendations of Universal Health Coverage Meeting July, 2012

8 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 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 "

9 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 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 to 2015 Covers 330 townships GOM-MOH-DOH S/R Governments +DPs

10 Gaps in Health Information System Data Quality-not highly valid Data Flow- still manual Timeliness of data affecting completeness of data

11 Strengthening Health Information System Priority activities for strengthening information system What will be done 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 By when to 2015 Expected outputs Covers (2) Townships -quality and highly valid data By whom GOM-MOH-DHP-DOH S/R Governments + DPs +Private sector Development of Information Policy on strengthening existing HMIS and including private sector information "

12 Gaps in HRH Population coverage ( Std) 1MW : 4000 pop 1MW : 5 V Delivery by Skilled Birth Attendants 58-64% Actual 1 MW : >5000 pop 1 MW : > 10 V Still rely on AMW/TBA for delivery in the rural remote areas Skill Mix Issues - Midwives: PHS 2 still 10:1 which has to be 1:1 Lack of HRH Master Plan for recruitment & deployment Midwives lack financial support Maternal Mortality 200/100,000 LB MDG Goals

13 What will be done Supply side Systems Strengthening 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 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 Priority activities for HRH By when to 2015 To 2015 Expected output Estimated 10,000 MW + 10,000 PHS2 By 3 years Rural retention of HWF By whom GOM-MOH-DOH S/R Governments 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 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) ,000 AMW GOM-MOH-DOH DPs Local Government

14 What will be done Implementation of National HRH Master Plan (Draft) Supply side Systems Strengthening HRH Policy Formulation including strategy for community based health workers (e.g. volunteers) Priority activities for HRH continued: By when To 2016 Expected output - 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 By whom GOM-MOH- DMS/DOH/DHP Other Ministries DPs Stakeholders

15 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 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 ) Community Based Health Protection scheme piloted in one township Guidelines, trial and scale up of CBHP scheme to 2015 to 2015 to twps 150 twps twps 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-DOH/DHP +DPs GOM-MOH-DOH/DHP S/R Governments + DPs + Local NGOs/CBOs GOM-MOH-DHP/DOH + DPs + Community GOM-MOH-DHP/DOH S/R Governments + DPs + Community + Private Sector

16 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

17 Strengthening Medical Care & Support Services What will be done Priority activities for high standard medical care services Strengthening Hospital Infrastructure/ Laboratory/ Imaging Procedures Pharmaceutical Factories By when to -- Expected outputs 5-10 International Standard Hospitals/Labs/ Imaging Centers 5-10 Pharmaceutical, Vaccine and Traditional Medicine Factories By whom Investments Joint venture/ Public-Private 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

18 Plan for Foreign Investment in Health Sector (US$ in million) Sr. Project Name National Nutrition Control Center * Development of Nutrition Lab 2. Expanded Program for Immunization * Vaccine Plant 3. Food and Drug Administration * High Standard Lab Development

19 Plan for Foreign Investment in Health Sector (US$ in million) Sr. Project Name Medical Care * Construction of Quality Hospitals (Public-Private, Joint Venture, Private) * National Blood Centers plus *Construction of new Medical Sub Depot (2 in number) Ambulance Services * Procurement of well- equipped ambulances (300)

20 Updating overall Policies and Plans Priority activities for health sector investments What will be done Building the evidence for Health Policy particularly in terms of health systems research, social research and health financing evaluations. 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 Improving Governance at all levels Leadership and Management Capacity By when Expected outputs - -Provider payments -medical benefits packages -Poverty identification schemes -levels of financial risk protection - Updated health policies Costed Plans Updated NH Laws - Decentralization Accountability & Transparency By whom GOM-MOH- Research Institutes S/R Govts +DPs GOM-MOH S/R Govts +DPs GOM-MOH +DPs

21 Enhancing Coordination & Collaboration Mechanisms What will be done Priority activities for health sector investments Developing and strengthening collaborating mechanisms with donors & development partners Expand scope of M-CCM By when Expected outputs - Broader scope of CCM covering all health sector By whom 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 The foundation of PHC system strengthening through increases in tax based financing and improved aid effectiveness - Identify gaps and fill up gaps Set common performance Indicators - -one plan -one monitoring & evaluation system -one financial management system -Efficiency/Equity GOM-MOH +DPs GOM-MOH +DPs

22 Thank You