MYANMAR COUNTRY REPORT
Since November 1994, the project has been implemented in forty-one townships, with a cost recovery rate of around 20%. Project expansion to twenty-five more townships began in September 1996.
I. Overall Goals and Objectives
○ Ensure that all groups in Myanmar's population have access to affordable, good quality essential drugs and equitable basic health services
○ Identify most appropriate, feasible and operational community cost sharing schemes for implementation, given Myanmar's social environment and transitional economic situation
○ Reduce morbidity and mortality of children under five by providing standard care given by trained health workers or volunteers
II. Achievements against Specific Objectives
Specific Objective |
|
Achievement |
1. Establish clear policy guidelines on drug pricing |
|
Decentralized the pricing of drugs |
2. Define exemption policy and establish exemption criteria |
|
Supervisory committees for health development funds set up exemption mechanisms in all project townships. Exemptions applicable to:
- families designated as indigent by supervisory committees
- homeless people
- orphans
- cases of medical emergency
- members of religious orders |
3. Establish transparent and accountable financial systems |
|
Financial guidelines laid out and dispersed to townships by finance section of the Department of Health |
4. Operationalize effective drug replenishment systems |
|
Formed central level drug replenishment committee; issued call for tenders from approved drug manufacturers |
5. Increase coverage and utilization of services |
|
Increased coverage and utilization of services, observable in increasing trends |
6. Rationalize use of staff time for delivery of basic health services |
|
Rationalized use of staff time |
7. Ensure that basic health workers apply essential drugs concepts |
|
Conducted series of training courses |
8. Ensure active community involvement in cost sharing schemes, particularly in planning decision making and resource management |
|
Improving community involvement in cost sharing scheme, but involvement still weak in terms of planning, decision making and resource management; held series of advocacy meetings for community leaders and treasurers |
9. Train and equip midwives and volunteers on management of local endemic diseases affecting children under five |
|
Trained midwives supplied them with essential drugs; planned training for volunteers |
10. Build capacity in area of health economics within the Ministry of Health |
|
Held workshop on cost, resource use and financing of health services |
11. Develop plan for building national capacity to produce essential drugs |
|
Will invite consultant to survey local capacity for drug production |
III. Actions in Response to Problems Encountered
Problem |
|
Action |
1. Financial management still weak among some basic health staff |
|
Conducted workshop on cost resource use and financing which was attended by trainers; translated financial management modules to be published for use in training sessions |
2. Regularity in submitting reports and returns still weak in some townships |
|
Instructed township medical officers to submit monthly reports by telegram or telephone at month end (see flow chart) |
3. Some basic health staff still prescribing irrationally |
|
Instructed TMOs to conduct monthly continuing education sessions on standard treatment schedules; planned flow charts on diagnosis and treatment of common health problems |
4. Community awareness of principles and practice of the community cost sharing scheme still needs strengthening |
|
Approached and trained community leaders and treasurers in skills for imparting knowledge of RDFs |
5. Low utilization patterns in terms of percentage of population covered |
|
Developed posters, pamphlets and folders for distribution to communities and basic health services |
6. Township medical officers still reluctant to practice exemptions |
|
Informed health care providers that the CHMF dose not deny the poor health care |
7. Drug replenishment mechanisms operational, but local importers still unable to supply full list of essential drugs |
|
CMSD now searching for local suppliers able to provide complete list |
8. Affordability to consumers still an issue |
|
Localized pricing of drugs; developed guidelines to exempt unaffordable items |
9. Latest consignment of drugs experienced problems in terms of prices (unit prices higher than UNIPAC prices) and packing sizes (did not conform to specifications of order) |
|
Reported to The Nippon Foundation |
10. Basic health staff involved in community cost sharing still need incentives |
|
Planned cash incentives; may create external study tours in collaboration with The Nippon Foundation |
Flow Chart. Monitoring Process in Myanmar
IV. Future Plans
○ Further develop ongoing training programs at various levels
○ Train volunteers in RDF systems, focusing on management of common diseases such as diarrhea, malaria and ARI
○ Produce training and IEC material
○ Update training modules
○ Continue training and technical assistance