Health Systems in Myanmar

Dr. Nilar TinDirector Planning

Department of HealthMinistry of Health

Ministry of Health

Minister for Health

TEXTTEXT

Deputy Minister

Dept ofMedical

ResearchLM

Dept ofMedical

ResearchCM

Dept ofMedical

ResearchUM

Dept ofMedicalScience

Dept ofTraditionalMedicine

� National Health Policy� National Health Committee� Health Legislation� National Health Plan� Myanmar Health Vision 2030� Millennium Development Goals� Rural Health Development Plan� ASEAN /Regional/ Global

Deputy Minister

Deptof

Health

Dept ofHealth

Planning

UN Agencies, Bilateral, INGOs, …

Other MinistriesNational NGOs, Private Sector,

CBOs…..

Department of Health

Director General

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DDG (Med Care) DDG (D/S Control) DDG (Pub Health)

Disease Control

MedicalCare

PublicHealth

Planning AdminFDA

Nursing EpidemiologyBudgetLaw/Regulations)

OccupationalHealth

Department of Traditional Medicine

Department of Medical Research (Central)

Department of Medical Research (Upper)

Department of Medical Research (Lower)

Department of Medical Science

THE REPUBLIC OF THE UNION OF MYANMAR

NHP M & E

Committee

Ministry of Health

Department of Health

Department of Health Planning

State/Regional Government 1. Ministries

2. MWAF3. MMCWA4. MRCS5. MMA6. MDA7. MNMA8. MHAA9. Traditional Medicine

Practitioners Association10. Religious Organization

CABINET

District Authority

Township Authority

Ward/ VillageAuthority

State/Region Health Committee

DistrictHealth Committee

TownshipHealth Committee

Ward/ Village TractHealth Committee

State/Region Health Department

DistrictHealth Department

TownshipHealth Department

Station Hospital

Rural Health Center

Village Volunteers

National Health Committee

Township Health System Township Medical Officer

Curative Public Health Disease Control

Administration Cooperation

T/S & Station Hospital

Inpatients/ Outpatients

wardsOT/

Labor room

Lab/Radiology

Medical Store

Urban Health Center

Malaria Team

OfficeLocal

Authority/Other DeptsMCH

Leprosy team Dispensary

NGO- INGONational NGO

School Health TB team

RHCs/ Sub-RHCs

VHWs

HIV/STD

COMMUNITY

THC

Health Care Service Delivery

Immunization

Examination for Leprosy

Antenatal Care

RDT for MalariaMedical Care 943Hosp

DOTS treatment

Provisionof safeblood

Preventive & Promotive Health Interventions

Health Education on HIV/AIDS

Nutrition GMP by MCWA

ITN demonstrationSchool Nutrition

Referral of patient H5N1 Prevention

Supportive Health Care Services

Capacity Building at all levels

Environmental Health

FDA

Laboratory Services

Occupational Health

Department of Medical Science

Departments of Medical Research

Department of Health Planning

Director General

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DDG

Information R&D E-HealthPlanning Admin

� Formulation of National Health Plan�Health Financing and National Health Accounts�Health Management Information System�Health Policy and Research�Networking and E-Health ( including GIS mapping for the whole country)

Department of Traditional Medicine

Health Indicators

s/n Indicators Source/year

1 Life expectancy at birth65.1 (male)

70.5 (female)

(Statistical Year Book 2009) 2008

2 Infant Mortality Rate

(per 1000 live births)

37.5 Multiple Indicator Cluster Survey

2009-2010

3 Under 5 Mortality Rate

(per 1000 live births)

46.1 Multiple Indicator Cluster Survey

2009-2010

4 Maternal Mortality Ratio

(per 100,000 live births)

240 UN Interagency 2010

5Delivery by Skilled Birth Attendants 64.8 HMIS

6HIV/AIDS prevalence rate

0.61 Estimated by NAP and partners, 2010

7 TB Prevalence

(per 100,000 population)525 Nationwide TB Prevalence survey

2010

8Malaria Prevalence

(per 1000 population) 11.7 VBDC Report , 2010

Myanmar Health Care Situation

Health Care Priorities• National Health Plan (2006-2011) identified and ranked 42 priority

diseases and health conditions: 2/3 classified under communicable,

maternal, perinatal and nutritional conditions. HIV/AIDS, malaria and

tuberculosis topped the list.

• NCDs: cardiovascular diseases, cancer, diabetes mellitus and mental

illness were also included in the priority list.

• Accidents and injuries are also included in the list.

NHP (2011-2016) have been prepared in multi-disciplinary, multi-sector approach and become a part of national, social and economic group

• Issues on importance of Human Resource for Health, health financing

and systems development came up as priority areas apart from CDs

and NCDs

7

14 15

36

51

32

48

85 85

20 22 24 24

42

68 68

86

95 97 99

0

10

20

30

40

50

60

70

80

90

100

Nepal Bangladesh Bhutan Timor-Leste India Myanmar Indonesia Maldives Thailand Sri LankaDPR Korea

Pe

rce

nta

ge

1990 2005

WHERE ARE WE IN SEAR? Proportion of births attended by skilled health personnel

Source : Country reports on MDG

Reference year of data vary f rom 2000 to 2005

281

380

225

660

301

380

307

72

47

97

14

20

30

32

32

54

68

72

87

97

98

98

Nepal

Bangladesh

Bhutan

Timor-Leste

India

Myanmar

Indonesia

Maldives

Sri Lanka

DPR Korea

Thailand

(Countries with higher level of coverage of deliveries by skilled birth attendants tend to have lower maternal mortality )*

Deliveries attended byskilled health personnel

MMR (maternal deaths per 100,000 live births)

Relationship between Coverage of deliveries by SBA&MMR 2005

Notes : Reference year of data vary f rom 2000 to 2005

* Not a univariate relation as there are other determinants of it

Where are we in relation to this population norm?

0 . 0 0 0

1 . 0 0 0

2 . 0 0 0

3 . 0 0 0

4 . 0 0 0

5 . 0 0 0

6 . 0 0 0

7 . 0 0 0

8 . 0 0 0

B A N B H U D P R K I N D I N O M A V M M R N E P S R L T H A T L S

T h r e s h h o l d 2 . 2 8

Number of (Doctors + Nurses + Midwives) per 1,000 population

Health Expenditure in South East Asia Countries, 2006

High Out-of-Pocket Expenditure on Health

The WHO Health System Framework

Health Systems Strengthening-Service Delivery Identifying Gaps- and Measures to counter

Hard to ReachAreas

Retention ofHWF

Medicines & equipment

Information& Mgmt

-Mapping for• Physical HTR

-Package of service/ in group of providers - TA & DA for performance-Support fuel cost/ vehicles-Check list for supervision & monitoring -CTHP

HealthFinancing

• Evidence based research - consideration for infrastructure -happy working environment - welfare- Incentives and motivation - Recognition

• Insufficient Supplies & equipment

-Increase GE for health-Logistics and supply management-support from organizations

• Economic HTR

Protection of the Poor-Health Equity Fund-TBHP scheme- CBOsDSF- Maternal Voucher Scheme-Hardship allowance ? P4P

• existing HMIS

- DQA -Adequate forms/records- Improve reporting system

-Capacity building for L&M x TMOs

Future Thinking

Health Systems

Strengthening

Service Delivery

HRH

HF

HIS Meds &Equipment

Leadership& Governance

Objectives of MOH1.To enable every citizen to attain full life expectancy and enjoy longevity of life.2.To ensure that every citizen is free from diseases.

THANK YOU FOR YOUR KIND ATTENTION