ANCP: Improving maternal and child health outcomes in Myanmar

In Myanmar, high burden health problems include a high maternal mortality ratio (MMR) of 240 per 100,000 live births and a high under five mortality rate of 71 per 1,000 live births (2010, UNICEF). The leading direct causes of maternal deaths in Myanmar are post-partum haemorrhage, hypertensive diseases of pregnancy and abortion-related sepsis.

Major issues include a weak health system and lack of facilities, which undermine the capacity of the public sector to deliver basic health care services. There is poor antenatal care coverage, low skilled birth attendance rates and inadequate or absent referral mechanisms at the community level. Emergency obstetric care is mostly inadequate or unavailable and often unaffordable for poor and vulnerable women who need it. The challenge is exacerbated by inadequate or absent referral mechanisms at the community level.

There are social, financial and cultural barriers to health seeking behaviours and limited health literacy across both urban and rural populations. Pre-service training for nurses and midwives does not include full skills and knowledge to address all competencies for basic and emergency obstetric care, although steps are now being taken to address this gap.

The sector faces challenges in planning, management and organisation.

The ANCP project aims to improve maternal, neonatal and child health in project communities by addressing critical gaps in health service delivery and health care seeking behaviour.

• ANCP Year 1: July 2011-June 2012
• ANCP Year 2: July 2012-June 2013
• ANCP Year 3: July 2013-June 2014
• ANCP Year 4: July 2014-June 2015
• ANCP Year 5: July 2015-June 2016

Health systems strengthening activities will be undertaken according to the needs and resources of each township in 2013. The focus is on the Ministry of Health’s Essential Maternal, Neonatal and Child Health (MNCH) Services Package but will also include elements of nutrition and hygiene.

Year 1 of the ANCP programme commenced in July 2011 with the implementation of a maternal and child health (MCH) project. This involved strengthening the capacity of communities to address MNCH needs and promote safe motherhood initiatives. The project is to be undertaken in three peri urban areas of Insein and Mingaladon, and two rural areas of Thanlyin townships within the Yangon Division.

In 2013, ANCP Phase 3, health systems strengthening activities were conducted in four townships across Yangon Division, Insein, Mingalardon, Thanlyin and South Dagon. Key project counterparts are local government authorities and Township Medical Officers (TMO), with non-government/local organisation partners continuing to be engaged around community mobilisation activities.

The main approach will include:

1. Support to the TMO to develop and disseminate Township Health Plans and Referral Guidelines
2. Support the implementation of the Essential MNCH Health Services Package at both the facility and community level
3. Support to community mobilisation activities with local organisations and through existing community groups (including mothers groups and village health committees)

Results

1. Coordinated and endorsed Township Health Plan in Thanlyin Township and South Dagon Township
2. Essential MNCH Health Services Package (HSP) developed for Thanlyin and South Dagon township as per their needs
3. Capacity building of Basic Health Staff (BHS) to deliver and supervise MCH HSP in Thanlyin and South Dagon
4. Commodities related to BI workplan identified, costed, procured and distributed
5. Township level Referral Process Guidelines developed and utilised in South Dagon and Thanlyin
6. Capacity building and support for Volunteer Health Workforce in three townships (AMW & CHW’s)
7. Improved community access with Township level health services in Ywarma urban area in Insein
8. Improved partner organisations to undertake community mobilisation activities
9. Improved community knowledge and demand for Essential MNCH activities
10. Equitable and increased access to birth and emergency preparedness at the community level
11. Improved male involvement in maternal and child health care in Insein, Thanlyin and South Dagon.

Outcomes

1. Revised and disseminated Township Health Plan and prioritised MCH Essential Package of services supported by trained BHS and strengthened policy guidelines for referral mechanisms.
2. Increased coverage of MCH services in urban wards, more effective community based referral mechanisms, increased distribution of contraceptives.
3. Increased ANC attendance by pregnant women and their husbands and increased access to skilled birth attendance and postnatal care.