UN Assistance to Health System Strengthening (HSS) in The Republic of the Union of Myanmar (the “Activities”) in support of the Three Millennium Development Goal Fund (“3MDG”)
| GRANT No. | UNICEF-HSS-3MDG-C3-15-00094363 |
| Budget | US$ 12,803,340 |
| Partner | UNICEF |
| Start | 01 January, 2015 |
| End | 01 January, 2017 |
| Coverage | 6 |
| Activities | - |
Areas of Work-Health System Strengthening
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Human Resources for health
The 3MDG Fund is supporting the Ministry of Health in the strengthening of its health workforce, by financing the training of midwives and auxiliary midwives. This support will lead to more and better quality health services across the country. In 2015, significant progress was made across many aspects of this work.
Auxiliary midwife training by the ministry
The 3MDG-funded Auxiliary Midwife Training Project implemented by the Ministry of Health started on 1st November 2014, and was completed by the end of December 2015. This grant allowed for the basic training of 4,520 auxiliary midwives in 178 townships.
Support to pre-service and in-service training of midwives
3MDG is financing technical assistance to strengthen the midwifery health workforce in Myanmar. This work comprehensively addresses quality improvement, through curriculum and accreditation reviews, standard setting improvements, and improved training. Jhpiego, an affiliate of John Hopkins University, was contracted as a technical assistance partner to the ministry. During 2015, Jhpiego supported the Myanmar Nursing and Midwifery Council in their work on setting standards for the accreditation of nurses and midwives. The council has also been supported to develop guidelines for registered nurses and midwives and, with the Ministry of Health, to conduct a rapid assessment of eleven midwifery schools. A range of capacity building interventions were carried out in 2015 to ensure that future training will be skills and competency based. 68 ‘master mentors’ were trained across 20 midwifery schools in clinical skills and standards, who then trained 164 other faculty members and service providers in the best practices in maternal and new-born care. Skills laboratories were upgraded in ten midwifery schools with the provision of simulators and equipment. A number of initiatives have also been undertaken to strengthen in-service training. During 2015, 3MDG provided support to the Ministry of Health to plan for and rollout master mentor training for a refresher course in Basic Emergency Obstetric Care, which will be rolled out to all midwives nationally. 3MDG partners have supported the cascade training in the 34 townships.
Service quality improvement for maternal, newborn and child health
Efforts to improve service quality improvement are part of 3MDG’s wider work, as well as being undertaken through important stand-alone initiatives. Progress in a number of these areas is described here. As mentioned, Jhpiego has made a significant commitment to improving maternal and newborn care in their support to the MoH skills-based training for midwives, and a continuing supervision system that will be delivered throughout the country. Other work has included addressing the gaps in the legal framework, introducing legislation, and Training of Trainers programme and equipment to improve neonatal resuscitation, which has been delivered on to 34 townships. Supervision of health facilities helps to improve services, yet is challenging due to human resource constraints and transportation challenges. 3MDG supports supervision of facilities at state, township, rural and subrural health centre levels. As part of these efforts and in order to improve the health information system, 3MDG in partnership with the HMIS section of the MoH is now piloting the introduction of the District Health Information System 2 across 3MDG supported townships, which will enable health planning decisions to be based on updated data and analysis.
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Support to evidence based policy and strategy
Supporting evidence-based policy
Analytical work: To improve service delivery and design a people-centered health system for Myanmar, 3MDG collaborated with the ministry to build on the existing evidence base of health systems research and translate evidence into policy. Studies include:
• Health financing
—’Review of evidence on reducing outof-pocket expenditure’ (World Bank) (unpublished)
—’Summary of experiences in Myanmar to target the poor’ (World Bank) (unpublished)
—’Options for health financing’ (World Bank) (unpublished)
—’Public financial management in the health sector preliminary assessment’ (World Bank) (unpublished) • Health system overview
—’Four policy briefs on universal health coverage, health equity, township health systems and financial risk protection (WHOAPO)’
• Midwifery
—’Assessment of eleven midwifery training schools’ (Jhpiego) (unpublished)
—’Rapid task analysis on three pillars of midwifery: education, practice, and regulation’ (Jhpiego) (unpublished)
• Supply chain management
—’National baseline assessment’ (The Partnership For Supply Chain Management)
• Universal health coverage
—’Essential package of health services policy note’ (World Bank) (unpublished) —’Framework for private sector engagement in Myanmar presentation’ (UCSF)
• Emergency referral
—’Emergency referral lessons learned’ (3MDG)
Evidence for policy: While producing high-quality evidence is critical, the presentation of key findings in ways that enables policy makers to make informed policies is just as important. In 2015 3MDG, in partnership with WHO – Asia Pacific Observatory, launched the first ’Myanmar Health Systems in Transition (HiT) Review.’ The HiT review provides a comprehensive overview of the health care system in Myanmar.
To strengthen the country’s capacity to generate policy-relevant evidence and to formulate evidence-based policy options, 3MDG initiated consultation with a wide range of stakeholders on the establishment of a policy forum to strengthen the country’s capacity to generate policy-relevant evidence and formulate evidence-based policy options.
Strengthening technical capacity: 3MDG supported scholarships for master’s degrees in public health at the Royal Tropical Institute in Amsterdam, Netherlands. Six MoH staff attended the year-long course, and returned to Myanmar after graduation to undertake important policy work, including drafting of the Reproductive Maternal Adolescent and Child Health Strategy, and coordinating training on community engagement for township planning.
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System Support
System Support
Suply chain strengthening
Regional supply chain management: To strengthen the supply chain system and to reduce stock-outs of essential medicines in selected regions, 3MDG awarded a $4.2 million grant to the Partnership for Supply Chain Management in March 2015. This followed a first grant, whereby the organization supported the MoH in conducting a nationwide assessment of the supply-chain system. The national assessment report highlighted several areas that required additional support. They include improved logistics management, strengthened technical capacities at the state/region levels, updated and streamlined procurement and distribution process, and upgraded warehouse space and information management systems. Based on recommendations of the Phase 1 report, 3MDG in collaboration with the MoH, selected three regions (Bago, Ayeyarwady, and Magway) to implement an approach which focuses on developing and strengthening a dedicated regional/state level logistics management unit. In 2015, the Partnership For Supply Chain Management supported the MoH in training staff at the regional and township levels on forecasting and supply planning, development of procurement handbooks and development of a training curriculum based on the newly approved procurement guidelines. In addition, 3MDG with co-financing by USAID, supported the renovation of the central medical warehouse in Mandalay. The facility serves the health supply needs of six states and regions covering approximately 14.7 million residents of Upper Myanmar. This new model warehouse will become a training site for other facilities and will provide a basis for building a more integrated and efficient national health supply chain.
Cold Chain: 3MDG is investing in strengthening the cold chain to improve immunization coverage. With funding provided through the joint UN grant, UNICEF conducted a countrywide assessment of capacities to store and manage vaccines at township and rural health centres. Following the assessment, 1292 refrigerators have been procured. Of these, 80% have been distributed to health facilities and will be installed in 2016. With the increased capacity (and through GAVI financing for the vaccines), it is expected that pneumococcal vaccine, an essential immunization that protects children against pneumonia and meningitis, will be added to the Expanded Programme on Immunization and made available nationwide by June 2016.
Infrastructure
Communities in rural and hard-to-reach areas continue to face geographic barriers to access services. 3MDG has committed resources to construct up to 78 health facilities by 2017. The team, in consultation with the ministry, selected 66 sites based on a set of criteria including accessibility, population coverage, security, and availability of water and electricity. Discussions on site selection for the remaining 12 health facilities are underway. In 2015, 17 health facilities in Magway region were constructed. The 2015 annual target for the infrastructure team was 28 health facilities. However delays in the approval process led to slower progress. An additional 26 health facilities are under construction and plans are in place for the remaining health facilities.
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Governance and Stewardship
According to the WHO, governance refers to “a wide range of steering and rule-making functions carried out by governments/decision makers as they seek to achieve national health policy objectives that are conducive to universal health coverage” (World Health Organization, 2016. Governance in the health sector ). As health systems mature, governance and stewardship become two of the main functions of a health ministry. Towards this goal 3MDG supported the following programmes:
Universal health coverage knowledge improvement
3MDG provided funding to the World Bank to conduct a series of courses on universal health coverage. In 2015, 125 stakeholders, including policy makers and staff from several ministries, community-based organizations, and ethnic health organizations attended the course.
Public Financial Management
Public financial management (PFM) involves planning, budgeting, cash management, fund flows, accounting, financial reporting, internal controls, and accountability. These elements have a direct effect on how services are delivered and who has access to them, and how payments are made.
With funding support from 3MDG, the World Bank initiated a multi-year programme (2015-2017) to strengthen PFM. Activities in 2015 included a rapid assessment of key PFM functions, development of standard operating procedures and tailored trainings on financial management. Support to strengthen PFM will accelerate in 2016 and 2017 with the roll-out of a nation-wide mentorship programme.
Myanmar Health Forum
3MDG provided financial support to UNAIDS for the organization of the first Myanmar Health Forum in Nay Pyi Taw. Over 700 international and national participants attended and discussed the unmet health and development needs, progress and challenges to reaching universal health coverage and linkages between health and other sectors.
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Community Engagement
Community engagement creates opportunities for learning from the ground up, and community views can be used to inform health policies, programmes, services and projects. Effective community engagement also enables health providers to be more responsive to the needs of people, which improves the quality of health services and enhances satisfaction.
DEVELOPING CAPACITY
3MDG partners and other organizations need tools and resources, awareness, skills and confidence to use responsible, fair and inclusive practices in their everyday work.
In 2014, the 3MDG Fund committed to developing the capacity and awareness of its implementing partners to engage their target communities.
Partners were supported through a series of eight training sessions throughout the year, and provided with technical assistance to assess their organizational policies and practices, including approaches to community participation, information sharing and mechanisms for community feedback.
3MDG established eight new standards and an assessment tool to guide partners in the application and measurement of their good practices and areas for improvement.
Significantly, as part of the assessment process in 2014, focus group discussions were convened between 3MDG partners and a total of 921 community beneficiaries (458 women and 463 men) to hear their perspectives on 3MDG -funded services.
SUPPORTING LOCAL ORGANIZATIONS
In an effort to generate better information for all stakeholders on community health needs and to empower local organizations to implement effective approaches at the community level, in June 2014 the 3MDG Fund issued a call for proposals for local Community Based Organizations (CBOs). Six organizations were selected for the ‘Collective Voices: Understanding Community Health Experiences’ funding stream and started their contracts in 2015:
- Ar Yone Oo Social Development Association
- Bright Future (La Yee Anar Gut)
- Community Driven Development & Capacity Building Enhancement Team
- Charity Oriented Myanmar
- Community Agency for Rural Development
- Phan Tee Eain
Five of the organisations will focus on issues that are gender specific or related to sexual and reproductive health, including improving access to quality health services for disadvantaged women; developing greater understanding of the relationship between gender and health-related knowledge, behaviours and attitudes; and contributing to community awareness and accurate utilization of family planning services. Findings and experiences from the projects will be shared nationally.
Each lead organization is required to partner with a minimum of three additional CBOs to develop the capacity of smaller organizations. This means that in total 3MDG will reach 25 CBOs through this funding stream.
In 2014, 3MDG engaged Pact Myanmar to provide organizational capacity development to local NGO/ CBO implementing partners to enhance ownership and sustainability. This support will continue until the end of 2016, enabling robust and comprehensive capacity development for 3MDG local organizations.
MORE INFORMATION
Project database
impact
3,534
Health facilities across Ayeryawady, Bago, and Magway are submitting monthly consumption reports using a standardized stock book since the start of the fund
impact
22
Midwifery schools and one lady health visitor school upgraded for more hands-on learning since the start of the fund
impact
264
Townships (80%) have functional cold chain equipment and adequate storage space for EPI since the start of the fund