Dr. Nilar Tin

1. Proposal Development, submission, review 1. Proposal Development, submission, review

2. Implementation prior to funding 2. Implementation prior to funding

3. Implementation with funds 3. Implementation with funds

Proposal Development, submission, review

Proposal

development

Submission

Review

Process

Grant

• 2007-2008 March • Worked well with HSS Technical Working Group + Consultants +WHO +UNICEF • 4 evidence-based studies• Working retreat in Mandalay (S/R,TMO)• Oversee by the National Health Sector Coordinating Body (NHSC)

•FMA during 2010 Jan-Dec•1st 10 Township assessment in May 2010 (SEARO)• Results being disseminatied in Sept 2010• Feasibility study for MCHVS 2010-2011•Aide Memoire signed in Feb2011

• Funds received by June 2011

• Activities started in August 2011

• Acceptance with clarification in May 2008• Approval of proposal by July 2008

• Develop HSS Assessment Guidelines 2009• Pre-tested in Lewe, Ngaputaw• CTHP guidelines 2009

System Building Blocks

HSS Framework Myanmar

Service

Delivery

Gap Program

Coordination

gapHuman

Resource

Gap

Many areas of the

country have low

service access to MCH

and other services

due to a range of

management ,

infrastructure,

logistics, demand side

and security barriers

Lack of organizational

capacity, guidelines and

strategic framework on

how to coordinate

immunization, nutrition,

environmental health and

MCH service is leading to

fragmentation and

inefficiencies in health

service delivery

There is lack of

clarity in the roles

and functions of

basic health staff,

and inequities in the

distribution of staff

resulting in lack of

access to health

services in hard to

reach areas

HSS Goal

The Goal of the HSS program in Myanmar is to achieve improved service coverage for essential PHC components of Immunization and Maternal and Child Health, in support of MDG goal 4, 2/3 reduction in under 5 child mortality between 1990 and 2015 through -strengthening programme coordination, -improving health planning systems and

-strengthening of human resource management

Service Delivery Gap

Theme1. Reaching communities (applying supply & demand strategies) with essential health system delivery components of MCH, nutrition, Immunization & EH with emphasis on HTR areas

Main activities-

• Guideline development for HSS Assessment

• Baseline surveys

• Logistics & supplies

• Transport

• Social mobilization (AMW/ CHW training/refresher training)

• RHC/sub RHC refurbishment & construction

Objective1 By the end of four years 180 selected townships with identified HTR areas will have increased access to essential components of MCH, EPI and HSS as measured by increased DPT from 70-90% and SBA from 67.5 to 80%

Program Coordination Gap

Theme 2.

Strengthening coordination, management & organization of the

health system at all levels with a focus on the Township Level

Objective 2 : By the end of four years 180 selected townships with identified HTR areas will have developed and implemented a coordinated township health plan

Main activities-

• Research & development of coordinated planning & supervision

• Quarterly review meeting & Annual program review

• Demand side financing (MCHVS & HEF)

• Guidelines development & Implementation

• Establish HSR funds , training HSR & conduct research

Human Resource Gap

Theme 3.

Improving distribution , skill , number and mix of health workers

with emphasis on hard to reach areas

Objective 3: By the end of four years 90 selected townships with identified HTR will be staffed by MWs and PHS2 according to National HR standards

Main activities-

• HR research on rural retention of health workforce

• Financial incentives for HWF

• Policy mapping and analysis of rural retention of HWF

• Continuing training

• Leadership Development (SSA for HSSO)

• Asia Region study tour (exchange of experiences )

M&E IndicatorsImpact and Outcome Indicators

(morbidity, mortality and program coverage)1. Township DTP3 coverage (%)

2. Number / % of districts achieving ≥80% DTP3 coverage (National)

3. Delivery by Skilled Birth Attendants (HSS targeted Townships)

4. Rate of ORT Use of <5 children (Township)

5. % of 6-59 months children having Vitamin A during past 6 months (Township)

Output Indicators (health system capacity)1. % of townships have developed and implemented coordinated

plans according to national framework 2. Number/% of RHC/sub centre visited at least 6 times in the last

year using a quantified checklist (supervision) 10

M&E IndicatorsOutput Indicators (health system capacity)

3. Number of managers/ trainers / BHS trained for Management and Leadership at each level per year (management training)

4. Proportion of RHCs with no stock out of essential supplies in the last 6 months

5. No: of RHC and sub RHC renovated and/or constructed per year, including improved drinking water and sanitation facilities

6. % of selected Townships with identified HTR areas staffed by midwives and PHS2 according to the National HR Standards.

7. % of Townships implementing Community based health insurance scheme

8. % Townships with active health committees

9. % Townships have coordinated package of services (MCH, EPI, Nutrition, and EH)

11

States & Divisions Township

Kachin 16

Kayah 7

Kayin 8

Chin 9

Mon 8

Rakhine 7

Shan(East), (North), (South), 45

Sagaing 13

Mandalay 12

Magway 15

Bago 12

Yangon 11

Ayeyawady 7

Taninthayi 10

TOTAL 180

HSS Implementation

Criteria for selection-DPT3 coverage < 80% -SBA < 60%

National Health Sector Coordinating Body

DOHDHPDMS

JICAUN AgenciesWHOUNICEF

INGOsNational NGOs

Other Ministries

• Oversee the whole process of development and implementation of National Health Systems Strengthening Strategies• Monitor evolving financial, human resource and technical support needs for HSS• Systematically overview HSS implementation and develop Annual Progress Report to GAVI and the government • Revise annual HSS plans as needed

3 Before 3 After

What we need to do to meet the goals?

• Sustaining through management support• Research and development of Health Financing Schemes• Increasing government financial commitments• Strengthening demand side strategies•Increasing financial management capacity of townships

• Sustaining through management support• Research and development of Health Financing Schemes• Increasing government financial commitments• Strengthening demand side strategies•Increasing financial management capacity of townships

• Training Strategy• Supervision & management strategy• NGO Collaboration strategy• National coordination•HSR Fund•Health Systems leadership program

• Training Strategy• Supervision & management strategy• NGO Collaboration strategy• National coordination•HSR Fund•Health Systems leadership program

Technical SustainabilityTechnical Sustainability Financial Sustainability Financial Sustainability

Thank You