1. Dr. Nilar Tin

2. 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

3. Proposal Development, submission, review
t
l
sa men
o
op l o p
Pr ve
de
• 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)
n
si o
s
mi
b
Su
• 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
ew
vi ess
Re oc
Pr
•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
t
an
Gr
• Funds received
by June 2011
• Activities
started in
August 2011

4. System Building Blocks

5. HSS Framework Myanmar
p
e Ga
c
vi ery
r
Se liv
De
n
ram atio
g
ro rdin
P o
Co p
ga
an rce
m u
Hu eso
R ap
G
Many areas of the
Lack of organizational
There is lack of
country have low
capacity, guidelines and
clarity in the roles
service access to MCH
strategic framework on
and functions of
and other services due
how to coordinate
basic health staff,
to a range of
immunization, nutrition,
and inequities in the
management ,
environmental health and
distribution of staff
infrastructure,
MCH service is leading to
resulting in lack of
logistics, demand side
fragmentation and
access to health
and security barriers
inefficiencies in health
services in hard to
service delivery
reach areas

6. 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

7. 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
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%
Main activities• Guideline development for HSS Assessment
• Baseline surveys
• Logistics & supplies
• Transport
• Social mobilization (AMW/ CHW training/refresher training)
• RHC/sub RHC refurbishment & construction

8. 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

9. 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 )

10. M&E Indicators
Impact and Outcome Indicators
1.
2.
3.
4.
5.
1.
2.
(morbidity, mortality and program coverage)
Township DTP3 coverage (%)
Number / % of districts achieving ≥80% DTP3 coverage
(National)
Delivery by Skilled Birth Attendants
(HSS targeted
Townships)
Rate of ORT Use of <5 children (Township)
% of 6-59 months children having Vitamin A during past 6
months (Township)
Output Indicators (health system capacity)
% of townships have developed and implemented coordinated
plans according to national framework
Number/% of RHC/sub centre visited at least 6 times in the last
year using a quantified checklist (supervision)
10

11. M&E Indicators
3.
4.
5.
6.
7.
8.
9.
Output Indicators (health system capacity)
Number of managers/ trainers / BHS trained for Management
and Leadership at each level per year (management training)
Proportion of RHCs with no stock out of essential supplies in
the last 6 months
No: of RHC and sub RHC renovated and/or constructed per
year, including improved drinking water and sanitation
facilities
% of selected Townships with identified HTR areas staffed by
midwives and PHS2 according to the National HR Standards.
% of Townships implementing Community based health
insurance scheme
% Townships with active health committees
% Townships have coordinated package of services (MCH, EPI,
Nutrition, and EH)
11

12. HSS Implementation
States & Divisions
Township
Kachin
16
Kayah
7
Kayin
8
Chin
9
Mon
8
Rakhine
7
Shan(East), (North), (South), 45
Sagaing
Mandalay
12
Magway
15
Bago
12
Yangon
11
Ayeyawady
Criteria for selection-DPT3 coverage < 80%
-SBA < 60%
13
7
Taninthayi
10
TOTAL
180

13. 3 Before
DOH
DHP
DMS
National Health Sector Coordinating Body
UN Agencies
WHO
UNICEF
JICA
INGOs
National
NGOs
3 After
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

14. What we need to do to meet the goals?
Technical Sustainability
Technical Sustainability
Financial Sustainability
Financial Sustainability
•• Sustaining through management
Sustaining through management
••Training Strategy
support
Training Strategy
support
••Supervision & management• Research and development of Health
Supervision & management• Research and development of Health
strategy
Financing Schemes
strategy
Financing Schemes
•• NGO Collaboration strategy Increasing government financial
••
NGO Collaboration strategy Increasing government financial
••National coordination
commitments
National coordination
commitments
••HSRFund
HSR Fund
•• Strengthening demand side strategies
Strengthening demand side strategies
••HealthSystems leadership •Increasing financial management
Health Systems leadership •
Increasing financial management
program
capacity of townships
program
capacity of townships

15. Thank You