1. 22-6-2010
Dr. Nilar Tin
1

2. Service Delivery Gaps
Many areas of the country
have low service access to
MCH and other services due to
a range of management,
infrastructure, logistics and
security barriers.
Program Coordination Gaps
Lack of organizational capacity,
guidelines and strategic
framework on how to coordinate
immunization, nutrition,
environmental health and RH
services is leading to
fragmentation and inefficiencies
in health service delivery
Human Resource Gaps
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: Achieve improved service delivery of essential components of Immunization, MCH, Nutrition,
Environmental Health by strengthening programme coordination, sub-national micro-planning, and human
resources management and development in support of MDG goal 2/3 reduction in under 5 child mortality
between 1990 and 2015.
Theme 1 Service Delivery
Reaching communities with
essential health system delivery
components of MCH, nutrition,
immunization and environmental
health, with emphasis on hard to
reach areas
Theme 2 Health Program
Coordination and Capacity
Building Strengthening
coordination, management and
organization of the health system
at all levels with a focus on the
Township Level
Theme 3 Human
Resource Management
and Development
Improving distribution, skill,
number and mix of health
workers with emphasis on
hard to reach areas

3. 
By the end of year 4, 180 selected townships with
identified hard to reach areas will have increased
access to essential components of MCH-EPI and
HSS as measured by increased DPT from 70% to
90% and SBA from 67.5% to 80%
3

4. 
Activity 1.1: SURVEY:
Survey to establish base line indicators & outcome, impact and research for
operation (including mapping)

Activity 1.2: SUPPLIES:
Increase availability of Essential Supplies and equipment based on needs
identified in Coordinated Township Health Plan (CTHP).
Activity 1.3: INFRASTRUCTURE:
540 RHCs and 324 sub-RHCs in 180 HSS-targeted Townships will be
renovated/constructed by year 4, based on needs identified in CTHP.


Activity 1.4: TRANSPORT
Provision of essential transport for township and BHS to reach hard-toreach areas, based on needs assessment analysis in CTHP: Transport
Allowance + capital for vehicles, bicycles, trolley jeeps

Activity 1.5: PARTICIPATION
Involving NGOs, local authorities and Community Health Workers in
developing and implementing CTHP
4

5. 
By the end of year 4, 180 selected townships with
identified hard to reach areas will have developed
and implemented CTHP.
5

6. 
Activity 2.1: GUIDELINES DEVELOPMENT:
Develop national guidelines for CTHP (including financial management and
health financing) & supervision at all levels (including checklists)

Activity 2.2: HEALTH FINANCING RESEARCH
Complete a research program on financial management capacity and
feasibility and effectiveness of health financing schemes in HSS targeted
townships by year 2.




Activity 2.3: OPERATIONAL RESEARCH:
Pilot community based health initiative (financing schemes) according to
national guidelines in 50 townships by year 4
Activity 2.4: TRAINING
Implement the training program on coordinated management through the
modified MEP program
Activity 2.5: PLAN DEVELOPMENT:
Develop and monitor coordinated health planning of HSS-targeted tsps
Activity 2.6: EVALUATION:
Assess process and impact of coordinated State & Township coordinated
health planning, and then disseminate findings
6

7. 
By the end of year 4, 20 selected townships with
identified hard to reach areas will be staffed by
midwives and PHS2 according to the National HR
Standards.
7

8. 
Activity 3.1: RESEARCH:
Conduct Research program for HR planning focusing on distribution mix
function and motivation and management capacity (including financing), by
year 3.

Activity 3.2: HR PLAN:
Develop HR Plan recommending strategies for retention and deployment of
staff in hard-to-reach areas, based in part on research from activity 3.1

Activity 3.3: HR PROPOSAL:
Development of Proposal to MOH recommending appropriate deployment
number and pattern of MW and PHS2 in hard-to-reach areas, assessing
retentions scheme options that include financial incentives.

Activity 3.4: CONTINUING TRAINING:
Conduct coordinated MCH, EPI, Nutrition & EH training programs applying
the principles of MEP
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9. Impact and Outcome Indicators (morbidity, mortality and program coverage)
1. National DTP3 coverage (%)
2. Number / % of districts achieving ≥80% DTP3 coverage (National)
3. Under five mortality rate (per 1000) (national)
4. Delivery by Skilled Birth Attendants (HSS targeted Townships)
5. Rate of ORT Use of <5 children (National)
6. % of 6-59 months children having Vitamin A during past 6 months (National)
Output Indicator (health system capacity)
1. % of townships have developed and implemented coordinated plans according to national framework
2. Number/% of RHC visited at least 6 times in the last year using a quantified checklist (supervision)
3. Number of managers/ trainers / BHS trained for MEP at each level per year (management training)
4. Proportion of RHCs with no stock out of essential supplies in the last 6 months (availability, service
access, utilization, quality)
5. No of RHC and sub RHC renovated and/or constructed per year, including improved drinking water
and sanitation facilities
6. Percent of selected Townships with identified hard to reach areas staffed by midwives and PHS2
according to the National HR Standards.(In one RHC, 5 midwives and 5 PHS 2, 1 Lady Health Visitor
and 1 Health Assistance. Each rural sub centre should have one midwife and 1 PHS2)
7. % of Townships implementing Community based health insurance scheme
8. % Townships with active health committees
9. % Townships have coordinated MCH package of services (ANC, TT, Nutrition, BF, BS and VCCT)
and IMCI

10. Year 1 -20 townships
Year 2- 40
Year 3- 60
Year 4- 60
States & Divisions
Kachin
Kayah
Kayin
Chin
Mon
Rakhine
Shan(East), (North), (South),
Sagaing
Mandalay
Magway
Bago(East), Bago(West)
Yangon
Ayeyawady
Taninthayi

11. Myanmar GAVI HSS Budget by System Level
Central and
State
7%
% Allocations to Coordinated Township
Health Plan
NGO, $12,700
, 7%
International
8%
GAVI HSS,
$54,775 , 31%
UN AGENCY,
$34,500 , 20%
Township
Level & Below
85%
GOVT.,
$73,580 , 42%

12. Activities initiated after approval of GAVI HSS
Proposal in July 2008
TWG and Consultant
January 2009
 Development of guidelines and tools for Baseline
Health System Rapid Assessment (township survey)
February 2009
 Development of guidelines for Coordinated Township
Health Plan
12

13. 19th -20th March 2009
Health Assessment conducted in Lewe township by
DOH/DHP
4th -7th May 2009
Health Assessment conducted in Ngaputaw township
by DOH/WHO/consultant
13th -15th May 2009
 Workshop on sharing findings of Township Health
Systems Assessment in Lewe and Ngaputaw
townships- conducted at NPT

Finalization of the Health Assessment Tool for HSS
townships
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14. 10th September 2009
 One day workshop for Township coordinated Plan
was held by TWG with consultant
11th -13th December 2009
 Conducted experimental costed Township
Coordinated Health Planning at Lewe township

Need-based, bottom-up approach was sensitized to
providers in providing package of health care
(EPI+ANC+Nutrition+EH) to mother and child
14

15. From GAVI Board
November 2009
 Dr.Ranjana Kumar and Dr.Mercy Ahun from GAVI Board,
Geneva visited NPT (GAVI HSS & ISS)
18th -19th January 2010
 Mr. Joe Martin Consultant GAVI Transparency and
Accountability (TAP) came to NPT for Financial
Management Assessment of both HSS and ISS
23rd February 2010
 FMA Questions to MOH/WHO/UNICEF was sent by Mr.
Joe Martin (TAP) from Geneva
25th March 2010
 MOH able to send back the FMA document
TAP asked for Clarifications –Final FMA able to send back
on 18-6-10
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16. Recent progress with funds from SEARO
 Surveyor teams had conducted HSS
Assessment in 10 townships according to
GAVI HSS plan (20 Year 1) in 1st week of May
Surveyors:
 DOH Planning, PH, EPI
 DHP
 DMS (Teaching staff and MPH students from
UOPH)
Still in analysis stage
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17. 1.
2.
3.
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5.
6.
7.
8.
9.
10.
Cover sheet
Health Management and Planning
Mapping Hard to reach
Human resources
Health Finance and Financial Management
Community participation
Essential drugs and equipment
Infrastructure
Data and Service Quality
Summary Report
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18. Summary Report Township
Availability of Services
What is the general analysis of availability of services in this
Township?
Figure 8 Making a Summary Report
What are the main factors effecting availability?
Accessibility of Services
What is the general analysis of accessibility of services in this
Township?
What are the main factors effecting accessibility?
Utilization of Services
What is the general analysis of utilization of services in this
Township?
What are the main factors effecting utilization?
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19. Summary Report Township X
Utilization of Quality Services
What is the general analysis of quality of services in this
Figure 8 Making a Summary Report
Township?
What are the main factors effecting quality?
Main conclusions and Recommendations
What are the main health system bottlenecks for improvement
of maternal and child health services?
What strategies and investments are best placed to remove
these bottlenecks?
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20. 
Health system analysis examines gaps in operations
across health programmes and service delivery units

Making the transition from “management by project”
to “management through systems” is a critical step
in achieving:
◦
Equity: in distribution
◦
Efficiency through coordination and reduction of overlap of
resources in favour of hard to reach areas
◦
Effectiveness: improved health coverage
◦
Sustainability: strengthening self reliance and management
capacity
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21. SERVICE DELIVERY FOR COMMUNITIES
Township Coordinated Health Plan
Hospital Care
Public Health
Disease Control
Systems Analysis
Planning & management
Human Resources
Finance & Financial Management
Infrastructure
Data and Service Quality
Essential Drugs & Equipment
Community participation
Hard to reach (equity analysis)
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22. 
With funds support as well as technical support
from SEARO

Feasibility Study on Effectiveness of Community
Based Health Initiatives (CBHI): Maternal Voucher
Scheme in Township Health System
(May -October 2010)

(DHP/DOH)

This activity will evaluate the effectiveness of
community based schemes in shorter term and in
longer term will lead to development of national
guidelines for management of health financing.
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