Qualität in der Primärversorgung Offener Zugang

Abstrakt

Hard-to-Reach Villages in Myanmar: Challenges in Access to Health Services and Interim Solutions

Sangay Wangmo, Walaiporn Patcharanarumol, Mya Lay Nwe, Viroj Tangcharoensathien

Background: After decades of under investment in health system, strengthening primary health care becomes a central focus of Myanmar’s National Health Plan (2017- 2020). In 2011, a health systems strengthening programme was piloted in 20 hard-to-reach townships of Myanmar with support from the Vaccine Alliance. Programme reached the hard-to-reach population with outreach health services, and introduced Hospital Equity Fund to provide free hospitalbased MCH services for poor mothers and children. Prior to its implementation, a baseline assessment was conducted in 2010 and early 2011 and after 2 years, in 2013, programme performance was assessed. This paper reviews the baseline health system situation of 20 hard-to-reach townships in 2010 and assesses programme outputs in 2013. Further, it draws key lessons from implementing interim strategy of primary health care strengthening, to inform current primary health care reform in Myanmar.

Method: Findings from baseline assessment of 20 hard-to-reach townships in 2010-2011 are reviewed to understand township health system situation. Programme outputs after 2 years, in 2013, are assessed through routine monitoring data and reports review, in-depth interviews of total 48 key informants from two selected townships who are township medical officers and basic health staffs, and field observations by the authors.

Results: Baseline assessment uncovered large gaps and multiple challenges that impeded delivery of primary health service in hard-to-reach areas of Myanmar. For example, shortage and misdistribution of primary health workers, lack of essential medicines, equipment, infrastructure and allowances hampered the delivery of outreach and static primary health services. Only 7% of rural health centers met the 13-health workers standard; while 19% of sub centres did not have sheltered premises for service provision. Poverty, low education, financial, geographical and social barriers were key demand side barriers. After two years, in 20 townships, statistics showed increased rates of antenatal care in 19 townships, Skilled Birth Attendants in 15 townships, and coverage of 2nd dose of Tetanus Toxoid and BCG in 11 townships. The Hospital Equity Fund prevented 1,327 potential maternal deaths through obstetric emergency.

Conclusion: Outreach services in low resource setting can ensure improved access to essential health services for the hard-to reach population. While investment in Interim strategy such as outreach services and hospital equity fund demonstrates positive changes in primary health care indicators, it should be gradually replaced by a sustainable primary health care system, for progressive realization of universal health coverage.