Meeting of South-East Asia Regional
Programme Managers on Child Health,
Kathmandu, 15 – 18 Nov 2011
Progress in Implementation of Child
Health Programme
Country: MYANMAR
15-18 Nov 2011
Child Health Programme
Managers' Meeting
1
• Total population-59.13 million (2009-2010,
CSO)
• 11.7%- under five population
• DOH, MOH is mainly taking the
responsibilities for promotive, preventive,
curative and rehabilitative health care
services for the people.
• WCHD is the main section for child health
development.
• Child health related projects and program
15-18 Nov 2011
Child Health Programme
Managers' Meeting
2
EPIDEMIOLOGY / BURDEN OF
CHILDHOOD DISEASES:
15-18 Nov 2011
Child Health Programme
Managers' Meeting
3
TRENDS IN CHILD MORTALITY
RELATED TO MDG 4, MYANMAR
140
130
U5MR
Series1
Deaths per 1,000 LB
120
IMR
Series2
100
80
98
82.4
MDG
77.77
66.1
60
55.4
40
55.1
46.1
49.7
37.5
20
43.3
32.7
0
1990
DOH
15-18 Nov 2011
1995
1999
2003
2010
DOH
CSO
DOH
MICS
Child Health Programme
Managers' Meeting
2015
4
NUTRITION STATUS
45
40
38.6
Percentage
35
41.6
35.3
31.8
30
33.9 35.1
32.2
22.6
25
20
15
8.2 9.4 8.6 7.9
10
8.6
5
0
1
2
Under weight
1997
15-18 Nov 2011
2000
3
Stunting
2003
Wasting
4
LBW
2010
Child Health Programme
Managers' Meeting
5
MAIN CAUSES OF UNDER-FIVE DEATHS
Diarrhoea
(18%)
Pneumonia
(27%)
Brain Infection
(17%)
Malaria
(8%)
Others
( 14%)
Malnutrition
(1%)
Measles
(1%)
DHF
( 1%)
Septicaemia
(6%)
Beri Beri
(7%)
(Source: Cause specific under five mortality survey, DOH/UNICEF, 2003)
15-18 Nov 2011
Child Health Programme
Managers' Meeting
6
MAIN CAUSES OF NEONATAL MORTALITY
Sepsis (25%)
Prematurity,
(31%)
Congenital
anomaly (3%)
Asphyxia
(24%)
Brain infection
(4%)
Unknown
(13%)
(Source: Cause specific under five mortality survey, DOH/UNICEF, 2003)
15-18 Nov 2011
Child Health Programme
Managers' Meeting
7
IMCI IMPLEMENTATION
15-18 Nov 2011
Child Health Programme
Managers' Meeting
8
National adaptation of IMCI Training Package
IMMCI Implementation started in the country
WCHD/IMMNCI Implementation started in
the country
IMCI implementation started (If yes, year)
Newborn included in WCHD (0-1 month)
Newborn Added to IMCI
Number and Proportion of districts
implementing WCHD
Number and Proportion of districts
implementing IMCI
15-18 Nov 2011
Child Health Programme
Managers' Meeting
1998
1998-2001
2001 upto
now
2004-2005
Upto now
2001
2011
200
18
9
IMCI Implementation 2004 - 2011
Number and proportion of MOs trained for IMCI
Number and proportion of Nurses/other workers trained
for IMCI
80
810
Proportion of districts (out of IMCI districts) with 60 % or
more health providers trained
18/18
IMCI supervisory checklists introduced
2004-2005
Proportion of first-level health facilities that had at least
one supervisory visit over a period of 6 month during
previous year
7 tsp
47 RHC &
SubRHC
18/18
Proportion of districts (out of IMCI districts) covered with
Follow-up IMCI training
15-18 Nov 2011
Child Health Programme
Managers' Meeting
10
IMCI implementation review conducted (If yes, year;
National and sub-national)
IMCI Health Facility Survey conducted (If yes, year;
National or sub-national)
2009
2008
Proportion of first-level health facilities with at least one
health worker who cares for children trained in IMCI
Pre-Service IMCI teaching/training:
18
Number and proportion of Medical Schools teaching IMCI
4 out 4
Number and proportion of Nursing Schools teaching IMCI
23
Number and proportion of Midwifery Schools teaching
IMCI
ICATT introduced (If yes, year and scale)
15-18 Nov 2011
Child Health Programme
Managers' Meeting
20/22
Not yet
11
Key factors that helped scaling up:
1. Political and community commitment
2. Priority issue in National Health Plan
3. Existence of Child Health Development Strategic
Plan and implementation plan
4. Strong coordination/cooperation/collaboration with
UN agencies, NGOs, related departments and
ministries and projects and program
Key challenges to scaling up:
1. Policy shift
2. Funding gaps
3. HR gaps
15-18 Nov 2011
Child Health Programme
Managers' Meeting
12
NEWBORN HEALTH
15-18 Nov 2011
Child Health Programme
Managers' Meeting
13
• ENC Course adapted: Year 2006
• Other training courses: IMCI, PCPNC,
WCHD, Management of Critically ill children
• Healthcare providers trained: in 30 Tsps out
of 330 tsps
Healthcare
providers
MO (public only)
Nurses
Total
no.
10927
25644
Midwives
19554
No.
Trained
142
Negligible
"
535
CHW
500
Volunteers
nil
15-18 Nov 2011
%
Child Health Programme
Managers' Meeting
14
IN-PATIENT (HOSPITAL) CARE OF
SICK NEBORNS AND CHILDREN
15-18 Nov 2011
Child Health Programme
Managers' Meeting
15
• WHO Pocket Book introduced: Year 2008-2009
• Training courses for Hospital care done: Yes
• Details: Four days training for doctors and
nurses
• Number and proportion of Healthcare providers
trained:
– MOs: 864 /10927
– Nurses: 865/25644
– BHS: 16,172/19556
• Proportion of hospitals providing pediatric care
having oxygen: No exact data
• Hospital assessment using WHO tools carried out:
not yet
– Year/s: planned for 2012-13
– How many hospitals
covered:
15-18 Nov 2011
Child Health Programme
16
Managers' Meeting
CHW APPROACH FOR CARE OF
SICK NEWBORNS AND CHILDREN
15-18 Nov 2011
Child Health Programme
Managers' Meeting
17
District
Total Implementi
implementing CHW No. of ng Districts
approach
Distt
Home based
newborn care
Sick child package
330
10
330
1
Healthy child
package (ECD)
Any review of the
experience
330
none
15-18 Nov 2011
Child Health Programme
Managers' Meeting
%
18
PROGRAMME REVIEW AND
MANAGEMENT
15-18 Nov 2011
Child Health Programme
Managers' Meeting
19
• CH Short Programme Review introduced, if
yes :
– Year: 2009
– National or sub-national: both
• Programme Management Course introduced,
Not yet. Planned for 2012-13
15-18 Nov 2011
Child Health Programme
Managers' Meeting
20
HEALTH MANAGEMENT
INFORMATION SYSTEM (HMIS)
AND DHS/MICS
15-18 Nov 2011
Child Health Programme
Managers' Meeting
21
Indicators related to ARI/pneumonia
No
Key indicators
1
Morbidity and mortality rates of ARI
2
Care seeking for ARI
15-18 Nov 2011
Child Health Programme
Managers' Meeting
Source of
data
HMIS
MICS
22
Indicators related to diarrhoea
No
1
Key indicators
2
Percentage of under five diarrhoea
with severe dehydration and treated
with ORT
ORT use rate
3
Home management of diarrhoea
15-18 Nov 2011
Child Health Programme
Managers' Meeting
Source of
data
HMIS
MICS
MICS
23
Indicators related to nutrition
No
Key indicators
Source of
data
HMIS
1
LBW among MW delivery
2
LBW among AMW delivery
HMIS
3
Under three years old under weight (%)
4
Stunting prevalence
HMIS
MICS
MICS
5
Wasting prevalence
MICS
6
EBF
MICS
15-18 Nov 2011
Child Health Programme
Managers' Meeting
24
Indicators related to nutrition
No
Key indicators
7 Continued BF rate
Source of
data
MICS
8 Timely complementary feeding rate
MICS
9 Children receiving Vitamin A
supplementation
MICS
10 Iodized salt consumption
15-18 Nov 2011
Child Health Programme
Managers' Meeting
MICS
25
Indicators related to WASH
No
Key indicators
1
Sanitary latrine coverage
2
Use of drinking water
15-18 Nov 2011
Child Health Programme
Managers' Meeting
Source of
data
HMIS
MICS
MICS
26
Indicators related to EPI
No
Key indicators
1
Immunization coverage (DPT,OPV,
Hepatitis B, BCG, Measels)
2
Morbidity and morality of neonatal
tetanus
3
Morbidity and mortality rates of
vaccine preventable diseases
Children protected against neonatal
tetanus
4
15-18 Nov 2011
Child Health Programme
Managers' Meeting
Source of
data
HMIS
MICS
HMIS
MICS
HMIS
MICS
27
Indicators related to vital statistics
No
Key indicators
Source of
data
HMIS
1
Early neonatal death rate
2
NMR (2012)
HMIS
3
IMR
4
U5MR
HMIS
MICS
HMIS
MICS
HMIS
5
Under five referral to the higher
center (%)
15-18 Nov 2011
Child Health Programme
Managers' Meeting
28
Other Indicator related to NCH
No
1
Key indicators
2
New cases of ophthalmia
neonatorum
SBA
3
AN coverage
4
Post natal visit
15-18 Nov 2011
Child Health Programme
Managers' Meeting
Source of
data
HMIS
HMIS
MICS
HMIS
MICS
HMIS
29
Data collection and management in HMIS
Data collection
• Data Collection System was well established
• Cover the whole country
• Statistician at state and regional level
• Integrated data set
• Standing order/clear instruction
• Data dictionary to reduce systemic error
Processing and analysis
• Manual data editing
• Data entry by Epi data program
• Data analysis by SPSS program
15-18 Nov 2011
Child Health Programme
Managers' Meeting
30
Data collection and management in HMIS
Dissemination &Use
• Monthly and quarterly report
• Annual statistics report
• Township health profile
Quality Control of HMIS Data
• Monitoring and supervision
– Desk monitoring and feedback at each and every
level
– Field monitoring and supportive supervision
– Data quality assessment in selected township
15-18 Nov 2011
Child Health Programme
Managers' Meeting
31
FUTURE PLAN
15-18 Nov 2011
Child Health Programme
Managers' Meeting
32
Strengthening and scale-up plans for Next 2 years
• IMCI: IMNCI trainings to 2 more townships
• ICATT use: not planned yet
• CHW Packages:
– Home Based NB Care package:10 townships
– Sick child package: CCM-5 townships
– Healthy Child (ECD) package from 2012-13
biennium
• Referral (Hospital) Care: F-IMNCI planned 2012-13
• Programme Review and Management:
– CH Short Programme Review: 2013
– Programme Managers Course: 2012-13
15-18 Nov 2011
Child Health Programme
Managers' Meeting
33
• Strengthening of HMIS at all levels e.g. training of
HMIS with newly revised data set is urgently needed
in 2012.
• Capacity building of information staff at various level
is needed for data management.
15-18 Nov 2011
Child Health Programme
Managers' Meeting
34
THANK YOU
15-18 Nov 2011
Child Health Programme
Managers' Meeting
35