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Win PP, Hlaing T, Win HH. Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review. PLoS One 2024; 19:e0293197. [PMID: 38758946 PMCID: PMC11101123 DOI: 10.1371/journal.pone.0293197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/08/2023] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries. METHODS This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings. RESULTS Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited. CONCLUSION Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare.
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Affiliation(s)
- Pyae Phyo Win
- Department of Public Health and Social Medicine, University of Medicine, Magwae, Myanmar
| | - Thein Hlaing
- District Public Health Department (Ministry of Health), Pyay District, Bago Region, Myanmar
| | - Hla Hla Win
- Department of Health and Social Sciences, STI Myanmar University, Yangon, Myanmar
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Griffin G, Bradfield Z, Than KK, Smith R, Tanimizu A, Raina N, Homer CSE. Strengthening midwifery in the South-East Asian region: A scoping review of midwifery-related research. PLoS One 2023; 18:e0294294. [PMID: 38100488 PMCID: PMC10723687 DOI: 10.1371/journal.pone.0294294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/29/2023] [Indexed: 12/17/2023] Open
Abstract
Improving sexual, reproductive, maternal, newborn, and adolescent health outcomes necessitates greater commitment to, and investments in, midwifery. To identify future research priorities to advance and strengthen midwifery, we conducted a scoping review to synthesise and report areas of midwifery that have been explored in the previous 10 years in the 11 countries of the World Health Organization's South-East Asia region. Electronic peer-reviewed databases were searched for primary peer-reviewed research published in any language, published between January 2012 and December 2022 inclusive. A total of 7086 citations were screened against the review inclusion criteria. After screening and full text review, 195 sources were included. There were 94 quantitative (48.2%), 67 qualitative (34.4%) and 31 mixed methods (15.9%) studies. The majority were from Indonesia (n = 93, 47.7%), India (n = 41, 21.0%) and Bangladesh (n = 26, 13.3%). There were no sources identified from the Democratic People's Republic of Korea or the Maldives. We mapped the findings against six priority areas adapted from the 2021 State of the World's Midwifery Report and Regional Strategic Directions for Strengthening Midwifery in the South-East Asia region (2020-2024): practice or service delivery (n = 73, 37.4%), pre-service education (n = 60, 30.8%), in-service education or continuing professional development (n = 51, 26.2%), workforce management (n = 46, 23.6%), governance and regulation (n = 21, 10.8%) and leadership (n = 12, 6.2%). Most were published by authors with affiliations from the country where the research was conducted. The volume of published midwifery research reflects country-specific investment in developing a midwifery workforce, and the transition to midwifery-led care. There was variation between countries in how midwife was defined, education pathways, professional regulation, education accreditation, governance models and scope of practice. Further evaluation of the return on investment in midwifery education, regulation, deployment and retention to support strategic decision-making is recommended. Key elements of leadership requiring further exploration included career pathways, education and development needs and regulatory frameworks to support and embed effective midwifery leadership at all levels of health service governance.
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Affiliation(s)
- Georgia Griffin
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Zoe Bradfield
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Kyu Kyu Than
- Burnet Myanmar Program, Burnet Institute, Yangon, Myanmar
| | - Rachel Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Ai Tanimizu
- Family and Gender through the Life Course, South-East Asia Regional Office, World Health Organization, New Delhi, India
| | - Neena Raina
- Family and Gender through the Life Course, South-East Asia Regional Office, World Health Organization, New Delhi, India
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
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Altijani N, Khogali M, Hinton L, Opondo C, Eljack E, Knight M, Nair M. Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014). Front Glob Womens Health 2023; 4:1012676. [PMID: 37711966 PMCID: PMC10498120 DOI: 10.3389/fgwh.2023.1012676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of different birth attendants and their relationship with the maternal mortality ratio (MMR). Methods Trend analyses were conducted using data from the 2006, 2010, and 2014 Sudan Household surveys. Three categories of birth attendants were identified: (1) skilled birth attendants (SBA) such as doctors, nurse-midwives, and health visitors, (2) locally certified midwives, and (3) traditional birth attendants (TBA). Multivariable logistic regression models were used to examine trends in SBAs (vs. locally certified midwives and TBAs), locally certified midwives (vs SBAs and TBAs), and SBAs and locally certified midwives by place of birth (health facility and home). The analyses were adjusted for potential confounders. An ecological analysis was conducted to assess the relationship between birth attendants by place of birth and MMR at the state level. Results Births by 15,848 women were analysed. Locally certified midwives attended most births in each survey year, with their contribution increasing from 36.3% in 2006 to 55.5% in 2014. The contributions of SBAs and TBAs decreased over the same period. In 2014 compared with 2006, births were more likely to be attended by a locally certified midwife (aOR: 2.19; 95%CI: 1.82-2.63) but less likely to be attended by a SBA (aOR: 0.46; 95%CI: 0.37-0.56). The decrease in SBA was more substantial for births taking place at home (aOR: 0.17; 95%CI: 0.12-0.23) than for health facility births (aOR: 0.45; 95%CI: 0.31-0.65). In the ecological analysis 2014-2016, the proportion of births attended by SBA in health facilities correlated negatively with MMR at state level (rho -0.55; p: 0.02). Conclusion This analysis suggests that although an improved coverage of maternal health with locally certified midwives has been observed, it has not provided the skill level reached by SBA. SBAs working in facility settings were a key correlating factor to reduced maternal mortality. Urgent action is needed to improve access to SBAs in health facilities, thereby accelerating progress in reducing maternal mortality.
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Affiliation(s)
- Noon Altijani
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mustafa Khogali
- School of Medicine, Ahfad University for Women, Omdurman, Sudan
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Eman Eljack
- Health Systems Strengthening and Malaria Program Management Unit, Federal Ministry of Health, Khartoum, Sudan
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Karamagi HC, Ben Charif A, Ngusbrhan Kidane S, Yohanes T, Kariuki D, Titus M, Batungwanayo C, Seydi ABW, Berhane A, Nzinga J, Njuguna D, Kipruto HK, Andrews Annan E, Droti B. Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001076. [PMID: 36962623 PMCID: PMC10021830 DOI: 10.1371/journal.pgph.0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Tewelde Yohanes
- Division of Policy and Planning, Ministry of Health, Asmara, Eritrea
| | | | | | | | - Aminata Binetou-Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Araia Berhane
- Conmmunicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Njuguna
- Health Economist, Ministry of Health, Nairobi, Kenya
| | - Hillary Kipchumba Kipruto
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Edith Andrews Annan
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Benson Droti
- Health Information Systems, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Congo
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Nikoloski Z, McGuire A, Mossialos E. Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis. PLoS Med 2021; 18:e1003811. [PMID: 34653183 PMCID: PMC8519424 DOI: 10.1371/journal.pmed.1003811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Universal health coverage (UHC) encompasses 2 main components: access to essential healthcare services and protection from financial hardship when using healthcare. This study examines Myanmar's efforts to achieve UHC on a national and subnational level. It is a primer of studying the concept of UHC on a subnational level, and it also establishes a baseline for assessing future progress toward reaching UHC in Myanmar. METHODS AND FINDINGS The study uses the Demographic and Health Survey (2015) and the Myanmar Living Conditions Survey (MLCS; 2017) and adapts a previously developed UHC index to provide insights into the main barriers preventing the country's progress toward UHC. We find a negative correlation between the UHC index and the state/region poverty levels. The equity of access analysis reveals significant pro-rich inequity in access to all essential healthcare services. Socioeconomic status and limited availability of healthcare infrastructure are the main driving forces behind the unequal access to interventions that are crucial to achieving UHC by 2030. Finally, financial risk protection analysis shows that the poor are less likely to use healthcare services, and, once they do, they are at a greater risk of suffering financial catastrophe. Limitations of this study revolve around its correlational, rather than causal, nature. CONCLUSIONS We suggest a 2-pronged approach to help Myanmar achieve UHC: Government and state authorities should reduce the financial burden of seeking healthcare, and, coupled with this, significant investment in and expansion of health infrastructure and the health workforce should be made, particularly in the poorer and more remote states.
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Affiliation(s)
- Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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O'Sullivan B, Chater B, Bingham A, Wynn-Jones J, Couper I, Hegazy NN, Kumar R, Lawson H, Martinez-Bianchi V, Randenikumara S, Rourke J, Strasser S, Worley P. A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries. Front Med (Lausanne) 2020; 7:594728. [PMID: 33330559 PMCID: PMC7729061 DOI: 10.3389/fmed.2020.594728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem. Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period. Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type. Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of "grow your own" strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.
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Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Bruce Chater
- Faculty of Medicine, Rural Clinical School, University of Queensland, Theodore, QLD, Australia
| | - Amie Bingham
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - John Wynn-Jones
- Keele Medical School, Keele University, Keele, United Kingdom
| | - Ian Couper
- Ukwanda Center for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nagwa Nashat Hegazy
- Medical Education and Human Resources Center, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt
| | - Raman Kumar
- Family Medicine Practitioner, DOC24 Family Practice Clinic, Ghaziabad, India
| | - Henry Lawson
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | - James Rourke
- Center for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sarah Strasser
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Naher N, Balabanova D, Hutchinson E, Marten R, Hoque R, Tune SNBK, Islam BZ, Ahmed SM. Do social accountability approaches work? A review of the literature from selected low- and middle-income countries in the WHO South-East Asia region. Health Policy Plan 2020; 35:i76-i96. [PMID: 33165587 PMCID: PMC7649670 DOI: 10.1093/heapol/czaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/12/2022] Open
Abstract
Governance failures undermine efforts to achieve universal health coverage and improve health in low- and middle-income countries by decreasing efficiency and equity. Punitive measures to improve governance are largely ineffective. Social accountability strategies are perceived to enhance transparency and accountability through bottom-up approaches, but their effectiveness has not been explored comprehensively in the health systems of low- and middle-income countries in south and Southeast Asia where these strategies have been promoted. We conducted a narrative literature review to explore innovative social accountability approaches in Bangladesh, Bhutan, India, Indonesia, the Maldives, Myanmar and Nepal spanning the period 2007-August 2017, searching PubMed, Scopus and Google Scholar. To augment this, we also performed additional PubMed and Google Scholar searches (September 2017-December 2019) to identify recent papers, resulting in 38 documents (24 peer-reviewed articles and 14 grey sources), which we reviewed. Findings were analysed using framework analysis and categorized into three major themes: transparency/governance (eight), accountability (11) and community participation (five) papers. The majority of the reviewed approaches were implemented in Bangladesh, India and Nepal. The interventions differed on context (geographical to social), range (boarder reform to specific approaches), actors (public to private) and levels (community-specific to system level). The initiatives were associated with a variety of positive outcomes (e.g. improved monitoring, resource mobilization, service provision plus as a bridge between the engaged community and the health system), yet the evidence is inconclusive as to the extent that these influence health outcomes and access to health care. The review shows that there is no common blueprint which makes accountability mechanisms viable and effective; the effectiveness of these initiatives depended largely on context, capacity, information, spectrum of actor involvement, independence from power agendas and leadership. Major challenges that undermined effective implementation include lack of capacity, poor commitment and design and insufficient community participation.
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Affiliation(s)
- Nahitun Naher
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization, avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Roksana Hoque
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Samiun Nazrin Bente Kamal Tune
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Bushra Zarin Islam
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS&UHC), BRAC James P. Grant School of Public Health, BRAC University, 5th Floor (Level-6), ICDDR,B Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
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Oguma T, Watanabe E, Mori T, Fujino Y. Autonomous Continuation of Community Health Workers' Activities in Thegon Township, Bago Region, Myanmar. Front Public Health 2020; 8:201. [PMID: 32582608 PMCID: PMC7280436 DOI: 10.3389/fpubh.2020.00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Few studies have reported on the autonomous continuation of Community Health Worker (CHW) activities after external supervision and support have ended. Objective: The study reports CHW activity continuation in Thegon Township, Bago Region, Myanmar, observed after the supervision by the external organization is completed. Method: Following the completion of a child nutrition program in Thegon Township, CHWs were left unsupervised and uninformed of a follow-up at 10, 23, and 40 months from the end of the program survey due to unforeseen circumstances. In a follow-up survey in 2014, data on the activity implementation status from CHWs and activity attendance from caregivers of the target children were collected. Focus group discussions were held with caregivers concerning their information sources on child nutrition and health. Results: On average, CHWs were found to have continued with 2.6 of the four core activities, often with modifications, irrespective of the time since completion of the non-profit-organization-led program. Meanwhile, caregiver attendance decreased over time. Caregivers recognized CHWs as information sources. Discussion: Although unsupervised, CHWs ambitiously continued with their activities, but sorted through and modified them, which may have been unrelated to the local acceptance of the program, as caregiver attendance decreased even as CHWs continued the activities. The observation may highlight the importance of proactive engagement and thus, the autonomy of CHWs in their activity continuation.
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Affiliation(s)
- Taeko Oguma
- Takemi Program in International Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Etsuko Watanabe
- Division of Nursing, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan
| | - Tomoari Mori
- Office of the Dean of Research, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
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Seo DH, Kim H, Kim KH, Park J, Shin DW, Park JM, Kim H, Jeon W, Kim JE. Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey. West J Emerg Med 2019; 20:903-909. [PMID: 31738717 PMCID: PMC6860398 DOI: 10.5811/westjem.2019.7.43014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Low- and middle-income countries (LMICs) have a large percentage of global mortality and morbidity rates from non-communicable diseases, including trauma. The establishment and development of emergency care systems is crucial for addressing this problem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICs is essential for proper design and operation of ECS (emergency care services) reinforcement programs. Myanmar has particular challenges with road access for providing timely emergency medical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar, we used the Emergency Care Assessment Tool (ECAT), which features newly developed tools for assessing sentinel conditions and signal functions (key interventions to address morbidity and mortality) in emergency care facilities. Methods ECAT is composed of six emergent sentinel conditions and corresponding signal functions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed survey sheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarify ambiguous answers. Results We categorized the nine participating institutions according to predefined criteria: four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basic hospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of the intermediate hospitals showed weakness in trauma care, as well as critical care such as shock management. Only half had a separate triage area for patients. In contrast, all signal functions and resources listed in ECAT were available in the advanced-level hospital. Conclusion Basic-level facilities in Myanmar were shown to be suboptimal in trauma management, with critical care also inadequate in intermediate facilities. To reinforce signal functions in Myanmar health facilities, stakeholders should consider expanding critical functions in selected lower-level health facilities. A larger scale survey would provide more comprehensive data to improve emergency care in Myanmar.
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Affiliation(s)
- Dong Hyun Seo
- Na-eun Hospital, Department of Emergency Medicine, Incheon, Korea
| | - Hoon Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Kyung Hwan Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Junseok Park
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Dong Wun Shin
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Joon Min Park
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Hyunjong Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Woochan Jeon
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Jung Eon Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
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Seo D, Kim H, Kim K, Park J, Shin D, Park J, Kim H, Jeon W, Kim J. Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey. West J Emerg Med 2019. [DOI: 10.5811//westjem.2019.7.43014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Dong Seo
- Na-eun Hospital, Department of Emergency Medicine, Incheon, Korea
| | - Hoon Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Kyung Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Junseok Park
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Dong Shin
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Joon Park
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Hyunjong Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Woochan Jeon
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
| | - Jung Kim
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, Goyang, South Korea
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Than KK, Luchters S, Tin KN, La T, Beeson J, Morgan A. The salt between the beans: a qualitative study of the role of auxiliary midwives in a hard-to-reach area of Myanmar. BMC Health Serv Res 2019; 19:138. [PMID: 30819167 PMCID: PMC6393966 DOI: 10.1186/s12913-019-3958-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Auxiliary Midwives (AMWs) are unpaid volunteer health workers assisting qualified paid midwives in maternal and child health care mainly in hard-to-reach areas of Myanmar. This paper describes the relationship between AMWs and the health system in providing maternal and child services as perceived by the community, AMWs themselves and health care providers in one remote township of Myanmar. Method A qualitative study was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, AMWs, community members and mothers were conducted. Ten key informant interviews were performed with national, district and township level health planners and implementers of maternal and child health services. Thematic analysis was done using the ATLAS.ti software. Results AMWs occupy a unique position between the community and the health sector in the study township. The relationship and trust with the community is built upon prolonged presence providing health care, skill building and fulfilling community expectations. Health care providers’ expectations to provide only preventive care, health promotion and education and childbirth care are often exceeded in reality when emergencies occur in hard-to-reach areas. This challenge to handle emergency situations with no support and limited skills and training is considered as most difficult by the AMWs. This mismatch of service provision expectations by both the community and other health care providers has put AMWs in a position which they describe as being the “salt between the beans” an essential ingredient but often invisible between the beans. Conclusion The trust and relationship developed by AMWs over four decades of community practice serving as the mediator role is an untapped resource that can facilitate future community-based maternal and child health interventions in Myanmar.
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Affiliation(s)
- Kyu Kyu Than
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
| | - Stanley Luchters
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Epidemiology and Preventive Medicine, and Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Khaing Nwe Tin
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Daw, Myanmar
| | - Thazin La
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - James Beeson
- Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, and Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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12
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Than KK, Oliver V, Mohamed Y, La T, Lambert P, McIntosh M, Luchters S. Assessing the operational feasibility and acceptability of an inhalable formulation of oxytocin for improving community-based prevention of postpartum haemorrhage in Myanmar: a qualitative inquiry. BMJ Open 2018; 8:e022140. [PMID: 30361400 PMCID: PMC6224761 DOI: 10.1136/bmjopen-2018-022140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study assessed the potential operational feasibility and acceptability of a heat-stable, inhaled oxytocin (IOT) product for community-based prevention of postpartum haemorrhage in Myanmar. METHODS A qualitative inquiry was conducted between June 2015 and February 2016 through focus group discussions and in-depth interviews. Research was conducted in South Dagon township (urban setting) and in Ngape and Thanlyin townships (rural settings) in Myanmar. Eleven focus group discussions and 16 in-depth interviews were conducted with mothers, healthcare providers and other key informants. All audio recordings were transcribed verbatim in Myanmar language and were translated into English. Thematic content analysis was done using NVivo software. RESULTS Future introduction of an IOT product for community-based services was found to be acceptable among mothers and healthcare providers and would be feasible for use by lower cadres of healthcare providers, even in remote settings. Responses from healthcare providers and community members highlighted that midwives and volunteer auxiliary midwives would be key advocates for promoting community acceptance of the product. Healthcare providers perceived the ease of use and lack of dependence on cold storage as the main enablers for IOT compared with the current gold standard oxytocin injection. A single-use disposable device with clear pictorial instructions and a price that would be affordable by the poorest communities was suggested. Appropriate training was also said to be essential for the future induction of the product into community settings. CONCLUSION In Myanmar, where home births are common, access to cold storage and skilled personnel who are able to deliver injectable oxytocin is limited. Among community members and healthcare providers, IOT was perceived to be an acceptable and feasible intervention for use by lower cadres of healthcare workers, and thus may be an alternative solution for the prevention of postpartum haemorrhage in community-based settings in the future.
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Affiliation(s)
- Kyu Kyu Than
- Burnet Institute, Melbourne, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Victoria Oliver
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thazin La
- Burnet Institute, Melbourne, Australia
| | - Pete Lambert
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Michelle McIntosh
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
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13
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Han SM, Rahman MM, Rahman MS, Swe KT, Palmer M, Sakamoto H, Nomura S, Shibuya K. Progress towards universal health coverage in Myanmar: a national and subnational assessment. LANCET GLOBAL HEALTH 2018; 6:e989-e997. [PMID: 30056050 DOI: 10.1016/s2214-109x(18)30318-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection. METHODS We used nationally representative data from the Myanmar Demographic and Health Survey (2016) and the Integrated Household Living Condition Assessment (2010) to examine 26 health service indicators and explored the incidence of catastrophic health payment and impoverishment caused by out-of-pocket payments. We used logistic regression models of inequalities in, and risk factors for, indicators of universal health coverage. FINDINGS Nationally, the coverage of health service indicators ranged from 18·4% (95% CI 14·9-21·9) to 96·2% (95·9-96·5). Coverage of most health services indicators was below the universal health coverage target of 80%. 14·6% (95% CI 13·9-15·3) of households that used health services faced catastrophic health-care payments. 2·0% (95% CI 1·7-2·3) of non-poor households became poor because of out-of-pocket payments for health. Health service coverage and financial risk protection varied substantially by region. Although the richest quintiles had better access to health services than the poorest quintiles, they also had a higher incidence of financial catastrophe as a result of payments for health care. Of the indicators included in the study, coverage of adequate sanitation, no indoor use of solid fuels, at least four antenatal care visits, postnatal care for mothers, skilled birth attendance, and institutional delivery were the most inequitable by wealth quintile. INTERPRETATION Attainment of universal health coverage in Myanmar in the immediate future will be very challenging as a result of the low health service coverage, high financial risk, and inequalities in access to care. Health service coverage and financial risk protection for vulnerable, disadvantaged populations should be prioritised. FUNDING Japanese Ministry of Health, Labour and Welfare, Ministry of Education, Culture, Sports, Science and Technology of Japan.
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Affiliation(s)
- Su Myat Han
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Md Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Khin Thet Swe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Matthew Palmer
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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14
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Becker S. Progress towards health systems strengthening in Myanmar. JOURNAL OF GLOBAL HEALTH REPORTS 2018. [DOI: 10.29392/joghr.2.e2018006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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15
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Myint NPST, Aung NM, Win MS, Htut TY, Ralph AP, Cooper DA, Nyein ML, Kyi MM, Hanson J. The clinical characteristics of adults with rheumatic heart disease in Yangon, Myanmar: An observational study. PLoS One 2018; 13:e0192880. [PMID: 29466408 PMCID: PMC5821331 DOI: 10.1371/journal.pone.0192880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/31/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a major cause of premature death in low and middle-income countries. The greatest barrier to RHD control is neglect of the disease in national health policies and a lack of prevalence data that might inform control efforts. Myanmar is making remarkable progress against many infectious diseases, but there are almost no data to define the clinical burden of RHD in the country. This prospective audit was performed in an adult medical ward of a tertiary-referral hospital in Yangon, to gain an insight into the prevalence of RHD in Myanmar. PRINCIPAL FINDINGS All patients admitted to the ward between May 1, 2016 and April 30, 2017 were eligible for enrolment. RHD was confirmed in 96 patients who were admitted on 134 occasions, representing 1.1% of the 12,172 adult medical admissions during the study period. This compared with 410 (3.4%) admissions with HIV and 14 (0.1%) with malaria. Patients with RHD had a median age of 44 years (interquartile range: 35-59); 70 (73%) were female. Only one patient had ever had surgery despite 79 (82%) meeting criteria for intervention; 54 (56%) patients were not receiving any regular clinician review. Prior to hospitalisation only 18 (19%) patients were receiving regular penicillin. Only 8 (19%) of the 42 women <50 years were using contraception. Of 49 patients who had been hospitalised previously, 22 (45%) were receiving no regular therapy. During the study three (3.1%) patients died, and 28 (29%) were lost to follow-up. Of the 65 (68%) alive and retained in care, 21 (32%) were still experiencing moderate-severe RHD-related symptoms at the study's end. CONCLUSIONS There is a significant and unmet clinical burden of RHD in Myanmar. A national RHD programme would improve patient care, reducing morbidity and mortality from this preventable disease.
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Affiliation(s)
- Nan Phyu Sin Toe Myint
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
- University of Medicine 2, Yangon, Myanmar
| | - Ne Myo Aung
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
- University of Medicine 2, Yangon, Myanmar
| | - Myint Soe Win
- Department of Cardiology, North Okkalapa General Hospital, Yangon, Myanmar
| | - Thu Ya Htut
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
| | - Anna P. Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - David A. Cooper
- Director’s Unit, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Myo Lwin Nyein
- University of Medicine 2, Yangon, Myanmar
- Department of Cardiology, North Okkalapa General Hospital, Yangon, Myanmar
| | - Mar Mar Kyi
- Department of Medicine, Insein General Hospital, Yangon, Myanmar
- University of Medicine 2, Yangon, Myanmar
| | - Josh Hanson
- University of Medicine 2, Yangon, Myanmar
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Director’s Unit, Kirby Institute, University of New South Wales, Sydney, Australia
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16
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Than KK, Tin KN, La T, Thant KS, Myint T, Beeson JG, Luchters S, Morgan A. The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study. BMC Public Health 2018; 18:99. [PMID: 29298715 PMCID: PMC5751822 DOI: 10.1186/s12889-017-5020-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022] Open
Abstract
Background An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar. Methods A mixed methods study was conducted in Magwe Region, Myanmar involving a survey of 262 AMWs, complemented by 15 focus group discussions with midwives (MWs), AMWs, mothers and community members, and 10 key informant interviews with health care providers at different levels within the health care system. Results According to current government policy, AMWs are responsible for identifying pregnant women, screening for danger signs and facilitating early referral, provision of counselling on nutrition and birth preparedness for women in hard-to-reach areas. AMWs also assist at normal deliveries and help MWs provide immunization services. In practice, they also provide oral supplements to pregnant women (84%), provide antibiotics to mothers during the puerperium (43%), and provide misoprostol to prevent postpartum haemorrhage (41%). The current practices of AMWs demonstrate the potential for task shifting on selected essential maternal interventions. However, to integrate these interventions into formal practice they must be complemented with appropriate training, clear guidelines on drug use, systematic recording and reporting, supportive monitoring and supervision and a clear political commitment towards task shifting. Conclusion With the current national government’s commitment towards one AMW in one village, this study highlights the potential for shifting specific maternal lifesaving tasks to AMWs.
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Affiliation(s)
- Kyu Kyu Than
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Khaing Nwe Tin
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Daw, Myanmar
| | - Thazin La
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Kyaw Soe Thant
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Theingi Myint
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Daw, Myanmar
| | - James G Beeson
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine and Central Clinical School, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine and Central Clinical School, Monash University, Melbourne, Australia.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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17
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Erratum to: Auxiliary midwives in hard to reach rural areas of Myanmar: filling MCH gaps. BMC Public Health 2016; 16:1074. [PMID: 27733143 PMCID: PMC5059977 DOI: 10.1186/s12889-016-3747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Sommanustweechai A, Putthasri W, Nwe ML, Aung ST, Theint MM, Tangcharoensathien V, Wynn SS. Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps. HUMAN RESOURCES FOR HEALTH 2016; 14:64. [PMID: 27769312 PMCID: PMC5075211 DOI: 10.1186/s12960-016-0161-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/01/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND Myanmar is classified as critical shortage of health workforce. In responses to limited number of trained health workforce in the hard-to-reach and remote areas, the MOH trained the Community Health Worker (CHW) as health volunteers serving these communities on a pro bono basis. This study aimed to assess the socio-economic profiles, contributions of CHW to primary health care services and their needs for supports to maintain their quality contributions in rural hard to reach areas in Myanmar. METHODS In 2013, cross-sectional census survey was conducted on all three groups of CHW classified by their training dates: (1) prior to 2000, (2) between 2000 and 2011, and (3) more recently trained in 2012, who are still working in 21 townships of 17 states and regions in Myanmar, using a self-administered questionnaire survey in the Burmese language. FINDINGS The total 715 CHWs from 21 townships had completely responded to the questionnaire. CHWs were trained to support the work of midwives in the sub-centres and health assistant and midwives in rural health centres (RHCs) such as community mobilization for immunization, advocates of safe water and sanitation, and general health education and health awareness for the citizens. CHWs were able to provide some of the services by themselves, such as treatment of simple illnesses, and they provided services to 62 patients in the last 6 months. Their contributions to primary health care services were well accepted by the communities as they are geographically and culturally accessible. However, supports from the RHC were inadequate in particular technical supervision, as well as replenishment of CHW kits and financial support for their work and transportation. In practice, 6 % of service provided by CHWs was funded by the community and 22 % by the patients. The CHW's confidence in providing health services was positively associated with their age, education, and more recent training. A majority of them intended to serve as a CHW for more than the next 5 years which was determined by their ages, confidence, and training batch. CONCLUSIONS CHWs are the health volunteers in the community supporting the midwives in hard-to-reach areas; given their contributions and easy access, policies to strengthen support to sustain their contributions and ensure the quality of services are recommended.
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Affiliation(s)
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| | - Mya Lay Nwe
- Ministry of Health, the Republic of the Union of Myanmar, Naypyidaw, Myanmar
| | - Saw Thetlya Aung
- Ministry of Health, the Republic of the Union of Myanmar, Naypyidaw, Myanmar
| | - Mya Min Theint
- Ministry of Health, the Republic of the Union of Myanmar, Naypyidaw, Myanmar
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