Maternal, Newborn and Child Health (MNCH)

Maternal, newborn and child health (MNCH) is the largest component of 3MDG’s activities, covering maternal and newborn health, child health, immunization, nutrition, and health promotion.
50,307
births attended by a skilled person in 2015
14,364
pregnant women used emergency referrals in 2015
71,597
children immunized with penta 3 in 2015
50,960
women visited four times for ante-natal care in 2015

Covering 4.5 million people

Maternal, newborn and child health (MNCH) is the largest component of 3MDG’s activities, covering maternal and newborn health, child health, immunization, nutrition, and health promotion. The purpose  is to support township health planning and service delivery in order to scale-up and strengthen access to health services.

Delivering essential services

Our strategy is to deliver an essential package of MNCH services through a continuum of care approach. Working through and in partnership with the Ministry of Health as well as state and region health departments, 3MDG is supporting the work of basic health staff across hundreds of clinics in Myanmar.

Community-based work and the private sector

Alongside support to strengthen facility-based healthcare services, the Fund is providing significant financing for community-based work as well as quality service provision through the private sector. Economic modelling and early design work undertaken by the Fund clearly demonstrated that support to all these aspects of the health sector is critical if the 3MDG is to reach targets set for lives saved.  The Fund therefore provides financing support to the public sector, to international and local non-governmental organizations and to health care providers that use a social franchising approach.

Promoting township health plans

All elements of work are brought together under a township health plan in order to promote good governance and oversight, to ensure that resourcing is targeted towards those who need it and for greater efficiency.

Supporting the Ministry of Health

3MDG  is also supporting the Ministry of Health in the implementation of their health workforce strategy; and generating evidence through supporting research and sector-wide assessments to inform national policies and strategies.  We are financing the training of more than 5,000 volunteer ‘auxiliary’ midwives nationwide and providing technical assistance to the Ministry of Health to strengthen midwifery across Myanmar. These additional areas of work reflect a change of strategy underpinning how 3MDG will have the most beneficial impact.

A family in Ayeyarwaddy Region that benefited from essential package of MNCH services supported by the 3MDG Fund.

Areas of Work-Maternal Newborn and Child Health

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Evidence base for national MNCH strategies

The Ministry of Health and the 3MDG Fund are generating an evidence base to inform national strategies, guidelines and policy. Evidence-based public health means applying the best available evidence to set policies and practices. The 3MDG Fund and its partners are collecting systematic information through routine monitoring systems and specific operational studies. Initial work in 2014 included a number of interventions that will lead to a more substantive body of work in 2015 and beyond:

MATERNAL DEATH AUDIT

The 3MDG Fund supported the Ministry of Health to develop and publish a comprehensive maternal death audit.

GUIDELINES FOR EMERGENCY MATERNAL AND CHILD REFERRAL

The Ministry of Health hosted a workshop where guidelines for emergency referrals from the secondary to tertiary levels of health care were discussed with experts from townships, implementing partners and the 3MDG Fund management office.

TOWNSHIP HEALTH PLANNING REVIEW

The experiences of different implementing partners in developing township plans were reviewed. The reporting of implementing partners enables the establishment of unit costs for key interventions and the creation of value for money analyses.

COMMUNITY HEALTH VOLUNTEER RECORDING AND REPORTING SYSTEM

A system was developed jointly with all implementing partners to enhance the recording and analysis of services provided by community health workers. The system will be implemented in 2015.

MONITORING AND EVALUATION TECHNICAL AND STRATEGY GROUP (M&E TSG)

The TSG met twice in 2014 with the 3MDG Fund management office as secretariat. The TSG agreed to develop a national research agenda that will lead to funding opportunities for 3MDG. The TSG will also be used for the dissemination of information relevant to public health and policies.

WORK IN CONFLICT-AFFECTED AREAS

The 3MDG Fund and its partners started the systematic assessment and recording of work in conflict-affected areas to better understand health programming in conflict-affected areas and the application of ‘do no harm’ principles.

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Service Quality Improvement for MNCH

Across Myanmar, there is a need both to get more out of limited resources for health, and to scale up existing health services to reach more people. The process of improvement and scaling up of services needs to be based upon sound local strategies for quality so that the best possible results are achieved from new investment.

Following a review of 3MDG financing for maternal, newborn and child health services, the Ministry of Health and the 3MDG Fund have agreed to focus on improving quality within the health sector as an explicit area of work. This will build upon work already being undertaken by the Fund. Examples of such work include:
 

  • Financing to improve quality of midwifery services
  • Strengthening of township health department supervision and monitoring of services across areas where 3MDG is providing financing support
  • On-the-job training and capacity building of basic health staff
  • Strengthening linkages between skilled midwives and auxiliary midwives to enhance quality and strengthen the continuum of care

The Fund will be working with the Ministry of Health to identify resourcing requirements to expand upon this work.

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Support to the MoH's Human Resources for Health strategy (HRH)

Well-trained health workers are essential to a well-functioning health system. The 3MDG Fund is supporting the Ministry of Health in the strengthening of its health workforce, and is financing the training of midwives and auxiliary midwives. This support will lead to more and better quality health services across the country.
 

SUPPORT TO PRE-SERVICE AND IN-SERVICE TRAINING OF MIDWIVES NATIONWIDE

The Ministry of Health’s Department of Health and the Department of Medical Science are supported through a multi-year grant totalling US$10 million to Jhpiego, an affiliate of John Hopkins University. The support has been strengthening midwifery nationwide since July 2014. This is a significant health system strengthening programme that supports the Ministry of Health in the improvement of the existing policy and regulatory framework guiding high-quality pre-service education and in-service training.

The programme will support improvements in midwifery education in up to 20 midwifery schools by 2016.

Additionally, it strengthens the continuing professional education system, including in-service training, which leads to optimal performance by midwives and provides support structures for midwives in facilities and communities.
 

AUXILIARY MIDWIFE TRAINING BY MINISTRY OF HEALTH

The Ministry of Health has set a national target to deploy at least one trained health care provider to every village, and to train 9,660 auxiliary midwives in the 2014-15 financial year.

In October 2014, 3MDG committed to support the ministry in the training of over 5,000 auxiliary midwives in nearly 200 townships.

The enrolled auxiliary midwives will undertake a six-month training, which combines theoretical training at the Township Hospital and then practical training at the Rural Health Centre to which they are attached. The trainees will commit to serve at least 3 years in the geographical area of their residence, and will be placed under the guidance of Health Officials. This training will allow them to provide effective support to midwives in the communities they serve and improve the delivery of antenatal and postnatal care for women and children.

During November and December 2014, a total of 1,588 auxiliary midwives were enrolled in training programmes, covering 77 townships. Trainings were conducted by the township health departments, and made use of the managed cash flow system designed by UNOPS for the disbursement of Global Fund-related expenses to TB, HIV and malaria activities.
 

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Strengthening service delivery in public and private sectors

Across Ayeyarwady, Magway and Chin regions and states, ‘supply and demand side interventions’ are being used to address the challenges people face in accessing essential services. On the supply side, the 3MDG Fund is providing financial and capacity building support to the public sector to strengthen service delivery. An essential part of the approach to improve service provision for hard to reach areas is through enhancing the planning capacity of the township health departments. On the demand side and through the public sector as well as the implementing partners, the 3MDG Fund is strengthening communitybased health services, the referral of emergency cases and private sector health care services.

AYEYARWADY REGION

In the Ayeyarwady Region, five partners whose work was extended from the Joint Initiative on Maternal, Newborn and Child Health (JIMNCH) were awarded new grants that harmonize with 3MDG ’s approach. In 2014, these partners supported the townships in the assessment and prioritization of needs and the planning of activities for the period 2014 to 2016.

CHIN STATE

In Chin State, support to the four townships of Mindat, Madupi, Tedim and Falam began at the end of 2013. Support to the remaining five townships of Hakha, Tonzang and Thantlang and Paletwa and Kanpetlet started in 2014. In all areas, support began with an inception and planning period of three to five months, followed by the implementation of activities. Some delays were experienced due to access issues during the rainy months and the high turnover of township health department staff.

MAGWAY REGION

In Magway Region, since February 2014, the 3MDG Fund supports the three townships of Seikphyu, Pauk and Myaing were granted to Marie Stopes International (MSI) and the two townships of Ngape and Gangaw to Save the Children (SCI). Activities began in July 2014 in the two SCI-supported townships, but in the other three did not start until September 2014 due to delays in the start-up of those programmes. There are areas of Gangaw, Myaing and Pauk townships that are geographically difficult to access and it will be particularly difficult to implement activities during the monsoon season.

CONSTRUCTION OF HEALTH FACILITIES

Across many remote areas of the country, there is a need for new and improved health facilities, particularly for rural health centres and sub-rural health centres. Wherever a health facility is to be constructed, housing is also built for basic health staff. Through this approach, a wider range of services can be provided and health staff can be better motivated and retained. The 3MDG Fund supports the construction of health facilities via an infrastructure team established as a separate unit within UNOPS Myanmar. The project is managed by a project board that includes the Ministry of Health.

PRIVATE SECTOR: STRENGTHENING SERVICE DELIVERY

In Myanmar, many people currently access health care services through the private sector. The 3MDG Fund supports interventions that both improve the quality and availability of private sector services and are complementary to public health services.
Population Services International (PSI) was contracted to provide complementary support for maternal and child health to the townships. This includes a franchised network of local doctors called the Sun Quality Network. PSI also uses a network of health care volunteers who sell quality-assured products at subsidized prices. Products for maternal and child health are made available through retail points. Finally, trained staff members work to create demand in 3MDG supported townships. PSI is also engaged in a public-private partnership with township health departments to support them in the provision of long term contraceptives and cryotherapy for cervical cancer.
Marie Stopes International (MSI) was awarded a grant to support 15 townships with static and mobile clinics, where they provided a full range of sexual and reproductive health services, as well as short-term contraceptives through retail outlets and demand creation. MSI also stated that they found that the demand for short-term contraceptives is lower than anticipated while the demand for long-term methods is higher than planned. Due to these challenges as well as difficulties in staffing the offices in the remote townships, MSI achievements have also been lower than their targets.
 

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Scale-up of services in conflict-affected areas

The 3MDG Fund is financing health care in conflict-affected areas to address the health needs of underserved populations. These are areas where the Ministry of Health has identified challenges to serve the population through the public health system. In agreement with the Ministry of Health and other stakeholders, an implementing partner works with the township health departments, ethnic health organizations and civil society groups that may have access to areas not accessible to basic health staff.

KAYAH STATE

Work in Kayah State began in July 2014. The International Rescue Committee (IRC) received a 3MDG grant to support maternal, newborn and child health service provision across all seven townships in the state. IRC worked closely with the state health department and also partnered with the Community and Health Development Network (CHDN), a local organization consisting of representatives of ethnic health organizations that are active in Kayah.
Recognising that the development of seven comprehensive township health plans in partially conflict- affected areas would take time in order to ensure the active participation of all stakeholders, IRC was granted funds to support priority service delivery activities alongside the planning phase. This included supporting the Ministry of Health’s ‘crash campaigns’ to bring immunization services to previously unreachable areas. 

As part of the 3MDG Fund’s monitoring of the roll out of its conflict sensitivity strategy, visits were undertaken throughout 2014, including by Fund Board members and conflict advisers. These highlighted the key role an implementing partner can play in mediating and facilitating between government health structures and ethnic health organizations. They emphasized the need to reinforce this coordination role first, before ambitious service delivery targets are set and implemented. 

SHAN STATE

In June 2014, 3MDG issued a call for proposals for a total of nine conflict-affected townships in Shan State. Applications for only seven townships were received. The review panel, which included the Ministry of Health, selected three implementing partners. Recognizing the challenging operational environment in Shan, the 3MDG Fund management office held preparatory meetings with the selected implementing partners and visited the townships in Northern Shan to assess the situation and collaborate with health authorities.

A grant to the three southern Shan townships of Hsihseng, Mawkme and Laikha with Relief International was finalized in December. In line with the recommendations of the Strategic Review, with this grant it was agreed that the partner would immediately support ongoing efforts by the Ministry of Health and others in activities such as outreach, immunization crash campaigns, emergency referrals, and assessments in addition to supporting the township planning process. Security conditions vary to a great extent in these three townships, which is likely to result in different approaches being applied to each. The implementing partners in the Northern Shan townships started their contracts on the first day of 2015.

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Support to health care in Special Regions

The 3MDG Fund will provide funding for health care services in Myanmar’s Special Regions to support integrated services for minorities and hard to reach populations. This support addresses the need to expand service coverage and improve the quality of service delivery. The implementing partners act as a bridge between the Ministry of Health and the Special Region health departments to maximize ministry support.

FIELD ASSESSMENT TO SPECIAL REGION 4 AND THE WA SELF-ADMINISTERED REGION

In June 2014, a team of Ministry of Health officials and 3MDG staff visited Monglar in Special Region 4 and the Wa Self-Administered Region. The mission explored ways to improve service delivery for a range of maternal, newborn and child health and disease control interventions. This visit was followed up by a ministry-organized workshop with participants from the Ministry of Health, the health departments of Wa and Monglar, 3MDG and non-governmental organizations operating in the area.
The participants agreed to develop a proposal for an integrated approach to expand maternal, newborn and child health, tuberculosis, malaria and HIV services to the townships in Wa and Special Region 4. At the end of 2014, workplans, budgets and proposals had been submitted by Health Poverty Action to the Fund Management Office and were being reviewed prior to submission to the Ministry of Health.

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