This report is findings from a fifth consecutive assessment of RHCS in Myanmar using standardized structured methodology of UNFPA, which cover both the availability of RH commodities and salient aspects of service delivery facilities that underpin good RH programmes. The report informs design of the Maternal and Reproductive Health programme for the planning, implementing and should also encourage some developments within the current one. Assessment activities and findings also reflect comparison among five consecutive years for the country.
A cross-sectional descriptive design covering all regions with a representative sample size and sampling methods was used. The standardized questionnaire which was adapted in translation and formatting was used. Department of Medical Research (Pyin Oo Lwin Branch) mainly carried out data collection activities with assistance of Department of Public Health and Department of Medical Services. A total of 380 health facilities were surveyed and this included 175 at primary level, 167 at secondary level, 19 at tertiary level and 19 at private hospitals. Out of the total number of health facilities surveyed; 148 were located at urban and 232 were at rural areas.
Modern contraceptives offered by health facilities: Out of total 175 primary level HFs, 94.3% were providing at least three modem contraceptives (compare to 81.4% at 2016 and 82.3% at 2017) and majority was fulfilling basically required services for family planning. Among secondary level HFs, 48.5% were available of at least ‘five’ modem contraceptive methods. The comparison between government and private sectors showed 52% vs. 79% respectively.
Availability of Maternal and RH Medicines: Of total HFs, 55% were available of essential life saving MRH medicine. It was highest in tertiary level (78.9%) and lowest in primary level (48%). The urban rural gap (4%) was narrower in 2018 compare to 2017 (8.7%). Less than 40% of HFs in Chin, Rakhine, Bago and Ayeyarwady were available 7 essential MRH medicines like 2017 situation. Four most common RH life-saving medicines available in 2018 were “Inj Metronidazole” (86.6%), “Inj Na Lactate” (93.9%), “Oral Misoprostol” (70.5%) and “Inj Oxytocin” (88.7%). Injection TT was available at 58.4% of HFs of all levels.
Incidence of contraceptives "No Stock-Out": It was 62% at the day of assessment. Stock for “OCP” and “Injectable” methods were high in all levels (>75%). Implant stock were lower in secondary level HFs compare to tertiary level HFs (35% vs. 68.4%). Five common modern methods (OCP, Male condom, Injectable, |UD and ECP) were available over all regions. Comparison for specific methods between five years showed reduction of stock-out of implant while other methods stock-out rates were increasing. Contraceptive “no stock-out” at last three months was well observed only for OCP and injectable at all level HFs (>65%). Female condom was least frequent for “no stock-out” for all level HFs (<20%).
Supply chain, including cold chain: Main responsible person for drug indent were “MS”, and “Assigned MO” at tertiary and secondary level HFs, while “HA/LHV/Sister’ in primary level HFs. Supplies for majority of secondary and primary levels HFs were also quantified by calculation (63%). Main source of supplies for all levels HFs were respective Township Health Department and State/Region Health Department (68.4% and 15.7% respectively). Most of HFs (>70%) at all levels had their own arrangement for transportation of supplies to their HFs. About 40% of HFs at all levels were irregular in the interval. Availability of cold chain was 67.6% of HFs and was higher in tertiary and secondary level HFs (100% & 86.2%) and too much less in primary level HFs (42.9%).
Staff training and supervision: About 61.6% of HFs had trained staff for birth spacing and it becomes higher than last two year figures (50.4% at 2017 and 55% at 2016). Proportion of HFs which had trained staff for implant was increased to 31.3% from the last year data (i.e. 21.1%). Supervision for RH matter was received by 52.1% of HFs and it was higher in secondary level (57.5%) and highest in private hospitals (63.2%).
Availability of guidelines, check-lists and job aids: Availability of any guidelines was (157/380=41.3%) of HFs. Most frequently available guidebook was “Job aid for antenatal care” (24.7%) and “Guidebook for antenatal care” (18.7%). “National guidebook for BS” was available at 7.1% of HFs only.
Use of Information Communication Technology (ICT): Almost all of HFs had at least one of ICT appliances and it was much higher than last year. Most frequently used ICT appliance were “Smart phone’ (92%), and “computer” (39.1%). Use ICT for "Hospital record”, and "patient register” were more prevalent in this year assessment.
Waste disposal: Burying and burning were still mostly used method for waste disposal. However, waste disposal of 52.6% of tertiary level and 100% of private HFs used municipal disposal system.
Charges for user fees: User fee charge was noted at (132/380=34.7%) of HFs. 33.4% of HFs charged user fees especially for “medicine”. Private sector HFs had no FOC services. User fees for medication was more frequent at tertiary level and at urban HFs.
Linking to NHP which township level EPHS is core function, RHCS should also align to NHP centering it towards secondary level HFs because web-based databased software called “Logistimo” could be mostly functioning at township level.
Standard operating procedures (SOP) for RHC-LS should be developed to support system implementation and management to optimize stock balance. The standardized LMIS forms and the inventory control system for each health facility could be used across townships and States/Regions by following SOP.
Stock reallocation among different levels of health facilities across townships should be encouraged to keep adequate stock for RH and FP logistics. Innovated distribution method to HF should be found out for reaching in shorter interval between townships to health centers.
The system management could be further strengthened with effective, efficient and consistant supervision, using a formal structure of checklist or logbook keeping at HFs at all levels. The standard supervision checklist logbook will help and guide supervisors/visitors reached to the HF at any time and any reasons.
Continuous supportive supervision, including responsiveness on clients’ need would improve service quality on the aspect of continuity of care and inter-personal communication. It needs to develop a formal mechanism for reporting side effects and adverse events related to contraceptive service provision for both short term and long term methods in all levels of health facilities.
Providing more training for staff at secondary level HFs with further strengthening capacities to effectively forecast, procure, distribute and track the delivery of sexual and reproductive health commodities should be expanded, ensuring resilient supply chains and services. Incorporation of FP training updates into pre-services curriculum on how to offer comprehensive, quality, and voluntary rights-based family planning and SRHR counseling should be considered.
Country capacities for quality assurance of procuring contraceptives and RH medicine should be facilitated by aligning national procurement policies and procedure with global intervention system to foster national ownership and multisectoral collaboration.
Ways for task shifting of volunteers in some of FP services (such as providing SC-DMPA, counseling, information sharing, referring etc.) should be considered.
The contraceptives waste disposal mechanism to be linked with other waste management systems. Distribution of the guidelines, SOP and system for monitoring & supervision of disposal practices should be assured to reach all target areas. There should be budget line with enough amount for establishment and maintenance of waste disposal systems at all level of HFs. Uniformity of implementing RH waste disposal at all level HFs should be monitored.