SPHC Myanmar - Union Minister for Health and EU ambassador mark end of the project to strengthen Myanmar's health system to tackle rising number of non-communicable diseases

Union Minister for Health and EU ambassador mark end of five-year project to strengthen Myanmar's health system to tackle rising number of non-communicable diseasesUnion Minister for Health and EU ambassador mark end of five-year project to strengthen Myanmar's health system to tackle rising number of non-communicable diseases

On 25 January 2020, Union Minister for Health Dr Myint Htwe and European Union (EU) ambassador Kristian Schmidt joined academics, frontline health staff and other stakeholders at the University of Public Health in Yangon to mark the end of a five-year EU-funded project to strengthen Myanmar's health system to better prevent, diagnose and manage non-communicable diseases (NCDs) in the country.

Over the past decades, non-communicable diseases (NCDs) have been sharply rising across Myanmar. Conditions such as heart disease, diabetes and cancer caused 49% of all deaths in 1990. In 2017 the figure had risen to 71 per cent.[1] This shift is being driven by Myanmar's ageing population, as NCDs are more common among older people, and by the prevalence of lifestyle choices that increase the risk of developing these conditions, such as poor diets, low physical activity, and alcohol and tobacco use. Yet, access to effective diagnosis and treatment is limited, especially in rural areas, while the population is unaware of the conditions and how they are putting themselves at risk.

The Ministry of Health and Sports, University of Public Health, Yangon, University of Medicine 2, Yangon, and Thammasat University, Thailand worked together with health professionals and international experts to strengthen Myanmar's health system, modernise healthcare services and improve their response to the rising number of NCDs. The five-year project to better prevent, diagnose and manage NCDs had been implemented by HelpAge International and funded by the EU, World Diabetes Foundation and Age International.

Attendees, which included senior officials from the Government, EU, UN, INGOs and civil society representatives, health staff involved in the project, and academics from partner universities, heard how the project focused on three key areas to strengthen the response to NCDs:

• Improving health service delivery to ensure it reaches a minimum quality standard and is accessible to those who need it.
• Enhancing the knowledge, skills and motivation of health staff.
• Expanding the availability of reliable data and using it to inform health policy decision-making.

Through the project, HelpAge supported the University of Public Health, the Ministry of Health and Sports and wider health stakeholders to develop the National Strategic Plan on Prevention and Control of NCDs (2017-2021). As a result, NCDs are now a part of mainstream health dialogue, and there is better collaboration across government departments and more space for evidence-based health policies. A standalone mental health policy, which was previously an issue only incorporated into the general health policy, has been drafted as a result of the project and is now awaiting approval.

Ten other policy briefs on topics including chronic respiratory disease and the role of communities in tackling NCDs are also being used to advocate for health service changes in Myanmar at state and region levels.

Over 1,300 health staff from all 330 townships have been trained on NCD diagnosis and management, which also equipped them with the skills to pass this knowledge to other health staff in their communities. They expanded their knowledge on areas including the inexpensive methods for screening and diagnosing NCDs early, approaches to reduce NCD risk factors, such as obesity and alcohol and tobacco use, and which affordable medicines can be used to treat conditions.

"The better care we are now providing has resulted in increased patient trust,” said Daw Tin Tin San, a health visitor in Thanlyin Township in Yangon.

"This project [has] helped patients and the broader community to understand that our role [as midwives] goes beyond maternal care: we can provide good quality care for NCDs too," said Daw Htet Htet Win, a midwife in Thanlyin Township in Yangon.

The project also implemented an innovative new pilot initiative in East Dagon in Yangon to screen people through community groups led by older women and men, known as inclusive self-help groups (ISHGs). We trained and equipped ISHGs to screen those aged 40 and over to detect early signs of NCDs, including diabetes, cardiovascular disease and oral cancer, referring those who show symptoms to health facilities and following up to ensure they attend clinics.

Seven ISHGs have already carried out over 10,000 screenings, referring 3,140 people to health facilities. The success of this pilot will be built on by expanding the work to 75 groups across Ayeyarwaddy, Mandalay and Yangon regions.

H.E. Kristian Schmidt, EU Ambassador to Myanmar said: "In Myanmar, as around the world, more people escape poverty and get older – but are we also getting healthier and equal access to quality care? Economic development and urbanisation brings pollution, chronic respiratory diseases, heart disease, diabetes and cancer, the so-called non-communicable diseases. To address these diseases, the European Union is proud to support the ability of the Ministry of Health and public health universities to develop and implement effective evidence-based policies for better health."

Eduardo Klien, Regional Director for HelpAge International in Asia, said: "Five years ago, Myanmar was unprepared for the growing burden non-communicable diseases were placing, and will continue to place, on its health system. But since 2015, with the support of this project, the Ministry of Health and Sports and partner universities have made huge progress to improve the quality of healthcare delivery, expand understanding of NCDs and ensure the control of these conditions is a priority in the coming years. A strong foundation has been laid and we look forward to continuing our collaboration with the ministry to improve NCD healthcare in the future."

[1] Global Burden of Disease Study 2017 (IHME, University of Washington) 2019: http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2017-permalink/d578f6ad369206a82451fe0d3496d8a3