SPHC Myanmar - enablers and barriers in implementation of PEN service in Myanmar

Abstract

Background Information: Package of Essential Non-Communicable Disease Intervention (PEN) was started in 2016 in Myanmar to combat the preventable non-communicable diseases (NCDs). This study was done to assess the enablers and barriers for PEN implementation service among community and health service providers.

Methods: Study was conducted in Nyaung-Oo, Lewe and Taung-Ngoo Townships of Myanmar in 2019 by using mixed methods among 330 community household members of age 40 year and above for quantitative study and 29 health care providers and 6 community leaders for qualitative portion.

Findings:  Of 330 participants, nearly half of the participants (44%) had known NCDs. More than half of participants who knew PEN services in their areas (61.5%) had not consulted in PEN clinic. The reason of not consulting in PEN clinic they mentioned were because of not presence of NCDs among them (56.4%) and some participants (13.5%) didn’t know about the PEN services and (12.7%) had already taken the NCDs treatments from physician or private clinic, (11.1%) mentioned that they had no extra time to come to PEN clinic and (1.6%) stated that because of deformity or stroke. From the qualitative study, enablers of PEN service they mentioned were supply of drugs with free of charge, getting of trust towards BHS from community, supporting of guideline for treatment,  increasing confident of BHS on NCDs treatment, easily accessible for treatment of NCDs for community, regular clinic day, early diagnosis and treatment of NCDs, increasing awareness of community on NCDs, presence of supporting organizations to PEN service and supporting  from the ministry of health and sports. Barriers were insufficiency of drugs, some problem in   equipment, not getting response in time repairing equipment from central level, some weakness in training, lower health education level and awareness on NCDs among community and shortage of manpower. Most of them suggested to supporting refresher trainings to basic health staff, to continuous supply of drugs and equipment and to combine the all reporting forms with standard reporting format.

Conclusion: On conclusion, nearly half of the participants had known NCDs but nearly two-third of the respondent had not utilized the PEN service. The main reasons of not using were lack of awareness on PEN service. Enablers were more than barriers on implementation of PEN service; therefore, PEN service should be continued to cover the whole country.