Strengthening Health- Applying Research Evidence (SHARE)

Background: Myanmar shares same fate with Bangladesh in relation to weak public health infrastructure and low spending on public health care and severe shortage of human resources at public health care level and preventive aspects, limited capacity of public health institutions in policy analysis and evidence-informed health policy making. Under this backdrop, European Union (EU) supported ‘SHARE’ (Strengthening Health, Applying Research Evidence) project of icddr,b organized an experience sharing visit in Yangon and Nay Pie Taw , Myanmar for policy makers, programme managers and researchers of  Bangladesh from July 17-23, 2016. The visit helped team members to know the details of the non-communicable diseases (NCDs) programme initiatives being implemented in Myanmar under the EU supported Strengthening of Public Health Institute Project (SPHIP), existing management information systems (MIS) of the Myanmar Ministry of Health. As part of the South-South Collaboration activity under the project, the visit has encouraged cooperation and exchange of knowledge and expertise on successful interventions and best practices in health sector. Senior representatives from the Directorate General of Health Services, and the Institute of Epidemiology, Disease Control and Research , Bangladesh and icddr,b joined the visiting team led by Dr. Iqbal Anwar, Scientist and Project Director of icddr,b.

Visit at HelpAge, Myanmar: The visit started with the meeting with health programme team of HelpAge International, Myanmar on July 18. Dr. Soe Myint, Public Health Technical Adviser, HelpAge International welcomed Bangladesh team at HelpAge International office in Yangon. HelpAge team briefed EU supported programme is strengthening public health capacity to respond to Myanmar’s disease transition. Under EU supported SPHIP, HelpAge Myanmar has planned to conduct future research studies on NCDs mortality and preparedness and responsiveness of health service delivery to NCDs.

Visit at University of Public Health: On 18 July afternoon, visiting team had an experience sharing meeting at University of Public Health (UPH), Yangon. Professor Dr. Nay Soe Maung, Rector welcomed the team at UPH. Visiting team learnt about UPH capacity building training on policy analysis and policy brief development in Myanmar. Dr. Sohana Shafique, Senior Research Investigator of icddr,b from the visiting team  talked about Health Policy Making training conducted by University College London under SHARE project and proposed for technical support if required.

 Learning Health Management Information System: On July 20, 2016, Dr Thet Thet Mu, Director, Health Management Information System and Department of Public Health, Ministry of Health and Sport, welcomed visiting team at her office in Nay Pyi Taw, Capital City of Myanmar. She demonstrated data flow of Health Information System (HIS) originated from rural and sub-rural health center, district or township health department up to Department of Public Health through State/Regional Health Department. District Health Information System2 (DHIS2) software use started at Region/State level in 2015 and now covered 30 Townships of Myanmar. Donor interest to support HMIS and willingness from private hospitals are creating more opportunities for strengthening HIS in Myanmar. From visiting team, Dr. Jannatul Ferdous, Senior Technical Expert of icddr,b briefed Myanmar team on overall progress of DHIS2in Bangladesh. Participants from Myanmar and Bangladesh team participated in mutual sharing on health information system. Visiting team from Bangladesh appreciated leadership and visionary efforts of Dr Thet Thet Mu in transitioning Health Management Information System of Myanmar at expected level. It was agreed that mutual sharing of technical expertise would be explored in the area between Myanmar and Bangladesh.

Visit at Department of Public Health: Team visited Department of Public Health, Nay Pyi Taw in the afternoon of July 20. The Department of Public Health, one of the seven departments under the Ministry of Health plays a major role in providing comprehensive health care throughout the country including remote and hard to reach border areas. Dr. Myint Shwe, Director (NCD) welcomed the team members and discussed about government steps on NCDs prevention and control in Myanmar.

Field visit at PEN site: In Myanmar, total number of deaths from NCD is 441,000 in 2014 and it comprises 59% of total deaths. It was learning experience to see advocacy and training for PEN (Package of Essential Non-communicable disease prevention) implementation by Basic Health Staff (BHS) at primary healthcare level in Myanmar. The goals of PEN intervention in Myanmar are to achieve universal access to high-quality diagnosis and patient- centered affordable treatment, to reduce the suffering and socioeconomic burden associated with major NCDs. On July 22, 2016, team visited a Package of Essential Non-communicable (PEN) site of a rural health center at Hmawbi Township. (Currently Hlegu and Hmawbi townships are included for PEN piloting). Head of rural health center and other project staff of HelpAge International gave briefing on PEN interventions in the center.  Under PEN interventions, inexpensive medications are used. These interventions include prevention of heart attack, stroke and diabetes, treatment of diabetes, hypertension and dyslipidaemia, counseling for cessation of smoking, avoidance of harmful use of alcohol, healthy diet and regular exercise. Visiting team observed access to health care in rural health centre and a community clinic under Hmawbi Township. Villages of Myanmar have primary health care centers like rural health center and community clinics where midwives and health assistants take caregivers role.

Visit at University of Medicine2: Experience sharing visit ended with meeting at University of Medicine2 in Yangon. Dr. Ko Ko, Professor and Senior Consultant Endocrinologist, Head of Department, Department of Diabetes and Endocrinology, University of Medicine (2) welcomed the participants at his department. Dr. Ko Ko and his team gave presentation on PEN interventions for Primary Health Care in low resource setting in Myanmar.

Way forward: Myanmar visit provided an excellent opportunity to share knowledge, skills, expertise and resources through concerted efforts on evidence-informed health policy making between two countries.

 In this visit, representatives of government partners from Bangladesh were included to facilitate sharing of knowledge and experience at government level. Importance of their participation has increased manifold since it may catalyze implementation efforts in EU supported activities in the coming days. Different meeting, consultation, field visit and sharing in Myanmar have emphasized the importance of South-South cooperation in capacity-building and setting best practices, particularly in the areas of health management information, NCDs prevention, and policy dialogue. Next programme on South-South Cooperation under SHARE project is planned to hold in Bangladesh in early 2017.

This visit has showcased how EU supported projects can serve as useful platform in promoting cooperation among developing countries and play asknowledge broker, capacity building and partnership catalyst in evidence-informed health policy making. Moreover this visit has underscored the necessity of creating linkage of research and health programme implementation in EU supported countries. “Such experience sharing visit will stimulate ‘out of the box’ thinking about the possibilities for regional cooperation, and inform policy makers on best practices and research evidence in health policy making. We must continue the momentum”, Dr. Iqbal Anwar shared his optimism while leading his Bangladesh team in Myanmar. Above all, it has accelerated professional motivation and capacity building of team members at different levels of evidence-informed health policy making in Bangladesh.