Technical Support and Capacity Building for Evidence-Based Policymaking in Myanmar
As part of their commitment to providing primary healthcare, Myanmar in 2008 began preparations for implementing a proposal called the Health System Strengthening (HSS) programme and received funding from the Global Alliance for Vaccines and Immunization (GAVI). A scheme – known as the Maternal and Child Health Voucher Scheme (MCHVS) – was developed and aimed to enhance accessibility to Antenatal Care (ANC) and delivery services by skilled birth attendants (SBAs) for poor mothers and their children. To understand the supply and demand side of financing and appropriately design the initiative, HITAP in collaboration with WHO provided technical support to Myanmar’s Ministry of Health (MoH) for the conduction of a feasibility study. Concomitantly, a capacity building programme on research methods, data collection and analysis, evidence-based policy decisions, as well as public communication to facilitate the services uptake was organized for local partners.
The study was conducted in the Lewe, Yedarshey and Tatkone Townships from May 2010 to March 2011. The first mission in May 2010 developed a protocol for the MCHVS which was technically and financially feasible, acceptable among stakeholders and also relevant to the country context. The second mission was conducted in August 2010 to assess the budgetary requirements for the newly designed maternal and child health initiative as well as to provide training to the local partners in Myanmar on conducting a costing study. The last mission, conducted during March 2011, estimated the potential cost and health outcomes from the future implementation of the scheme and devised a system and mechanism for its monitoring and evaluation.
With the implementation of the program and extensive efforts for increasing awareness and trust of MCHVS, the expected outcome is that mothers in the lower-income group would take advantage of this scheme, of which the long-term impacts are expected to be a reduction in overall health spending for pregnant mothers, provision of proper maternal and child care by SBAs, and a decrease in neonatal and maternal mortality rates. Lastly, this scheme must also be cost-effective for the government.
The results from this study showed that the MCHVS was feasible and had a good chance of being implemented in Myanmar and increasing the service utilization of ANC and delivery by SBAs, especially for poor households. Financing under the scheme would eliminate any provider fees and other household expenses related to the use of MCH services. As pregnant women had the choice of using MCH vouchers at any health facility and there were enough incentives for providers to offer to voucher holders, the scheme could promote the quality of MCH services and reduce both neonatal and maternal mortality.
After the study, the guidelines for the MCHVS were developed by the MoH and HITAP in collaboration and the responsibilities for further implementation of the scheme were transferred solely to the MoH. The guidelines consisted of four sections covering voucher distribution, financial management, communication, and monitoring and evaluation. Once the guidelines were approved, the MCHVS pilot programme was initiated in Yedarshey Township on 11 May 2013 after much preparation and advocacy.
Six months after the programme’s commencement, the WHO and MoH asked to see the current process being used according to the guidelines and the present utilization status of the MCHVS. HITAP visited Nay Pyi Taw to conduct a midterm review from 21 to 23 January 2014. The review showed that the scheme offers suitable incentives for poor pregnant women to undertake ANC and delivery by SBAs. The review also made policy recommendations, such as considering non-midwife voucher distributors to ensure better access to the target group (economically constrained mothers) and efforts to guarantee sustainability in the future.