Myanmar: Primary Health Care
The military coup in Myanmar has interrupted the progress towards Universal Health Coverage (UHC) and provoked a quasi-collapse of the public health system. Through the Primary Health Care project, Switzerland supports conflict-affected communities in Karen State by providing essential lifesaving healthcare and quality basic maternal and child health services through strengthening the ethnic health system and the community-based service provision.
Primary health care
Health systems strengthening
- Other international or foreign NGO North
- Foreign private sector North
- Save the Children Federation
|Background||The conflict in Myanmar is the world's longest ongoing civil war, having spanned more than seventy years. Decades of underinvestment in health care have resulted in an underdeveloped and fragile health system with poor health outcomes, especially in maternal and child health - the mortality and morbidity ratios still remain the highest in South East Asia. In many ethnic areas, there are two parallel health systems which are intertwined and overlapping: the national health system operated by government and the ethnic health system operated by Ethnic health organizations (EHOs) which are the civilian health departments of Ethnic armed organizations. The military coup in February 2021 has interrupted the progress towards UHC - especially on routine immunization - leading to considerable inequities in health access and provoked a quasi collapse of the public health system. The Primary Health Care (PHC) project was initially designed to bring convergence to the two parallel health systems in Karen State, seen as an entry point for “interim arrangement” and peace negotiations. Following the coup, PHC had to significantly adapt its interventions by suspending all activities with the regime Ministry of Health and reinforced their engagement with EHOs and Civil Society Organizations to deliver equitable and quality health services to the conflict-affected population. Switzerland brings comparative advantage from its long-standing experience working with EHOs as well as from its Nexus approach.|
|Objectives||Marginalized and conflict-affected communities have access to better basic healthinfrastructures and services and are enabled to contribute to local and ethnic health governance through enhanced individual and organizational capacities.|
- The project will serve a population of 422’238 beneficiaries in 666 villages in 4 conflict-affected townships in Karen State: Hlaingbwe, Myawaddy, Kawkareik, and Kyainseikkyi.
- The primary groups include pregnant mothers, under 5 children, women of reproductive age, persons with disability, and internally displaced persons (IDPs).
- ~150’000 women, 18’000 pregnant and lactating women, 25’000 under 5 children, and 368 Village Health Committees.
- Equitable provision of quality basic primary health care services is improved in rural areas of target townships;
- Communities are empowered to improve health status and local health governance;
- Local and Ethnic health governance as well las local and ethnic health systems in Southeast Myanmar are coordinated and strengthened.
1.1) Provision of quality basic maternal and child health services through mobile primary care units and Community-based health workers;
1.2) Community-based referral mechanisms established;
2.1) Established and revitalized VHCs are capacitated to promote local health governance;
2.2) Informed community members have the knowledge to identifyand seek physical and mental health services;
2.3) CBHWs are engaged in promoting women’s empowerment and gender equality;
3.1) Strengthened local community-based health care system in regime-controlled areas;
3.2) Strengthened ethnic health systems by establishing a prioritized health system strengthening package (health information, human resource, supply chain, service delivery and health financing);
3.3) Improved institutional capacity of EHOs to strengthen their leadership/governance, sustain their health system, and promote localization.
Results from previous phases:
286’309 beneficiaries (23’151 mothers,16’147 under 5 children):
- 4’941 emergency referrals
- 11’391 skilled birth attended deliveries
- 21’425 women received modern family planning
- 214 functioning Village Health Committees
- Renovation of 19 ethnic health facilities
Ethnic Health system strengthening: 14 ethnic health facilities applied standard Health Management Information System, Covid-19 vaccine pilot, cross-border routine immunization with support of Thai Public Health (twin village programme).
End-of-Phase evaluation advised to focus on EHSS, reinforce triple nexus approach, gender transformation, quality assurance system and sustainable exit strategy.
|Directorate/federal office responsible||
The contract partners will not provide any financial or technical assistance to the military government, as per Swiss engagement principles.
|Coordination with other projects and actors||
Within the Swiss portfolio, there are synergies at 3 levels:
with other Health projects (Access to Health Fund and Women and Girls First);
with other key bilateral projects (e.g. Direct Action Ethnic System Strengthening);
with other Swiss multilateral partners (ICRC, Myanmar Humanitarian Fund (MHF)).
Moreover, coordination with the USAID funded LEARN project (for local governance) and GAVI/UNICEF (on routine immunization).
|Budget||Current phase Swiss budget CHF 9’100’000 Swiss disbursement to date CHF 2’500’050|
|Project phases||Phase 3 01.05.2023 - 30.04.2026 (Current phase) Phase 2 01.01.2019 - 30.04.2023 (Completed) Phase 1 01.03.2014 - 31.12.2018 (Completed)|