Improving health and nutrition in Myanmar
Myanmar has transitioned towards democracy after decades of social and economic isolation. Years of under-investment in the health care sector have left it lagging behind in key indicators of public health and nutrition. Myanmar spends just 2% of its gross domestic product (GDP) on health care and government spending on health care accounts for only 12% of all health care spending.
The recent economic revitalization of the country brings with it opportunities to make up for lost time and focus on health care strengthening. The Myanmar government has pledged a fivefold increase in health care funding. Government investment is enhanced by significant foreign aid, including a pooled investment of $334 million dollars from the Three Millennium Development Goals Fund to achieve goals in the areas of maternal, newborn, and child health; HIV, tuberculosis, and malaria; and health care system strengthening.
PATH is committed to contributing to this health care transformation through strategic partnerships with the government, international and local nongovernmental organizations, and the private sector. In 2013, we signed a memorandum of understanding with the Myanmar Ministry of Health. Our unique contribution is our experience in introducing new technologies appropriate for low-resource environments and our deep expertise on a range of public health threats.
Our work so far has focused on training birth attendants to ensure newborns get a strong start in life, introducing simple and effective new methods to detect cervical cancer, and addressing micronutrient deficiencies with fortified rice. Going forward we will expand this repertoire with projects that leverage our strengths to help people in Myanmar live long and healthy lives.
PATH’s flagship project in Myanmar is improving nutrition through rice fortification. In Myanmar, rice is a staple food for all and the only major source of nutrition for many. This limited diet leads to high rates of micronutrient deficiencies, which have lifelong consequences on health, productivity, and mental development, particularly for women and children. In Myanmar, malnutrition is severe for children under age five, with 28% underweight, nearly 40% stunted, and nearly 8% wasted according to UNICEF.
PATH is responding with a unique approach that does not require people to change their eating habits. We are working with local partners to produce fortified rice grains using PATH’s Ultra Rice® technology. These vitamin- and mineral-packed grains are extruded through pasta-making equipment and formed into the shape of rice grains. The grains are then blended with traditional rice—typically at a ratio of 1 to 100. We know from more than 30 clinical trials and our experience in India, Brazil, and other countries that this fortified rice has proven its effectiveness in addressing micronutrient deficiencies.
Vaccines and immunizations
PATH has been instrumental in expanding vaccine and immunization rates across the Mekong region. We work closely with government officials in Vietnam, Laos, and Cambodia to assist them in applying for funding from Gavi, the Vaccine Alliance, and to design and implement successful campaigns.
PATH is eager to bring our vaccine and immunization expertise to Myanmar. In recent years, Myanmar’s immunization program has been steadily improving, with coverage rates reported to be 85%. But significant systemic barriers remain, particularly in the 70 townships identified as physically and socio-economically hard to reach.
PATH is mobilizing resources to assist the Myanmar government with these challenges and to support them in the introduction of new vaccines. In collaboration with the WHO and UNICEF, PATH is supporting the Myanmar Ministry of Health and Sports (MoHS) implement the Central Expanded Programme of Immunization, for the timely introduction of Japanese Encephalitis vaccines to save the lives of children in Myanmar.
Reproductive, maternal, and child health
PATH’s work in Myanmar began in 2012 with a project to improve community-based neonatal care. Many women in Myanmar deliver their babies at home, with midwives as their most common birth attendants. Infant mortality rates are high compared to other countries in the region at 62 deaths per every 1,000 births according to recently released census data. PATH has been working in partnership with government and nongovernmental organizations to improve care for newborns and strengthen women’s health.
Cervical cancer is easily prevented if precancerous lesions are detected early, yet it is a leading cause of cancer deaths among Myanmar women today. The rate of new cases of cervical cancer in Myanmar is about 3 times higher than in the US and the rate of deaths due to cervical cancer is nearly 5 times higher.
PATH is introducing Myanmar health practitioners to new and easy methods for screening and treatment that do not rely on sophisticated laboratories and can deliver quick results. Our pilots show that this visual inspection approach is easy to learn and apply in low-resource environments.
According to UNFPA’s 2013 profile, approximately one fourth of women of childbearing age in Myanmar (nearly 1.8 million women) would like to practice what is locally referred to as birth spacing, but they do not have access to contraception. Limited availability and financial constraints lead to unwanted pregnancies and unsafe abortions, a leading cause of maternal deaths.
At the 2013 International Conference on Family Planning in Addis Ababa, Myanmar officials publicly vowed to halve unmet need for contraception and raise the contraceptive prevalence rate from 40 percent to 60 percent. A working group is coordinating a national strategy to meet this goal by methods such as training health care providers in a greater range of contraceptive methods and making contraceptive pills and condoms more easily accessible.
PATH is supporting this transformation with analysis to inform a total market approach to family planning. This approach seeks to ensure that people who have the ability to pay for family planning access the services they need through the private sector (for-profit businesses and nonprofit organizations) so that limited public-sector (government) resources can be effectively targeted to those who cannot afford services. The goal is to ensure that the needs of the total population are met. To explore the viability of this approach, PATH has met with local stakeholders, developed a landscape analysis, and convened government officials and public- and private-sector leaders in this field.
Myanmar accounts for nearly 80% of malaria cases and 75% of malaria deaths in the Mekong region, according to a 2012 assessment (703 KB PDF) funded by the Bill & Melinda Gates Foundation.
The World Health Organization identifies more than 40 million of Myanmar’s nearly 55 million people as living in malaria-endemic areas.
PATH is addressing the needs of the malaria community in Myanmar with a pilot of new technology to test for glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency). Individuals who have this deficiency suffer severe adverse reactions from certain malaria drugs. PATH, in collaboration with the Mahidol Oxford Research Unit and the Shoklo Malaria Research Unit in Thailand, is paving the way for safe and effective malaria care by assessing the performance of new rapid diagnostic tests to screen for this deficiency and ensure high-quality care.