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Health Policy Brief~ Eng.Pmd Myanmar Policy for Early Childhood Care and Development Health “For national development, we have earmarked money to increase spending of the health sector by fourfold and that of the education sector by two fold in the coming financial year. With subtle reformation process plus increased State fund, we will encourage more development of human resources.” President U Thein Sein Speech delivered at third regular session of first Pyidaungsu Hluttaw (1.3.2012) “Total health spending in Myanmar is almost entirely relying on house- hold out-of-pocket payment with high catastrophic potential for the poor. Government investment in health though increasing annually is still not sufficient to keep pace with growing total health expenditure resulting from escalating population health needs. Health expenditures are found to be skewed more towards curative with overly investment in hospital sector.” (Dr. Pe Thet Khin, Union Minister of Health, MOH, at the Universal Health Care meeting, 12 July, 2012) In order for universal health care coverage to be provided and health sector targets met, more budget to be allocated especially for the following ECCD-related activities because investment in ECCD yields the highest return and lowers later health care costs: In expanding the ECCD services, i.e.,health care services during preconception, antenatal, postnatal period, services for children 0- 8 years using local languages to ensure parents, care givers and children understand and benefit from the services. To expand and improve health care services for people, more professionals should be appointed in order to meet the norm of the World Health Organisation to provide at least 25 health specialists, including nurses and midwives for each 10,000 people. Rural and remote areas especially require expanded services for health, nutrition and sanitation. Policy Provisions To achieve universal health care, monitoring will be needed to ensure that out-of-pocket expenditures will not exceed 30% to 40% of total health care expenditures. The health expenditure should be 4- 5% of GDP. For 90% of the population, a pre-payment and risk pool schemes will be used along with health and social protection and “safety-net” services for all vulnerable groups living in poverty. “ The Ministry of Health is playing a pivotal role in promotion and maintenance of health of the people for ensuring their health and longevity. Notwithstanding resource constraints as a developing country, Myanmar health sector could make substantial achievements in raising the health status and prolonging the lives of the people. Development and progress have brought about improved quality of life and increased life expectancy.” Dr. Pe Thet Khin, Union Minister of Health, Source: Health in Myanmar, 2012 Foreward The maternal mortality rate was very high in 2009 as it was estimated to be 141 cases in 100,000 child deliveries (MOH 2012). However, in 1999 it was 250, indicating that considerable efforts have been made to reduce the maternal mortality rate. The ECCD Policy calls for the promotion and expansion of health care services and the provision of antenatal education and health and nutrition care for all pregnant women and preparation for child delivery. Antenatal and post-natal services and continuing parent education activities will be provided to rapidly reduce the high mortality rate of mothers. Source - HEALTH IN MYANMAR 2012, MOH Child deliveries, with the assistance of skilled health service providers, were increased from 57.9% in 2010 to 67.1 % in 2011. Yet many more trained and skilled birth attendants are needed in health care centers in Myanmar. In addition the quality of health care services should be rapidly improved. “Governments to determine the appropriate health workforce skill mix and to institute coordinated policies, including through public private partnerships, for an immediate, massive scale-up of community and mid-level health workers, while also addressing the need for more highly trained and specialized staff.” (The Kampala Declaration and Agenda for Global Action, First Global Forum on Human Resource for Health, 2-7 March 2008, Kampala, Uganda) Policy Provisions The ECCD Policy includes objectives for ensuring mothers to be able to deliver healthy children and obtain health care services from trained and skilled health care providers. They will be able to deliver children safely, and all newborn children will receive good preventive and basic health care services. All newborn children will be registered and receive immunizations as scheduled. To the extent possible children will be breastfed exclusively for the first 6 months, continue breastfeeding while receiving appropriate complementary foods in order that they will be well nourished, strong, healthy and develop well. “early childhood development ... making sure the mother is well nourished and the child is properly nurtured. Early childhood development has proved to be very beneficial and very cost-effective in societies where this is been tried.” Daw Aung San Suu Kyi Extract from interview during visit to America, VOA interview, 18 September 2012 According to research results, exclusive breastfeeding of children for the first 6 months of life and continued breastfeeding from 6 to 11 months can reduce the under five mortality by 13%. By providing appropriate supplementary food in addition to breastfeeding after 6 months, under five mortality can be reduced by 6% (Lancet series, Vol. 362, 5th July 2003). In 2009, exclusive breastfeeding covered only 23.6% of children in Myanmar, and moderate to severe stunting of under 5 children was 35.1% due to malnutrition (MICS, 2009-2010). Therefore, the ECCD Policy calls for encouraging and rapidly promoting exclusive breastfeeding of children up to 6 months and systematic addition of supplementary food in addition to breastfeeding after six months. Stunting and other signs of malnutrition in children, insufficient nutritional care services, and the lack of feeding programmes in ECCD centers and preschools,reveal the need to expand and improve nutrition services. Therefore, greater attention will be given to the provision of nutrition education, breastfeeding, the provision of supplementary food, and providing feeding programmes for pregnant and breastfeeding mothers, child care and ECCD centres and preschools. Timely basic health care services should be made available in or near preschools and primary schools through the visits of basic health workers to ECCD centres and schools and ensuring health centres support those children. Basic health workers should also teach parents about basic requirements for good child health, nutrition and environmental sanitation. Breakfast and lunch should be provided in preschools and primary schools, and particularly those in poor areas. Parents should be encouraged to collaborate in school nutrition programmes after giving them training on how to prepare nutritious food in an hygienic manner. Policy Provisions All necessary activities should be carried out for: Improving and maintaining the child care and parenting skills of parents Providing basic health care services, preventing diseases and nutrition care services, including micronutrients, supplementary feeding and feeding services in ECCD centres, preschools and primary schools, especially for children living in poverty Ensuring timely immunizations Achieving exclusive breastfeeding up to 6 month and the systematic addition of appropriate supplementary food in addition to breastfeeding after the sixth month Taking safe and protective measures for all children Creating hygienic home environments and ECCD centers for children Ensuring the availability of quality day care centers and related services for the children of mothers working outside of the home We can make the most simple, the most powerful investment, for developing our economies, our communities and our societies. …investing in women’s and children’s health has a multiplier effect across the MDGs. It is the best investment we can make. UN Secretary-General Ban Ki-moon Remarks at launch of the Global Strategy for Women’s And Children’s Health - “Every Woman, Every Child”, UN Headquarters, 22 September 2010 The provision of Early Child- hood Intervention (ECI) services for children with developmental delays, malnutrition, disabilities, chronic illnesses and atypical behaviours such as autism, requires the collaboration of skilled professionals from various disciplines, including education, health, therapies, nutrition, social work, nursing and psychology. As the period from birth to 3 years of age is the most important period for brain development, attention should be given to providing ECI services for children with special needs beginning during this period. In providing ECI services, close collaboration is required among the sectors of health, education and protection. It will be very important to plan and implement nationwide sustainable ECI services. For the ECI system to achieve a strong collaboration among the health, education and protection sectors, formal agreements will be needed among the MoH, MoE and MoSWRR. Policy Provisions Children from 0 to 5 years of age with developmental delays, malnutrition, disabilities, chronic illnesses, or atypical behaviours such as autism will be screened, identified, assessed and provided ECI services. Such children increasingly will be accepted socially without any discrimination and will be enrolled in inclusive preschools and primary schools. They will not be placed in institutions but rather parents will be supported to provide a loving and stimulating home for their child. The ultimate goals will be to improve the development of these children, ensure they are included in school and society and achieve their full potential as well integrated members of society..
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