Provision of Primary Healthcare among the Internally Displaced Persons and Vulnerable Populations of Burma
BPHWT Mid-Year Report
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Table of Contents
Part I: 2016 Mid-Year Report ...... 3 1. Overview and Summary of the BPHWT...... 3 2. Map of BPHWT Operational Target Areas ...... 4 3. The Security Situation in BPHWT’s Target Areas ...... 5 4. Health Situation in the BPHWT Target Areas ...... 5 5. Obstacles and Threats to Delivering Health Care in the Field ...... 9 6. Human Rights / Environmental Issues in the BPHWT’s Target Areas ...... 10 7. Current Political Context ...... 11 8. Activities of Back Pack Health Worker Team ...... 11 A. Medical Care Program (MCP) ...... 12 B. Community Health Education and Prevention Program (CHEPP) ...... 15 C. Maternal and Child Healthcare Program (MCHP) ...... 21 9. Field Meetings and Workshops ...... 29 10. Capacity Building Program ...... 29 11. Convergence, Coordination and Collaboration ...... 34 12. Monitoring and Evaluation ...... 36 13. Financial Report: ...... 38 Part II: Program Workshops and 36th Semi-Annual Meeting Report ...... 39 1) Program Workshops at the BPHWT’s Mae Sot Office ...... 39 2) 36th BPHWT Semi-Annual General Meeting ...... 44
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Part I: 2016 Mid-Year Report
1. Overview and Summary of the BPHWT During the first six-month term of 2016, the Back Pack Health Worker Team (BPHWT) continued to provide healthcare in 21 field areas, with 113 teams assigned to a target population of over 247,810 people. There are currently 1,414 health workers living and working in the BPHWT target areas inside Burma; comprised of 333 men and 1,081 women including TBAs/TTBAs. The table below gives an overview of the BPHWT field areas, the number of health workers, target populations, and the total number of cases treated within the first six-month period of 2016. Table 1: BPHWT’s Target population summary: Gender Ages Total Male Female Under 5 year ages 22,078 24,299 46,377 Five and over 5 year ages 97,844 103,589 201,433 Total 119,922 127,888 247,810
Table 2: Summary of BPHWT Field, Health Workers, Target Population & cases Treated
# of
# of
# of HWs s
VHVs/VHWs TTBAs/TBAs
No. Areas load
Total Total Total
M W M W M W Villages
# of Teams of #
Population
Households Case 1 Kayah 7 11 13 24 4 8 12 0 40 40 50 3547 19820 3294 2 Kayan 7 8 16 24 3 7 10 0 30 30 46 1759 8957 3414 3 Special 3 8 2 10 0 0 0 1 5 6 16 1219 7626 1329 4 Taungoo 5 11 7 18 11 16 27 0 45 45 51 1993 11075 521 5 Kler Lwee Htoo 7 14 10 24 23 31 54 4 52 56 48 1922 12419 1612 6 Thaton 7 13 11 24 4 17 21 0 75 75 37 3280 19316 3863 7 Papun 12 25 13 38 21 18 39 19 85 104 109 4969 30515 5923 8 Pa An 8 14 12 26 10 24 34 4 83 87 29 3276 18892 2391 9 Dooplaya 7 10 14 24 4 13 17 10 48 58 55 4326 22994 2009 10 Kawkareik 3 7 5 12 7 9 16 5 26 31 11 877 4758 864 11 Win Yee 4 10 5 15 0 0 0 0 50 50 29 2098 12205 1739 12 Mergue/Tavoy 7 10 14 24 0 0 0 7 34 41 23 2070 11779 6058 13 Yee 6 4 17 21 0 0 0 0 29 29 19 2208 10309 5554 14 Moulamein 6 2 19 21 0 0 0 0 0 0 17 2507 12423 2627 15 Shan 6 11 10 21 0 0 0 0 10 10 52 2225 13520 2262 16 Palaung 2 8 13 21 0 0 0 0 20 20 14 621 3249 6431 17 Kachin 6 3 12 15 1 5 6 0 0 0 15 848 5320 1858 18 Arakan 4 10 2 12 0 0 0 0 15 15 11 2863 8197 750 19 Pa O 2 4 4 8 0 0 0 0 20 20 6 601 3801 689 20 Naga 3 4 2 6 0 0 0 0 0 0 10 1210 7235 632 21 Chin (WLC) 1 0 2 2 0 3 3 0 46 46 7 494 3400 793 Total 113 192 205 397 88 151 239 53 725 778 655 44,913 247,810 54,613
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2. Map of BPHWT Operational Target Areas
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3. The Security Situation in BPHWT’s Target Areas 1. Pa An Field Area On 19 Aug 2016, a local Border Guard Force of the Burma Army came into Thi War village and exchanged fire for about five minutes with a unit of the Democratic Karen Buddhist Army. Fortunately, there were no injuries of deaths. Burma Army Light Infantry Battalions 547, 548, and 549 from Na Boo Military Camp came for military maneuvers into the Back Pack areas of Htee Ka Lay and Naung Kine villages. These Burma Army soldiers remained for five days, causing fear among the villagers.
2. Palaung Field Area Fighting continued in this field area. There is ongoing fighting between ethnic armed organizations (EAOs) in Pan Hang and Yae Kwet villages of Namhkan Township. Due to the fighting, villagers fled to Mie Gee village. The fighting between two EAOs caused 500 IDPs to flee and stay in Pan Yaung village. The IDPs come from Man Ei, Thet Let, and Naung On villages in the Mine Yout village tract of Man Ton Township.
3. Arakan Field Area There is frequent fighting between the Arakan Army (AA) and Burma Army between Pa Lat Wat, and Kyet Taw villages The fighting lasted one or two days. Due to the fighting, villagers were unable to work in Yet Khon Tye, Tan Myar, Kynn Gyi, and Za Lin Taung villages. In those villages, the main means of livelihood is farming. There are a number of police checkpoints in Pa Lat Wat and Da Let May villages. Also, there are both police and Burma Army checkpoints in Tha Yor Wai village. These checkpoints are looking for AA soldiers and supporters as well as collecting intelligence about AA activities.
4. Health Situation in the BPHWT Target Areas 1. Taungoo Field Area Two midwives were sent from Burma Government’s Ministry of Health to West Ka Lay War and West Day Luu villages. They gave immunizations and Vitamin A to children under five years of age. The BPHWT gave Vitamin A to children five years of age and older. These midwives otherwise did not provide any other treatment, but referred patients to the BPHWT. On 6 April 2016, a team of twenty doctors and soldiers from the Burma Army came into the area to offer health care to local people. However, local people did not visit with them for health care.
2. Thaton Field Area The Burma Government Border Development and Security Team told local villages that they must refer patients to the Burma Government health facilities, not to ethnic health organizations. The Burma Government’s District Medical Officer was unaware of this policy change and said that he The Burma Government constructed a clinic in the Kweelay village.
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3. Papun Field Area A gold mining company is operating in and near the Mae Wai and Bilin Rivers. The water is becoming polluted and posing health issues to both humans and animals. 4. Pa An Field Area The Burma Government sent a midwife and health assistant into the field area to implement one stop antenatal care and immunizations services. The local Back Pack team tried unsuccessfully to negotiate with them to work together in this respect.
5. Doopalaya Field Area Four health workers from the Burma Government’s Ministry of Health came into the Kawkareik and Kyar Innsit Kyi areas for malaria control including the distribution of mosquito nets
6. Kawkareik Field Area There is a midwife from the Burma Government’s Ministry of Health in Noe Pho village. This is her native village. However, she tells pregnant women to get antenatal care from the BPHWT and will not take any responsibility for cases referred to her. Also, the BPHWT invited her to meetings, but she never came.
The Burma Government Ministry of Health constructed a hospital in the Su Ka Li village and assigned a Burma Government doctor and nurse to the hospital. The doctor and nurse are rotated out every three months.
7. Win Yee Field Area A Burma Government hospital in Three Pagoda Pass twice offered to assign their midwife to the Ma Za Li BPHWT station clinic. However, the BPHWT station clinic declined the offer because the midwife does not speak the local language and the station clinic does not have sufficient accommodations and food for the midwife. Also, the BPHWT clinic has its own capacity for safe deliveries.
8. Mergue/Tavoy Field Area The Burma Government’s Ministry of Health constructed a clinic in Ka Nel Kal village and another one west of Paw Tog village. They assigned three nurses there: one for Ka Nel Kal village and two for the west of Paw Tog Village. The three nurses come once monthly and stay one or two days in these villages. There are no overlapping and problems between these Burma Government clinics and the Back Pack health workers.
9. Moulamein Field Area One child contracted polio in the Wel Zin village. Unfortunately according to the local midwife, the child had received only one polio immunization. Worried about an outbreak, the Burma
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Government’s Ministry Of Health provided oral polio vaccine in the Wel Zin village, but not in nearby villages. Since the BPHWT does not have an immunization program, pregnant women go to the Burma Government hospital for immunizations. The Burma Government recognizes deliveries by Back Pack TBAs and health workers, and issues birth certificates.
10. Shan Field Area There is one Burma Government midwife assigned to Man Ton village and comes once monthly for only two days. There is no formal clinic and she gives treatment in the house of an ethnic host. However, she does not do deliveries – the Back Pack’s TBA takes responsibility for the deliveries.
According to the Man Ton Back Pack team in-charge, when a Back Pack TBA delivers a baby, the midwife places her name in delivery record instead of the name of the Back Pack’s TBA. The midwife also takes responsible for getting birth certificates from the Burma Government’s Ministry of Health. Villagers pay 6,000 kyats for a birth certificate, but the Ministry of Health price is only 3,500 kyats. If the baby’s age is over one year, villagers are charged 10,000 kyat for a birth certificate and for children over two years of age, the charge is 20,000 kyats.
The areas have many users of heroin and amphetamines. Children over ten years old have started to use amphetamines.
11. Palaung Field Area Heroin and amphetamines can easily get into Mie Gee village: thus, their prices are not expensive. Consequently, most villagers as well as internally displaced persons use heroin and amphetamines. The area around Namkhan and Mie Gee villages has a high incident of homicides.
12. Pa O Field Area Rape, homicide, heroin, and amphetamine cases increased over the past year in this field area. More is now known about them because of better communications and media attention. Recently, there have been two reported youth rape cases and four homicide cases. Heroin and amphetamine use contributed to the homicides as well as increased quarrelling and fighting.
13. Naga Field Area A measles outbreak occurred in the Nanyun and Lahe Townships. There are 500 households in Nanyun Township and 530 households in Lahe Township. According field information, 100 children contracted measles in Than Kho Lar Mar village of Lahe Township. Due to the measles outbreak, forty-two children died in Kho Lar Mar village. It is estimated that 200 children had measles in five to six villages in Nanyun Township.
In response to the outbreak, a medic from the Lahe Hospital came and gave treatment to the children. A medic from the Burma Army also came to assist. They had insufficient medicine, but 7 | P a g e
Lahe Hospital was unable to send additional medicines. The Naga Students Organization provided food in this situation. The BPHWT’s field in-charge and second field in-charge gave treatment in Kel San village of Nanyun Township which had a hundred households.
Due to this response, the outbreak has been contained. The Burma Government started giving immunization for measles in Than Khol Lar Mar village of Lahe Township. However, a nearby village was not involved in this immunization program. According to field reports, the Lahe Hospital no longer has immunization medicines.
In this field area, there are also problems with heroin use. The Eastern Naga Development Organization has taken responsibility for the health and rehabilitation of heroin users in their operational areas.
14. Special Field Area In Met Sa Mate village, it has become difficult to negotiate with the Burma Government’s midwife for immunizations, antenatal care, and deworming medicine. Moreover, she dismisses Back Pack health worker skills. When patients come to her clinic, her treatment is carelessly. Even if a patient is seriously ill and cannot come to her clinic, she never goes to the patient’s house and always tells them to come to the clinic. She does not like it when Back Pack health workers give Vitamin A and deworming medicine, and provide antenatal care. But the Burma Government clinic lacks sufficient Vitamin A and deworming medicine to cover the population of Met Sa Mate village. In response, Back Pack health workers offered to help with the Vitamin A and deworming medicine, but the midwife has refused this help, stating that the distribution of Vitamin A and deworming medicine was a project of the Burma Government’s Ministry of Health. Twice, the BPHWT’s field in-charge tried unsuccessfully to negotiate with her. Consequently, pregnant women do not go to her, but instead go to Back Pack TBAs. Near a BPHWT area, there is cement mining project between Ng Yat Chaung Phyar and Tha Yae Chaung Phyar villages. Due to this project, acute respiratory infection occurred in Ng Yat Chaung Phyar and Tha Yae Chaung Phyar villages. Naung Tai, Ka Tar, Khu Pine, and Tha War Tor villages asked the BPHWT for treatment because while there is a Burma Government clinic in the village, there are no health workers or medicine.
15. Chin Field Area There are many male heroin users in Koon Pyin, Gar La Mit, and Kha Mee. In Koon Pyin village, of the seventy households, forty households have heroin users. In Gar La Mit village, fifty of the one hundred households have heroin users. There are no treatment and rehabilitation stations in these villages. When there is no heroin available, users get sick, especially with diarrhea. In response, Back Pack health workers from the Chin Public Affairs Committee provide treatment to them. The Women League of Chinland has reported that one midwife from the Burma Government’s Ministry of Health is stationed in Pha Lan village. Also, a team of doctor from the Ministry of Health and an INGO came to the village and provided contraceptive service – pills and implants.
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While the contraceptive pills did not cause any problems, some implants resulted in infections. Since the team did not come back for follow-up, infected women were referred to Yid Hospital.
5. Obstacles and Threats to Delivering Health Care in the Field 1. Thaton Field Area To transport medicine and medical supplies by road to this field areas, official documents are required. Additionally, fees of 2,000 kyat must be paid at each checkpoint along the road - there are four checkpoints. This is adds to the costs and delays in deliveries to this field area.
2. Pa An Field Area At the Myawaddy Trade Zone, Burma Government customs officials take at least 1,000 kyats to bring Back Pack medicine and medical supplies into Burma from Mae Sot. The actual prices depend upon the situation at the customs’ office at the time.
3. Doopalaya Field Area Burma Government officials at the Myawaddy Trade Zone are checking documents and charging fees for medicine and medical supplies being delivered to this field area.
4. Kawkareik Field Area The local Back Pack team has been required to pay a 1,000 kyat fee to transport medicine and medical supplies through each of the three gates along the road around Tin Gan Ntyi.
5. Shan Field Area The Burma Government’s National Malaria Control Programme (NMCP) has implemented malaria control training in the area without involving the BPHWT. The duration of the training is one month and participants receive a salary and medicine. The BPHWT field in-charge is worried that Back Pack health workers may resign and go to work for the NMCP.
6. Arakan Field Area The transportation of medicine is difficult because the main means of transportation is by boat. Consequently during rainy season with storms and heavily raining, there are many transportation delays.
7. Pa O Field Area The Pa O Back Pack team has had to pay fees to transport medicine at the Tin Gan Nyi Naung and Tha Ton checkpoints: the fee was 1,000 kyats at each checkpoint. Whenever the BPHWT wants to implement a workshop or training in Si Sine Township, they must get permission from immigration, police, and township General Administration Department.
8. Chin Field Area When the Burma Army hears about treatments or workshops from Back Pack health workers, they always investigate about them with the chairperson of the local village.
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6. Human Rights / Environmental Issues in the BPHWT’s Target Areas 1. Kler Lwee Htoo Field Area In Met Ka Thi village, there is a logging project which is causing environmental damage.
2. Papun Field Area The Shin Thant Company implemented a road project in the area. They took villagers’ land without compensation. A local Border Guard Force of the Burma Army is logging in the field area and taking villagers’ land for teak tree cultivation without compensation.
3. Pa An Field Area On 12 August 2016, General Thein Tayzar Than led Burma Army Light Infantry Battalion (LIB) 548 to do illegal logging of over 1,000 trees which belonged to Kot Phan Ya village. The villagers had looked after their trees so as to provide roofing for the houses. Both the village administrator and local monk had prohibited local logging; however, the general and his LIB 548 continued with the illegal logging.
4. Palaung Field Area An ethnic armed organization (EAO) established a military camp between the Hang Pan and Sai Lain villages. They stopped villagers who went the Mie Gee market, asked questions, wanted to see documents, and took photographs. Also, the EAO explained why they were there. After finishing everything, the EAO allowed the villagers to go the Man Gee market. When the villagers returned back, they are again asked questions, and told to show documents and pose for photographs. When villagers went to that market to sell cows or water buffalos, that EAO took 50,000 kyats. If a charcoal truck goes to market to sell its charcoal, that EAO then charged 150,000 kyats. Also, the EAO does not allow the transportation of medicines and certain other supplies and equipment into the area, and restricts other items over a designated weight. During the fighting between two EAOs, twenty innocent villagers were bullied by one of the EAOs. These villagers came from Man Set and Lwe Moon villages, and worked at a corn plantation. One of the EAOs setup a roadblock between Nan Ma To and Mine Bar villages. They allowed Shan, Myanmar, and Chinese to through road block, but not Palaung people. When villagers fled to Mie Gee village due to fighting between two EAOs, one of the EAOs then searched each house, took money, and killed and cooked cows for food.
5. Kachin Field Area On 10 June 2016, a human right violation occurred at Hapaung Tu. Two Burma Army soldiers stopped a villager from Kyet Pyar village going to Man Yone market, stole 100,000 kyats from him and burned his motorcycle. The two soldiers were from the Burma Army Light Infantry Battalion 601 from the Burma Army camp in La Gat Dot village. The villager went to the local pastor who made a complaint to the Burma Army commander. As a result, the Burma Army commander gave compensation for new motorcycle and 100,000 kyats to the affected villager. The two soldiers also had made bad ethnic remarks to villagers from Kyet Pyar villages. During the first week of August 2016, the Yuzana Company confiscated twenty acres of land in Bangkok village located between Ja Htu Up and Wa Ra Zup villages. As a result, 1,700 villagers 10 | P a g e became homeless. The Yuzana Company negotiated with villagers for compensation. However, the Yuzana Company compensation was only for temporary housing, so villagers refused this offer. The Yuzana Company then proceeded to destroy their houses with a bulldozer. The Yuzana Company implemented a cassava plantation in Bangkok village. The Company discharged garbage and chemicals into the Moe Kaung River, killing the fish and causing the villagers to get diarrhea and skin diseases. The Yuzana Company also constructed a canal around the cassava plantation to protect it from intruding cows and water buffalos. Due to the canal, many cows and water buffalos from Bangkok and nearby villages fell into the canal and died.
6. Pa O Field Area The Burma Government Department of Forestry confiscated land from twenty villagers in Sike Khaung village of Si Sine Township. This issue is now in the local court system.
7. Current Political Context During this period, the new National League for Democracy (NLD) government came to power in Burma. The president and one of the vice presidents are from the NLD; while the other vice president is from the Burma Army. The NLD has a majority in both houses of the Union parliament and is able to pass its legislative agenda, excepting changes to the 2008 Constitution which would require approval by the members of parliament of the Burma Army. The NLD used its power in the Union parliament to create a new position for Aung San Suu Kyi, that of State Counselor. She has effectively pre-empted the new president in most matters of state. The NLD-led government also appointed its own members to the chief executive positions of all the states and regions, even in the two states – Arakan and Shan – where the NLD did not win a majority of the votes. This was not well received by the ethnic people in those states. The NLD government appears to be very autocratic and holding power close to the center. It allows little dissent from its Union members of parliament and little discussion in the Union parliament about issues which it considers important. They use their majority to push legislation through with little or no discussion or negotiations. The NLD government has scheduled a 21st Century Panglong Conference for August 2016 to address the ethnic conflict. However, the NLD government is not declaring a nationwide ceasefire to facilitate a positive environment for the Conference or inviting the three ethnic armed organizations with whom the Burma Army is still fighting. Not much is expected from the Conference by the ethnic political and armed organizations. Sustainable peace is the country still seems to be distant even with the new government. A health advisory group to the NLD conducted meeting in March 2016 and produced a Programme for Health Reforms. Despite inviting the ethnic health organizations to make presentations, the document failed to address the issue of devolving health decision making, administrative, and funding powers to sub-Union levels. It appears the focus is upon strengthening the existing centralized health system – following the path set by the previous government of Thein Sein.
8. Activities of Back Pack Health Worker Team The BPHWT continues to operate its three major programs: Medical Care Program (MCP), Community Health Education and Prevention Program (CHEPP), and Maternal and Child Healthcare Program (MCHP). In addition, capacity building, health information and documentation, and program management and evaluation remain integrated within these
11 | P a g e programs. In addition, the BPHWT has conducted this Auxiliary Midwife training since 2013 and there were five trainings completed and 107 AMWs were trained. Afterwards, the AMWs will be supervised by the midwives and implement MCH programs in their respective areas. One AMW will serve a target population of about 400 people. Vision: The vision of the Back Pack Health Worker Team is targeting the various ethnic nationalities and communities in Burma to be happy and healthy society. Mission: The Back Pack Health Worker Team is organized to equip people with the skills and abilities necessary to manage and address their own healthcare problems, while working toward the long-term sustainable development of a primary healthcare infrastructure in Burma. Goal: The goal of the BPHWT is to reduce morbidity and mortality, and minimize disability by enabling and empowering the community through primary healthcare.
A. Medical Care Program (MCP) During this six month period of 2016, the BPHWT delivered medical care in 21 field areas and treated 54,613 cases, of which 10,541 cases were of children under the age of five. The total cases on a gender basis included 25,375 cases involving men and 29,238 cases involving women. The six major diseases being treated by the BPHWT continue to be acute respiratory infections, malaria, anaemia, worm infestation, diarrhoea and dysentery. Also during this reporting period, the BPHWT health workers referred 55 cases which included 11 cases of serious obstetric emergency (EmOC). MCP Objectives: 1. Provide essential drugs for common diseases 2. Strengthen patient referral systems 3. Respond to disease outbreaks and emergency situations 4. Improve health workers’ skills and knowledge
Providing healthcare to a child in Taungoo Patient Referral in Palaung
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Table 3: Number of Cases Treated by Condition and Age Age Total Grand No Condition <5 >=5 Total M W M W M W 1 Anemia 181 183 1095 2052 1276 2235 3511 2 ARI, Mild 1198 1227 3063 3286 4261 4513 8774 3 ARI, Severe 624 626 883 1007 1507 1633 3140 4 Beri Beri 50 48 955 1536 1005 1584 2589 5 Water Diarrhea 500 542 932 986 1432 1528 2960 6 Diarrhea with Blood (Dysentery) 196 159 572 600 768 759 1527 7 Injury, Acute – Gunshot 1 0 39 16 40 16 56 8 Injury, Acute – Landmine 0 0 50 3 50 3 53 9 Injury, Acute – Other 119 70 820 499 939 569 1508 10 Injury, Old 18 6 272 121 290 127 417 11 Malaria (PF) 36 52 274 218 310 270 580 12 Malaria (PV) 42 57 206 151 248 208 456 13 Measles 25 17 15 18 40 35 75 14 Meningitis 4 4 14 11 18 15 33 15 Suspected AIDS 1 1 2 2 3 3 6 16 Suspected TB 14 20 98 79 112 99 211 17 Worm Infestation 562 532 1075 1192 1637 1724 3361 18 Abortion 0 0 0 69 0 69 69 19 Post-Partum Hemorrhage 0 0 0 21 0 21 21 20 Sepsis 2 0 2 26 4 26 30 21 Reproductive Tract Infection 0 0 0 152 0 152 152 22 UTI 23 36 688 1130 711 1166 1877 23 Skin Infection 388 431 798 794 1186 1225 2411 24 Hepatitis 3 5 99 93 102 98 200 25 Typhoid Fever 23 46 250 288 273 334 607 26 Arthritis 24 26 673 671 697 697 1394 27 GUDU 17 13 1776 2104 1793 2117 3910 28 Dental Problem 120 154 580 644 700 798 1498 29 Eye Problem 97 130 507 581 604 711 1315 30 Hypertention 0 0 1149 1437 1149 1437 2586 31 Abscess 159 144 588 504 747 648 1395 32 Others 800 785 2673 3633 3473 4418 7891 Total 5,227 5314 20,148 23,924 25,375 29,238 54,613 Grand Total 10,541 44,072
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Most Treated Diseases During January to June 2016
9000 8000
7000 6000 5000 4000 3000 Numberofcases 2000 1000 0 ARI, Mild GUDU Anemia Worm ARI, Severe Water Beri Beri Hypertentio Skin Infestation Diarrhea n Infection Men 4261 1793 1276 1637 1507 1432 1005 1149 1186 Women 4513 2117 2235 1724 1633 1528 1584 1437 1225 Total 8774 3910 3511 3361 3140 2960 2589 2586 2411
Table 4: Patient Referral Gender Age No Area Name EmOC Total M F <5 years >=5 years 1 Kayah 0 2 1 1 0 2 2 Taungoo 2 0 0 2 1 3 3 Kler Lwee Htoo 3 0 0 4 1 4 4 Papun 3 2 2 3 0 5 5 Pa An 8 1 2 4 7 16 6 WinYee 2 1 0 3 0 3 7 Mergue /Tavoy 3 1 0 6 2 6 8 Palaung 11 5 4 12 0 16 Total 32 12 9 35 11 55 Referral causes lists: 3 Obstructed labor 1 Placenta Retailed /PPH 4 Suspected TB 2 Prolong Labour 1 Motorbike Accident 2 Abortion 3 Suspected Cancer 2 Antepartum hemorrhage 1 Hypertension 2 Ascites 1 Meningitis 1 Polyhydramnios 2 Sever Pneumonia 2 Malnutrition 2 Gastritis (PU) 1 Nephritis Syndrome 3 Acute Incident Injury 1 Molar pregnant 2 Tumor 1 Septicemia 1 GI Bleeding 3 Severe Dehydration 1 Dengue hemorrhage fever 1 Severe Anemia 1 Dengue 5 Land mine injury 2 Eclampsia 4 Gunshot injury
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Referral Locations: Taungoo Hospital Kyaut Kyi Hospital Ta Eu Wah Plaw Clinine Pa An Hospital Num Ma Tu Hospital Thay S' Yah hospital Kacharna Bori Tavoy Hospital Kawkariek hospital Mae Tao Clinic Mae Sot hospital Malamyein Hospital Loi Kaw hospital
B. Community Health Education and Prevention Program (CHEPP) The Community Health Education and Prevention Program focuses on disease prevention and health education. There are five activities existing within CHEPP: Water and Sanitation Sub- Program, School Health Sub-Program, Nutrition Sub-Program, village health committee, Community Health Education and Village Health Workshops. CHEPP Objectives: 1. Improve water and sanitation systems in the community to reduce water-borne diseases 2. Educate students and communities about health 3. Reduce incidences of malnutrition and worm infestation 4. Improve networking among community health organizations (1) Water and Sanitation Sub-Program: During July to December 2016, the BPHWT installed 12 shallow wells and 9 gravity flows and 730 community latrines to the targeted communities in field areas. There were 3,346 populations who have access to gravity flow water system, 2,181 populations who have access to shallow wells and 3,554 populations who have access to latrines during this reporting period. The table below shows the field areas, households, and populations who now have access to water and sanitation systems.
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Table 5: Numbers of Gravity flows, Shallow wells, and Latrines installed Population No. Area Name No. Gravity flows HH Men Women Total 1 Papun 1 107 327 339 666 2 Pa An 3 218 496 516 1012 3 Dooplaya 1 135 398 406 804 4 Kawkariek 1 568 341 363 704 5 Mon Yee 1 138 232 267 499 6 Shan 2 68 148 149 297 Total 9 1,234 1,942 2,040 3,346 No. Shallow Population No. Area Name HH wells Men Women Total 1 Kayah 4 66 178 189 367 2 Special 2 104 400 426 826 3 Kler Lwee Htoo 3 109 373 257 630 4 Thaton 1 15 30 78 108 5 Dooplaya 1 30 70 80 150 6 Win Yee 1 30 37 63 100 Total 12 354 1,088 1,093 2,181 Population No. Area Name No. Latrines HH Men Women Total 93 93 224 241 465 2 Kayan 100 100 245 255 500 3 Thaton 50 50 110 140 250 4 Papun 57 57 133 138 271 5 Pa An 50 50 127 138 265 6 Dooplaya 40 40 90 110 200 7 Merque/Tavoy 100 100 249 265 514 8 Mon Yee 60 60 73 129 202 9 Shan 100 100 287 276 563 10 Palaung 80 80 148 176 324 Total 730 730 1686 1868 3,554
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(2) School Health Sub-Program: Through this sub-program, school children and their teachers received health education from health workers. Since the BPHWT programs are integrated, in some cases a school’s sanitation system has been improved, and nutritional supplements and de-worming medication were given to a school’s students (for details, see the Nutrition Sub-Program section below).
Table 6: Number of participants in school health sub-program Students Teachers No Areas # of schools Total Boy Girl M W 1 Kayah 17 611 609 23 75 1318 2 Kayan 13 325 357 11 33 726 3 Special 3 367 463 3 19 852 4 Taungoo 16 375 292 4 57 728 5 Kler Lwee Htoo 18 533 496 37 53 1119 6 Thaton 35 2321 2706 65 195 5287 7 Papun 110 3068 3069 110 283 6530 8 Pa An 33 1471 1767 23 154 3415 9 Dooplaya 47 2381 2522 36 147 5086 10 Kawkareik 12 492 523 23 46 1084 11 Win Yee 30 1237 1446 26 167 2876 12 Mergue/Tavoy 26 1495 1408 20 151 3074 Yee 19 562 871 3 59 1495 Moulamein 17 1187 1286 2 75 2550 Kachin 3 171 199 2 12 384 16,596 18,014 388 1526 Total 399 36,524 34,610 1914
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Health workers together with school teachers are providing Vitamin A, De-worming and personal hygiene kits to students in Thaton field area.
(3) Nutrition Sub-Program: Under the Nutrition Sub-Program of the CHEPP, the BPHWT distributed Vitamin A and de-worming medication to children from the age of six months to twelve year old. This is essential to preventing malnutrition. During the first-six month period of 2016, 32,479 children between the ages of six months and 12 years of age received preventative doses of Vitamin A. Also 24,771 children between the ages of one year and 12 years of age received de-worming medicine.
Table7: Numbers of Children Receiving De-Worming Medicine Age (1 to 12 Years) No Field Area Total M F 1 Kayah 1183 1237 2420 2 Kayan 868 878 1746 3 Special 544 910 1454 4 Taungoo 969 971 1940 5 Kler Lwee Htoo 790 660 1450 6 Thaton 114 136 250 7 Pa An 493 538 1031 8 Doo Pla Ya 1521 1639 3160 9 Kaw Karite 388 351 739 10 Mergue/Tavoy 570 556 1126 11 Yee 872 1076 1948 12 Moulamein 1067 1236 2303 13 Shan 1083 1316 2399 14 Palaung 1232 1573 2805 Total 11,694 13,077 24,771
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Table 8: Numbers of Children Receiving Vitamin A CHILDREN'S AGES No Area Name 6-12 months 1-6 years 6-12 years Total M F M F M F M F 1 Kayah 138 138 624 647 425 431 1187 1216 2 Kayan 219 220 394 421 521 529 1134 1170 3 Special 44 84 125 250 375 567 544 901 4 Taungoo 100 101 389 430 485 406 974 937 5 Kler Lwee Htoo 175 198 471 472 444 476 1090 1146 6 Thaton 50 64 678 715 549 626 1277 1405 7 Pa An 0 8 494 456 709 728 1203 1192 8 Doo Pla Ya 206 198 590 611 934 982 1730 1791 9 Kaw Karite 57 50 185 192 275 250 517 492 10 Mergue/Tavoy 79 80 349 390 505 506 933 976 11 Yee 68 99 279 441 578 723 925 1263 12 Moulamein 271 248 408 517 676 696 1355 1461 13 Shan 107 105 740 966 225 210 1072 1281 14 Palaung 256 317 622 814 603 695 1481 1826 1770 1910 6348 7322 7304 7825 15422 17057 Total 3680 13670 15129 32479
Health Education in Pa An Gravity flow water system in Thaton
Gravity flow water system in Dooplaya Community Latrine in Mergue/Tavoy
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(4) Village Health Workshops: During the first-six month period of 2016, the BPHWT organized 90 Village Health Workshops in 16 field areas. Through these workshops, there were 5,889 participants who gained improved knowledge of primary healthcare issues. The participants came from a wide variety of backgrounds and community groups, including shopkeepers, religious leaders, members of women organizations, teachers, students, TBAs/TTBAs, VHWs, health workers, youth organization, authorities, villagers and village heads. This wide and varied participation increases the likelihood of knowledge spreading and reaching all levels of the community. Women participation is high in every workshop.
Table 9: Number of Village Health Workshop and Participants Participants No Areas # of VH workshops Total M W 1 Kayah 17 321 271 592 2 Kayan 5 329 419 748 3 Special 3 161 233 394 4 Taungoo 3 82 91 173 5 Kler Lwee Htoo 3 158 200 358 6 Thaton 4 77 98 175 7 Papun 5 146 138 284 8 Pa An 9 190 250 440 9 Kawkareik 5 260 303 563 10 Win Yee 4 92 101 193 11 Mergue/Tavoy 10 234 292 526 12 Yee 11 275 404 679 13 Moulamein 6 190 225 415 14 Pa Oh 2 43 5 48 15 Palaung 2 81 104 185 16 Kachin 1 46 70 116 Total 90 2,685 3,204 5,889
(5) Village Health Committee (VHC): The BPHWT has established village health committees since the second period of 2015. The purpose of establishing VHC is to improve community participation and to sustain development of a primary healthcare in the field areas. The target goal is to have at least 30% participation from women in the VHCs. The VHCs surpassed that goal with 38% of VHC members being women. Each VHC targets to have 7-9 members. These representatives are from village administration committee, local health workers, teachers, religious leaders, women and youth groups. The VHCs are responsible for patient referral, community empowerment and participation, providing health education and environmental cleaning, oversight of clinic management, and coordination with other CBOs and NGOs activities. These VHCs organize quarterly regional meeting among themselves in their respective villages.
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Table 10: Village Health Committee participant list during January to June 2016 NO Area # of VHCs Men Women Total 1 Pa An 6 38 16 54 2 Kawkareik 3 16 13 29 3 Win Yee 4 19 16 35 4 Dooplaya 1 4 3 7 Total 14 77 48 125
C. Maternal and Child Healthcare Program (MCHP) During this period, the MCHP was carried out across 16 field areas. There were two integrated program in the Chin area and with the Karen Baptist Convention (KBC) in the Pan Ta Naw area. While 1,771 babies were delivered, one still-birth was recorded, and two babies died during the neo-natal period. There were also two maternal deaths recorded across all field areas because of post-partum hemorrhage. There were 1,085 birth records received from the targeted field areas. Some of deliveries received birth records from the government health providers as a number of people are still afraid of having the birth records from the BPHWT. There were 1,639 (93% from the total delivery) pregnant women received albandozole and 1,679 (95% from the total delivery) pregnant women and Antenatal Care in Yee mothers received ferrous sulphate, and folic acid. Objectives: 1. Increase maternal and child health care 2. Improve the knowledge and skills of TBAs/TTBAs and MCHP Supervisors 3. Encourage positive community attitudes towards, and utilization of, family planning methods 4. Provide records of deliveries
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Table 11: Summary Facts of the MCHP’s Activities Descriptions Numbers 1. Total Deliveries 1771 2. Live Births 1771 3. Still Births 1 4. Neonatal Deaths 2 5. Maternal Deaths 2 6. Low Birth Weight 64 7. Pregnant women receiving de-worming medicine 1639 8. Pregnant women and women receiving iron 1679 9. Newborn babies receiving birth records 1085 10. TBA/TTBA kits 580 11. Maternity kits 2030 12. Clients of Family planning 2740
1) Trained Traditional Birth Attendant (TTBA) Training: In 2010-2011, an external evaluation facilitated by Burma Relief Center (BRC) recommended that TBAs in the targeted villages must have more knowledge and skills in order to be more effective. Therefore, since 2012, the BPHWT has decided to train TBAs to become TTBAs who will have greater knowledge and skills to provide safe deliveries, related health education, and an effective referral system. It is a twenty-day training. During the first six-month period of 2016, the BPHWT conducted four TTBA training with 80 participants. The key topics are: Anatomy and physiology Antenatal care and post-natal care Delivery Danger signs of pregnancy Risk factors Family planning Maternal and neonatal deaths Health education
Table 12: Trained Traditional Birth Attendant Training Area # TTBA Training Men Women Total 1. Dooplaya 1 2 23 25 2. Yee 1 0 20 20 3. Pa Oh 1 0 20 20 4. Arakan 1 0 15 15 Total 4 2 78 80 2) TBA/TTBA Workshops: In addition, to training TBAs/TTBAs, the BPHWT organizes workshops every six months to refresh and improve the knowledge and skills of TBAs/TTBAs, allow them to share their experiences, and participate in ongoing learning opportunities. There were 62
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TBA/TTBA workshops conducted with the participation of 645 trained TBAs/TTBAs. During the workshops, 580 TBAs’/TTBAs’ Kits and 2,030 Maternity Kits were distributed in order to restock field areas.
Table 13: TBA/TTBA workshop TBAs TTBAs NO Area # TBA workshops Total Male Female Male Female 1 Kayah 4 0 22 0 18 40 2 Kayan 3 0 29 0 1 30 3 Taungoo 3 0 32 0 7 39 4 Klew Lwee Htoo 5 3 46 0 0 49 5 Thaton 7 0 43 0 32 75 6 Papun 9 15 52 4 33 104 7 Pa An 6 7 57 0 10 74 8 Dooplaya 2 6 12 0 0 18 9 Kawkareik 3 5 14 0 14 33 10 Win Yee 4 0 32 0 18 50 11 Mergue/Tavoy 5 7 33 0 0 40 12 Shan 1 0 10 0 0 10 13 Palaung 2 0 21 0 0 21 14 Chin 6 0 46 0 0 46 15 Special Pa An 1 1 5 0 0 6 16 KBC 1 3 7 0 0 10 Total 62 47 461 4 133 645 TBA/TTBA and Maternity Kit Distributed:
Maternity Kit Contents: TBA/TTBA Kit Contents: • Providone • Syringe ball • Compress • Cotton • Non-sterilized gloves • Multicolor bag for kit • Vitamin A • Sterilized gloves (smallest size) • Albendazole • Plastic bags for medicine • Plastic sheet • Folic C • Providone • Package of plastic bags for kit • Terramycin eye ointment • Towels • Thread • Nail clippers • Ink • Scissors 3) Reproductive Health Awareness The BPHWT has started to conduct Reproductive Health (RH) awareness workshop in the field areas since the late of 2015. Due to the limitation, the BPHWT has conducted RH awareness workshop only in Pa An, Dooplaya, Kawkareik, and Win Yee field areas. The purpose is to increase reproductive health awareness in the communities and to increase community participation in MCH program. The discussion topics:
Immunization Nutrition Antenatal care Post-natal care
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Danger signs of pregnancy Abortion Family planning Breastfeeding Referral
Table 14: Reproductive Health Awareness participant list <15 TTBAs Total NO Area # of RH Awareness Men Women Men Women 1 Pa An 6 8 13 67 131 219 2 Dooplaya 7 91 111 192 267 661 3 Kawkareik 3 0 0 62 71 133 4 Win Yee 4 20 20 103 107 250 Total 20 119 144 424 576 1,263 4) Nutrition for pregnancy The BPHWT has started to distribute nutrition foods to pregnant women in the field areas since the late of 2015. Due to the limitation, this activity was only conducted in Pa An, Dooplaya, Kawkareik, and Win Yee field areas. The nutrition foods are yellow bean, eggs, oil, sugar, iodine salt and dry fish.
Table 15: Number of pregnant women receiving nutrition foods NO Area # of P-W Nutrition March April May June 1 Pa An 6 213 0 49 259 2 Dooplaya 6 0 0 210 210 3 Kawkareik 3 0 54 56 98 4 Win Yee 4 0 147 153 146 Total 19 213 201 468 713
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Testimonials from the Field All of us health workers always give our all to patients, disregarding the low stipend and our own personal problems. In this testimonial, I would like to talk about one of the pregnant women, a rather extraordinary one, who was under my antenatal care. She was 39 years old with ten children; this one would be her eleventh one. I started scanning her vital signs: blood pressure was 140/100. Since she had already completed full-term pregnancy, I spoke to her about taking various precautions. I advised her to quit smoking so that she could give a birth to a healthy child. At first, she didn’t take my advice seriously. Then, I used a stronger tone to suggest again for her to quit smoking. I arranged an appointment with her for the next week. As I expected, she did not come back to me.
Then one night at about 11:00PM, the woman’s husband came and woke me up. I asked him what happened. He said that his wife has been contracting since 4:00PM and had high blood pressure. An attending TTBA had sent him to fetch me. Initially, I was in dilemma as to whether I should go to see the patient since my youngest son had a high fever. In the end, I decided to go to the patient. Upon my arrival, I measured her blood pressure which was 180/110. I became very worried; so I decided to stay and take care of her. Should her situation worsen, I could then take her to a hospital or clinic. During this time, I also tried to convince her to go to a hospital for delivery; but she insisted on having the delivery in her own house. After attempts-after-attempts to have her to go to the hospital for delivery, I gave up with this and “hoped to God” that the mother and child would both live. By the Grace of God after an hour, the labor finished with both the mother and newly-delivered baby healthy and well. Thus, I was able to go back to home in utter happiness.
Naw Aye Pwint, MCH Supervisor - Win Yee Field Area
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Testimonials from the Field Just after I finished my dinner at 7:00PM and was preparing to go to sleep, a man on a motorbike came to my house. He called out to me, saying “My wife is contracting and the government doctor has gone back to the city”. Since it was nighttime and the route was very rough because it was raining, at first, I did not want to go with him to see his wife. However, I became very concerned about her well-being; so I followed him to his village. It was already 11:00PM when we arrived at the village. There was a TBA was by her side when I entered into the room. The pregnant woman was strongly contracting and the amniotic sac has been ruptured. I scanned the vital signs: her blood pressure was 130/90. A frank breech was observed as the baby’s buttocks were aligned with the woman’s vagina. After a couple minutes of my monitoring, the TBA tried, but seemed unable to pull out the baby. I prepared a drip for the woman. Since this was the woman’s first pregnancy and she was short, I recommended to the family that we should go to the nearby hospital. The family agreed, but we needed a tractor to reach to the hospital in time. The nearest and the only tractor was in another village. Consequently, we left the village at Midnight using a cow- dragging-cart and arrived three hours later at the tractor village. We then immediately transferred to the tractor and rushed to the Cali Hospital. We arrived at the hospital at 7:00AM. The doctor administered oxytocin for the woman’s contraction. After getting a proper contraction, he began an episiotomy. About three minutes later, the doctor was able to pull out the fetus’ waist and hands. But he was unable to pull out the fetus’ head; so he has to perform a forceps’ delivery. After a few attempts, he asked a fellow doctor to hold on to his waist so that he could use force to pull out the fetus. Finally, the doctors successfully pulled out the fetus. The baby weighed about 3.8 kg and his lips were dull-colored. Unfortunately, the baby died, but the mother-should-be was alive and well. After everything, the doctor asked me about the patient and her situation. I told him that the woman never had ANC either with me or the government doctor in the village. I only knew about her status when her husband came to me and when I saw her contracting. The doctor mentioned that the woman was very lucky; she was supposed to give a birth by cesarean section. Had she not come to this hospital when she did, it would have not only cost the fetus’ life, but also hers. With this said, I went to comfort and explain everything to the family. Nang Khin Myint, MCH Supervisor, Shan field areas
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5) Family Planning Activities The BPHWT usually distributes and promotes the use of three family planning methods, namely the contraceptive pill, depo-provera, and condoms. However, the MCH workers were trained how to provide implants in the early of 2016. Therefore, there was one more family planning method provided during this reporting period. Family planning assistance was given to 2,740 participants during this period, including 121 women less than 19 years of age and 139 are men. There were 689 new clients from the total of the clients. There were 3,007 depo-provera injections, 5,529 packets of pills, 4,429 condoms and 57 implants provided during these six months. Transmuscular depo-provera was the most popular family planning method.
Family Planning Methods Used
1566 1600
1400 978 1200 1000 800 600 400 139 Numberof clients 57 200 0 Depo Pill Condon Implant
Reproductive Health Awareness Family Planning Health Education
Antenatal Care TTBA training
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Table 16: Family Planning methods used in January to June 2016
Age Gravida Parity (G/P) Visits Clients Quantity
No Area
4
-
Total
0
>4
Clients
Up
Pill Pill
1
(Inj)
< 19 <
New
Depo Depo
> = 19 = >
(Pack)
Follow/ Follow/
Condon Condon (Pieces)
Implant Implant
1 Kayah 148 4 144 0 85 63 68 80 87 42 9 10 174 252 225 10 2 Kayan 154 6 148 0 32 122 61 93 54 65 25 10 118 396 336 10 3 Taungoo 98 0 98 11 68 19 63 35 53 32 11 2 118 234 186 2 4 Klew Lwee Htoo 67 0 67 0 23 44 36 31 33 22 0 12 66 132 0 12 5 Thaton 447 4 443 12 210 225 129 318 270 162 15 0 538 966 687 0 6 Papun 222 0 222 3 112 107 27 195 84 132 6 0 174 780 126 0 7 Pa An 259 2 257 6 160 93 41 218 130 104 9 16 195 482 322 16 8 Dooplaya 117 5 112 17 60 40 23 94 47 53 17 0 104 306 438 0 9 Kawkareik 107 5 102 0 94 13 6 101 60 46 1 0 118 218 0 0 10 Win Yee 98 2 96 10 61 27 34 64 22 55 13 7 40 300 441 7 11 Mergue/Tavoy 62 2 60 3 44 15 29 33 35 24 3 0 74 126 318 0 12 Shan 74 11 63 11 60 3 31 43 49 25 0 0 100 99 0 0 13 Palaung 362 10 352 23 234 105 37 325 321 42 0 0 556 206 0 0 14 Arakan 185 70 115 30 96 59 78 107 65 90 30 0 132 522 1320 0 15 KBC 330 0 330 0 319 11 16 314 256 74 0 0 500 450 0 0 16 Special 10 0 10 0 7 3 10 0 0 10 0 0 0 60 30 0 Total 2740 121 2619 126 1665 949 689 2051 1566 978 139 57 3007 5529 4429 57
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9. Field Meetings and Workshops The BPHWT conducts field workshops and field meetings twice a year. During the first six-month period of 2016, there were 18 field workshops and 13 field meetings conducted in the targeted field areas; there were 337 participants who attended field meetings and 362 participants who attended field workshops.
Table 17: Field Workshops and Meetings –Jan to June, 2016 Description # of Field Workshops/Meetings Men Women Total Field Workshops 18 177 185 362 Field Meetings 13 197 140 337
10. Capacity Building Program During this reporting period, the Back Pack Health Worker Team organizes Community Health Worker trainings, Certificate in Public Health, Medic training, Trauma Management training, Village Health Worker trainings improve the health workers’ knowledge and skills as well as to provide updated health information to health workers to be better able to serve their communities. Additionally, trainings and workshops are also conducted for the health workers every six months in the Back Pack targeted field areas. Detail information of the trainings are showed at the table below. Five men participants from BPHWT joined Medic Level II ToT, three participants (2 women & 1 man) joined Health Facility Management training in part time course and six participants (1 woman & 5 men) joined Health facility management training in full time course. Table 18: Trainings Implemented during January to June 2016 Trainings Periods Training sites Community Health Worker Training 10 mths Thay Bay Hta,Mergue/Tavoy ,Mon, Kayah Certificate in Public Health 6 mths Mae Sot Medic training 9 mths Papun Trauma Management training 1 mth Kler Lwee Htoo Village Health Worker Training 3 mths Pa An & Papun Basic Computer & office management training 2 mths Mae Sot Metal health workshop 2 wks Mae Sot
A) Community Health Worker Trainings In this six month period, BPHWT organized four Community Health Worker (CHW) training in four different areas: Thay Bay Hta, Mon, Mergue/Tavoy and Kayah. This training lasted for ten-months; six-month in theory and four-month internship in their respective clinics to apply the knowledge and skill that they have learn from theory. There are totally 199 health workers, comprised of 117 women and 80 men have been training during January to June 2016. The CHW training in Thay Bay Hta in Karen State has started on 30 April, in Mergue/Tavoy started on 27 June, in Mon started on 15 May, and in Kayah started on 10 June. Therefore, all training are continuously conducting.
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Training Objectives: 1. Provide health workers with knowledge and skills, and recruit more community health workers in the communities 2. Provide healthcare services to the communities 3. Improve the health situation in the communities through prevention and treatment 4. Reduce the misusage of treatment among communities. Key Course Topics are: Health information Pharmacology Anatomy Epidemiology First aid Basic Medical Care II with history taking and physical examination Diseases prevention and control (water borne, vector borne, air borne, non-communicable diseases) Environmental health Family health and reproductive health Rehabilitation Community health promotion
Community Health Worker Training in Jan - Jun 2016
53 52 60 50 40 28 30 20 17 20 13 8 6
10 Numberofparticipants 0 Thay Bay Hta Mergue/Tavoy Mon Kayah Men 53 8 6 13 Women 52 17 28 20
B) Certificate in Public Health Training The Back Pack Health Worker has implemented this Certificate in Public Health training in Mae Sot since 2014 and three CPH trainings had already implemented including one CPH during the first period of 2016. This is six months training including field trip to schools and community. During reporting period, the total number of health workers attending the CPH training program were 34 participants comprised of 17 women and 17 men. This CPH training was
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started on 4 April and successfully completed on 6 September 2016. The trainees are being trained by doctors from Thamassat University, Mae Tao Clinic and Burma Medical Association. The CPH training topics are: • First Aid • Leprosy Control • Management on Minor Ailments • STI Control • Safe Water Supply • Trachoma Control • Sanitary Excreta Disposal • Health Education • Garbage and Refuse Disposal • School Health • Disposal of Sullage Water • Family Health Care • Rodent Control • Community Health Care • Vital and Health Statistics • Nutrition Promotion • Epidemiological Surveillance and • Health Management and Supervision Control of Communicable Diseases • Expanded Program on Immunization • Specific Communicable Diseases (EPI) Control • Malaria Control
• Filariasis Control • Tuberculosis Control C) Medic training course The BPHWT organized a Medic training in Papun area. This is nine months training including five-months theory and four-months practical at MTC in Mae Sot. The training conducted from 21 April and will be completed on 31 December 2016. The purpose of this training course is to improve the health workers’ knowledge and skills as well as to provide updated health information to the health workers so that they will be better able to serve their communities. There were 21 participants, comprised of 21 men and 10 women. The trainees were being trained by the donors from Shoglo Malaria Research Unit (SMRU), Kaw Thoo Lei Department Health and Welfare (KDHW), Burma Medical Association (BMA), Free Burma Ranger (FBR), and BPHWT and KDHW Senior Trainer and staff. The BPHWT has a training team to orgainze and monitor the training. Currently, the trainees are at MTC for practical and will complete their internship in December 2016. The Medic training topics: 1. Anatomy and physiology 2. Medical Term 3. First aid and trauma management 4. Medicine - communicable disease - Non communicable disease - Infection disease - History taking and Physical examination 5. Reproductive 6. Eye Care 7. Public health
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Medic Training Course Criteria for Participants: 1) Completed community health worker training 2) At least 2 years working experience as a health worker 3) Recommended by their community or the mother organization 4) All trainees must pass the entrance exam. 5) Be interested in primary healthcare. 6) after the trainee must work at least 2 years in their organization
D) Auxiliary Midwife Follow-up workshop The BPHWT continuous supporting of the Auxiliary Midwife (AMW) training that has been running since 2013 funded by SV award. The BPHWT with Phlon Education Development Unit (PEDU) and State Health Department (SHD) have organized five trainings for 107 AMWs. AMW training will be three months long, followed by a three month practical which take place in Mae Tao clinic at Reproductive Health (RH) department. The BPHWT has planned to organize regular follow-up workshop. According to the field trip assessment, some of the AMWs are working with Sub-Rural Health Centers. Therefore, instead of orgainzing follow up workshop, the Director with Doctors from IRC/PLE visited some Sub-RHC during January 2016. The detail visited locations are showed at the below table: Date of visits Locations 3.1.2106 1. Naung Pa Lain Sub-RHC 4.1.2016 2. Wah Pyan Gone Sub-RHC 6.1.2016 3. North Kyarin Sub-RHC 7.1.2016 4. Tha Yat Taw Sub-RHC 9.1.2016 5. Thone Se Thone Su RHC 9.1.2016 6. Ta Yi Ta Khaung Sub-RHC 13.1.2016 7. Kya Khat Chaung Sub-RHC 13.1.2016 8. Kyar In Sub-RHC
E) Trauma Management Training: This Trauma Management training conducted from 13 April to 10 May 2016 in Kler Lwee Htoo. This is one month training included both of theory and practical. There were 22 participants, comprised of 12 men and 10 women. The trainees were trained by BPHWT senior trainer. The key course topics are: Chain of survival Triage and referral system Shock and shock trauma action plan Check injuries management Limbs injuries and landmine injuries management Universal precaution Local anesthesia and ketamine general anesthesia
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F) Village Health Worker Training During reporting period, the BPHWT conducted two Village Health Worker trainings in Pa An and Papun areas. This VHW training in Pa An was conducted from 15 May and completed on 5 August 2016. This VHW training in Papun was conducted from 6 May and completed on 15 July 2016. This is three-months training and practical in their respective field areas. The key topics are: Basic Anatomy and Physiology Basic first aid Basic nursing care Basic history and physical exam medicine ( malaria, diarrhea, Pneumonia, malnutrition, measles, worm infection, family planning Basic public health Table 19: Village Health Worker Training Area Name Men Women Total Pa An 7 20 27 Papun 7 16 23 Total 14 36 50
G) Basic Computer and Office Management Training This training was conducted from 26 April and successfully completed on 2 July 2016. This training is lasted for two months. There were 18 participants, comprised of 11 men and 7 women. The trainees were trained by the BPHWT Office manager and Website and layout designer. The key course topics are: Typing tutor Basic micro soft word and Excel Basic office management Photoshop PageMaker Maintenance of Computer H) Metal health workshop This Mental Health workshop was organized from 8 March to 17 March 2016 in Mae Sot. This is two weeks workshop. The trainers are from Open Society Foundations (OSF). There were 52 participants, comprised of 40 men and 12 women.
The key discussion topics are: Mental assessment Causes of Mental Sign and symptoms Management of mental health Rehabilitation 33 | P a g e
11. Convergence, Coordination and Collaboration The health convergence initiative began in May 2012 with the establishment of the Health Convergence Core Group (HCCG), consisting now of nine ethnic health organizations (EHOs) and health community based organizations (HCBOs): Backpack Health Worker Team (BPHWT) Burma Medical Association (BMA) Chin Public Affairs Committee (CPAC) Karen Department of Health and Welfare (KDHW) Karenni Mobile Health Committee (KnMHC) Mae Tao Clinic (MTC) Mon National Health Committee (MNHC) National Health and Education Committee (NHEC) Shan State Development Foundation (SSDF)
The aim of the HCCG is to prepare existing ethnic community-based health networks, both inside Burma and those managed from the Burma border areas, for future possibilities to work together with Union and state/region government health agencies, ethnic authorities, international donors, international nongovernmental organizations, and civil society organizations. The purpose of the HCCG is to explore policy options for achieving the convergence of ethnic health networks with the health system of the Burma Government through political dialogue
The BPHWT has been moving forward with convergence activities at the program level; convergence at the policy, system and structural level will develop in conjunction with the ceasefire/peace process and as a durable, meaningful political change occurs in Burma. These ongoing initiatives with both Union and state/region health officials in Burma include: Expanding immunization programs Addressing the emergence of drug-resistant malaria Expanding the reproductive and child health workforce Information sharing on health indicators Health worker recognition and accreditation Procurement strategies Overlaps and gaps in programs, protocols, and target areas Pilot convergence activities (e.g., Auxiliary Midwife Program) Mutual recognition of health infrastructures Meetings and workshops Concept of health convergence
During the first six months’ period of 2016, the BPHWT participated in the following convergence activities: 1. EHO/HCBOs consultations with the National Health Governance Core Group (health reform advisory group for the National League for Democracy): 16 January 2016, Mae Sot, Thailand. 2. Maternal and child healthcare coordination meeting with the District Medical Officer at Kawkareik Hospital: 11 February 2016, Kawkareik, Karen State, Burma. 3. Sexual and Reproductive Health Program, Eighth South Asia-Pacific Conference (hosted by the Myanmar Ministry of Health): 23 February 2016, Naypyitaw, Burma.
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4. Myanmar Ministry of Health UNFPA Meeting: 29 February 2016, Pa An, Karen State, Burma. 5. Health Reform towards a Devolved Health System in Burma Seminar: 24-25 March 2016, Mae Sot, Thailand. 6. Maternal and child healthcare coordination meeting with the Kawkareik Township Officer, Burma Medical Association, and the Karen Department of Health & Welfare at Kawkareik Hospital: 27 June 2016, Naungkain, Karen State, Burma. The health convergence initiative works in concert and supports the ceasefire and peace negotiations between the Burma Government and the ethnic people. While supporting these negotiations, the movement and timing of health convergence entails certain real risks to ethnic health workers and infrastructures should the negotiations breakdown and fighting resume. With the signing of a Nationwide Ceasefire Agreement by some of the ethnic armed organizations, the risks to the ethnic health workers and infrastructures maybe be somewhat lessen in some targeted areas and more comprehensive health convergence activities can be delivered safely to those targeted populations. It is hoped that the new Burma Government and Parliament will actively support genuine peace negotiations with the EAOs such that the active conflicts will cease on a true nationwide basis in Burma to ameliorate the associated negative health outcomes. Maternal and Child Healthcare Program Convergence Activities: January - June 2016 On 13 February 2016, the Ethnic Health Organizations (EHOs) and Kawkareik District Medical Officer met at Kawkareik Hospital for a coordination meeting. In this meeting, the following topics were discussed: Kawkareik District Health Profile Border health overview - ethnic healthcare provision and system orientation Emergency referrals between Kawkareik Hospital and EHO clinics, Field level coordination and regular consultations
Participant organizations were: BPHWT, BMA, KDHW, Kawkareik District Medical Officer, and the Swiss Agency for Development and Cooperation. On 23 February 2016, the BPHWT attended the Sexual and Reproductive Health Workshop of the Eighth South Asia Pacific Conference on Reproductive and Sexual Health and Rights (SAPCRSHR). This workshop was conducted by the Myanmar Ministry of Health (MoH). The Workshop objectives were to: Provide a platform for SRHR stakeholders to share successes and lessons learned; Identify and agree on priority actions to advance universal access to SRHR for sustainable development; Review cutting–edge research finding on HRSR; Share evidence-based practices in advocacy, policy, financing, governance & accountability, SRHR program integration in health system; and, Strengthen partnerships and open opportunities for new alliances in SRHR. At this Workshop, the participants were from: Burmese EHOs, Myanmar MoH, Asian countries, INGOs, and consultants from European countries.
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On 29 February 2016, the BPHWT attend the Myanmar MoH- UNFPA meeting at Pa An. The meeting objective was for program convergence on basic EMoC and family planning. Presently, the Myanmar MoH has a program for basic EMoC and family planning. However, they are unable to implement the program by themselves in remote areas. Consequently, the meeting allowed for the sharing of information between the EHOs and Myanmar MoH about basic EMoC and family planning. The EHO leaders and Myanmar MoH agreed to meet in the very near future in Mae Sot, Thailand to discuss an implementation plan for Basic EMoC and family planning.
On 27 June 2016, the BPHWT, BMA, and KDHW conducted a coordination meeting with the Kawkareik Township District Medical Officer and the Swiss Agency for Development and Cooperation at Naung Kain village in Karen State. The meeting objective was convergence for referral issues and immunizations. Presently, when there are referrals from the EHOs to the Kawkareik Hospital, there is an ethnic language barrier and a lack of understanding of the referral document procedure. The meeting addressed both of these issues.
At this same meeting, there was also a discussion about immunizations for children under 5 years of age. The Myanmar MoH wishes to cooperate with the EHOs since the MoH has difficulty in both accessing and organizing immunizations in ethnic areas because of a language barrier and lack of community trust. Whereas, the EHOs have no such problems since they are community based.
12. Monitoring and Evaluation The Back Pack Health Worker Team organizes program activities meetings twice a year and a general meeting once a year, which include a monitoring and evaluation session. During these meetings, the Leading Committee specifically focuses on monitoring and evaluation. The Leading Committee monitors and analyzes data brought back from the field (e.g., caseload data and field in-charge reports) by looking at the presentations provided by the Program Coordinators. This allows for discussion on improvements which need to be made to the programs. During these meetings, Program Coordinators also offer advice on some health issues which the health workers could not solve by themselves, and then provide some suggestions for future planning. During this period of 2016, the Back Pack Health Worker Team organized a Monitoring and Evaluation (M&E) trip by the BPHWT Director and MCHP coordinator and M&E staff to different field areas - Kawkariek, Dooplaya, Thaton, Papun and Pa An. The purpose for these trips was to evaluate the program effectiveness, gather feedback from the communities, and plan for future development of the BPHWT programs. Monitoring and Evaluation Objectives: Assess the health needs in the community Improve health worker’s skills and knowledge Promote the skills, knowledge and participation of community TBAs/TTBAs and VHVs/VHWs Improve the program management skills of the field in-charges Improve program effectiveness The BPHWT also participates with Health System Strengthening project for field Continuous Medical Education (CME).
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Table 20: Monitoring and Evaluation Framework Key Indicators Methods Period Health worker performance Logbook reviews Every six months Program development Annual report comparing planned Once a year with actual activities Program management Leading Committee election and Every three years Executive Board appointments Outcome and impact assessment Conducting survey Every two years
Training effectiveness Pre-tests, post-tests, and Every six months examinations Financial management Comparing planned with actual Every six months budget External audit Once a year
Table 21: Gender Analysis of the People Working within the BPHWT (Jan-Jun 2016) Total # of Total # of Actual Category Workers Women Women % Leading Committee/Executive Board 15 6 40% Office Staff 12 3 25% Field Management Workers 59 27 46% Field Health Workers 338 178 53% Village Health Workers/VHVs 239 151 63% Trained Traditional Birth Attendants/TBAs 773 720 93% Organizational Total 1,436 1,085 76% Total Organization excluding TTBAs 55%
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13. Financial Report: BPHWT Income and Expenditures: 1st January- 31st June 2016 ITEMS Income Expenditure % (Thai Baht) (Thai Baht) OPENING BALANCE -1 JANUARY 2016 669,497 …… PERIOD INCOME International Rescue Committee (IRC/DFID) 6,466,848 32 % Stichting Vauchteling (SV)- Netherlands 3,909,075 19 % Burma Relief Center (Interparas) 2,800,000 14 % Swiss Agency for Development and Cooperation (SDC) 2,752,297 13 % International Rescue Committee (IRC/PLE) 2,510,635 12 % Burma Humanitarian Mission_BHM 838,855 4 % Marie Stope International Myarmar (MSIM) 400,455 2 % Other Donation 361,203 2 % Shoklo Malaria Research Unit (SMRU) 180,000 1 % Mae Toe Clinic (MTC) 300,000 1 %
Bank Interest 7,981 0 %
TOTAL PERIOD INCOME 20,527,349 100 % TOTAL INCOME 21,196,846 PERIOD EXPENDITURES Back Pack Medicine and Equipment (MCP) 4,844,785 27 % Back Pack Field Operation Supplies and Services 1,163,300 5 % Community Health Education and Prevention Program (CHEPP) 2,706,659 15 % Maternal and Child Health Care Program (MCHP) 2,644,445 14 % Capacity Building Program (CBP) 2,623,175 14 % Health information and Documentation (HID) 332,359 2 % Program Management and Evaluation (PME) 2,401,683 13 % General Administration 1,806,599 10 % TOTAL PERIOD EXPENDITURES 18,523,005 100 % CLOSING BALANCE - 31st June 2016 2,673,841
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Part II: Program Workshops and 36th Semi-Annual Meeting Report
1) Program Workshops at the BPHWT’s Mae Sot Office 1. Medical Care Program Workshop 2. Community Health Education and Prevention Program Workshop 3. Maternal and Child Healthcare Program Workshop 4. Organizational Management workshop 5. Data collection workshop 6. BBG update treatment guideline workshop 7. Pharmacy management workshop 8. Water and Sanitation workshop 9. Mental Health Assessment workshop 10. Strategic planning workshop
1. Medical Care Program Workshop Facilitators - Naw Hsa Mu Na Htoo and Nan Pa Pa Win Duration - 8-10 September 2016 Participants - 37 (28 men and 9 women) Discussion Topics: Field activities report presentation Discus with field missing reporting Discus MCP data collection & field missing reporting Review of distributed medicine and supplies list Update stationary BP team & Health worker name To clean of pilot and emergency All Data Report Form Review (Field I/C ,H.W Report & Other form ) 2. Community Health Education and Prevention Program Workshop Facilitators - Saw Eh Mwee and Pway Wah Poe Duration - 8-10 September 2016 Participants - 22 (16 men and 6 women) Discussion Topics:
Review of the field activities Field report form Discussion of health education on school health Discussion of village health workshop Water and sanitation Vit-A and De-worming Financial report
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3. Maternal and Child Healthcare refresher workshop Facilitator - Naw Thaw Thi Paw, Moe Moe Win & Naw Leh Nay Say Duration - 8-11 September 2016 Participants - 28 (2 men and 26 women)
Discussion Topics: MCH Supervisor report presentation (15 areas) Nutrition RH Awareness TBA Assessment Maternal death Review form Birth record Financial review Future plans
4. Organizational Development workshop
Facilitator - Nang Snow Duration - 5-7 September 2016 Participants - 27 (20 men & 7 women)
Discussion Topics: Project implementation and monitoring stage Project evaluation stage Project learning stage Review program goal, objectives, and activities
5. Data collecting workshop Facilitator - S’ Aung Than Oo & Naw Htoo Duration - 5-7 September 2016 Participants - 45 (15 men & 30 women)
Discussion Topics: Update report form Logbook form Human resource form Birth record form
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6. BBG Treatment Guideline update workshop Facilitator - Dr. Aung Pyi Pyo (SMRU), Dr. Aung Myit Thu (SMRU), & Dr. Thaw Dar Htwin (SMRU) Duration - 12-13 September 2016 Participants - 85 (46 men & 39 women)
Discussion Topics: Leptospirosis Scrub typhus Diarrhea & dysentery Typhoid fever Malaria Zika Japanese B encephalitis Dengue ARI, Mild (URTI) ARI, Severe (LRTI) Meningitis Gastritis (GU/DU) Hypertension Heart Disease UTI Urine distich & procedure
7. Pharmacy Management workshop Facilitator - Dr. Sai Lu (MTC) Duration - 14-15 September 2016 Participants - 75 (36 men & 39 women)
Discussion Topics: Medical store management overview Health Expenditure Drug donation record form Pharmacy checklist Overview outbreak investigations Physical inventory form (P1 to P8)
8. Water and Sanitation workshop Facilitator - Alex (TBC) Duration - 14 September 2016 Participants - 32 (20 men & 12 women)
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Discussion Topics: Rule and regulation of the project Data and Report forms Future plans
9. Mental Health Assessment result review workshop Facilitator -Dr. San San Oo (OSF), Dr. Ganesa (OSF) & Saya Ma Hpeh (OSF) Duration - 7-8 October 2016 Participants - 31 (20men & 11 women)
Discussion Topics: Objective Review the last field facing case assessment Depression case study Causes Clinical feature Clinical furfures Statistics Question to ask Suicidal ideas Treatment of preparation Treatment of depression Psychosis
10. Strategic Planning workshop Facilitator - Nai Aye Lwin Duration - 20-22 September 2016 Participants - 51 (32 Men and 20 women)
Discussion Topics: Current situation of field areas SWOT analysis
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Workshop photos during the six month meeting in Mae Sot:
Organizational Management workshop Financial Management workshop
CHEPP workshop Case definition workshop
MCP workshop Pharmacy Management workshop
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2) 36th BPHWT Semi-Annual General Meeting The 36th Semi-Annual Back Pack Health Worker Team General Meeting was conducted on 26th and 27th September 2016 at the BPHWT Mae Sot Office. There were 94 participants; comprised of 44 women and 50 men. The purpose of this session was to discuss the health worker experiences in the field, share knowledge, review which activities were and were not implemented as well as why some activities could not be implemented, compare outcomes in relation to plans made at the previous six-month meeting, and share difficulties encountered in the field. A week before the beginning of the meeting, the BPHWT’s data team entered, checked the quality of, and analyzed the data obtained from the field areas. During the meeting, the Leading Committee discussed the data, from a programmatic perspective, in order to monitor the events taking place in the targeted field areas. After this analysis, they discussed how to improve data collection methods. Also during the meeting, the Leading Committee offered advice for those issues that health workers were unable to solve by themselves, and provided suggestions for the planning of the next implementation period. After the meeting, the Leading Committee discussed possible ways to handle the problems identified during the session and came to decisions about how to take actions to solve these problems. Schedule of the BPHWT’s 36th Semi-Annual General Meeting Day (I) – 26 September 2016 Description of Presentation Responsibility Opening speech Dr. Cynthia Maung Introduction Facilitators Review and Discussion on 35th Six Monthly Meeting Decisions and All members of BPHWT General MCH program coordinator report and workshop report Naw Thaw Thi Paw Discussion on MCH report All members of BPHWT 1. CHEPP program coordinator report and workshop report Saw Eh Mwee and Jar Sai Khaung Discussion on CHEPP report All members of BPHWT MCP program coordinator report and workshop report Naw Hsa Mu Nar Htoo Discussion on MCP report All members of BPHWT Day (II) – 27 September 2016 1. HID report presentation Aung Than Oo 2. Discussion on HID report All members of BPHWT 1. Capacity Building coordinator report and workshop report Saw Christen 2. Discussion on CBP report All members of BPHWT Situation Update report & Discussion Ko Gyi Kyaw Office administration report presentation S’moe Naing Financial report presentation Saw Chit Win Closing Speech Chairperson
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BPHWT’s 36th Semi-Annual General Meeting Decisions: 1) All malaria posts, implemented in the BPHWT’s target field areas, will be directly supervised by the BPHWT. 2) Identification cards will be issued, during February in 2017 to all field health workers, stating that they are the BPHWT’s health workers. 3) Case definitions will be translated into Burmese versions in the logbooks. 4) The MCP Coordinator will complete an update of the Village Health Worker Handbook before the first six-month period of 2017. 5) The Leading Committee and Field in-Charges’ Meeting will discuss all the following requests: Confirm the conversion of the Chin (Woman’s League of Chinland) pilot Back Pack team into a permanent Back Pack team. Conduct Community Health Worker training in the Taungoo Field Area. Increase the medicine transportation expenditures for the Pa O and Palaung Field Area. Allow the Kachin and Palaung Field Areas to purchase medicine inside Burma. Recruit one additional Field in-Charge for the Papun Field Area. Additional requests from the MCP. 6) TBA/TTBA assessments of 704 TBAs/TTBAs will be conducted during the second six-month period of 2016. 7) The following MCHP activities will be implemented during the second six-month period of 2016:
Description Units TTBA Training Sessions 3 TBA/TTBA Workshops 69 TBA/TTBA Kits 43 Village Health Committee Meetings 14 Nutrition Food Provision for Pregnant Women (for 3 months) 20 Implant Procedures 110
8) All required narration and financial documents will be sent to the Mae Sot Head Office on time. 9) The Leading Committee and Field in-Charges’ Meeting will discuss all the following CHEPP requests: a. Support for Key Health Days and Village Health Workshops. b. The following water and sanitation requests:
Items Numbers Shallow wells 29 Gravity flows 14 Water filters 2 Community latrines 1950
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10) The Leading Committee and Field in-Charges’ Meeting will discuss the Capacity Building Program. 11) The Leading Committee and Field in-Charges’ Meeting will discuss conducting a Disease Outbreak Surveillance Workshop in the targeted field areas. 12) The field in-charges will inform the Mae Sot Head Office should they require HIS technical support for their field areas. 13) The Leading Committee and Field in-Charges’ Meeting will discuss using the BPHWT’s vehicles for transportation inside Burma. 14) The BPHWT will coordinate patient referrals with the Mae Tao Clinic. 15) Village Health Committees will be established in all Back Pack team areas during 2017. 16) A school health assessment will be conducted during the first six-month period of 2017. Leading Committee and Field In-Charge Meeting Decisions 1. These following members are appointed to the Executive Board: Names Positions 1. Saw Win Kyaw Director 2. Nang Snow Deputy Director 3. Naw Hser Moo Nar Htoo Coordinator - Medical Care Program 4. Naw Thaw Thi Paw Coordinator - Maternal and Child Healthcare Program 5. Saw Moo Thar Coordinator - Community Health Education and Prevention Program 6. Saw Christen Coordinator - Capacity Building Program 7. S’ Aung Than Oo Coordinator - Health Information and Documentation 8. Saw Soe Hla Oo Logistic manager 9. S’ Moe Naing Office Manager 10. Naw Leh Nay Say Finance Manager 11. ------Coordinator - Monitoring and Evaluation
2. Fundraising, and proposal and report writing staff will be recruited 3. The Chin (Women’s League of Chinland) Back Pack team will continue as a pilot Back Pack team. 4. Community Health Worker training will be conducted in the Taungoo and Pa O Field Areas, and at Thay Bay Hta during 2017 and 200,000 MMK will be used to support CHW training in the Taungoo Field Area. 5. One additional field in-charge will be recruited for the Papun Field Area to cover the supervision of all Back Pack teams in the Papun Field Area. 6. The Executive Board members will continue to discuss the field structure so as to make a decision during the first six-month period of 2017. 7. A Disease Outbreak Surveillance Workshop will be conducted during the first six-month period of 2017. 8. The BPHWT annual meeting will be conducted during in the third week of January 2017; therefore, all the field reports must be sent to the Mae Sot Head Office in the last week of December 2016. 9. A Village Health Committee (VHW) Workshop will be conducted during the first six-month period of 2017. Naw Thaw Thi Paw will be a facilitator for this VHC Workshop. 46 | P a g e
10. Auxiliary Midwife Training will be conducted during October 2016, inviting a participant from each of the twenty Back Pack teams in the Community Health for Eastern Burma (CHEB) Project and two participants from Balue Jone village. 11. Malaria activities, supported by the URC, will be implemented in the BPHWT’s targeted areas as a project. URC-supported malaria activities in non-Back Pack targeted areas must be as in- kind donations. 12. Nai Aye Lwin is responsible will contact Sayar Harry from IRC/PLE about conducting a BPHWT Human Resource and Finance Policy review in January 2017. 13. Nai Aye Lwin will “polish” the BPHWT Constitution, procedures, and policy. 14. MCH refresher training will be conducted during December 2016, inviting one participant from the Pa An, Dooplaya, Kawkareik, and Win Yee Field Areas, and two participants from the Special, Thaton, and Kler Lwee Htoo Field Areas. Participants will be invited from other field areas for a total number of 27 participants. 15. The following MCHP activities will be implemented during the second six-month period of 2016:
Description Units Area Reproductive Health Awareness Workshops (SDC) 11 Dooplaya, Win Yee, Kawkareik Reproductive Health Awareness Workshops (MSI) 73 All Areas Village Health Committee Meetings 14 Dooplaya Monitoring & Evaluation Trips 4 Birth Records Distribution 74
16. Seventy-two sessions of school health activities will be conducted and 950 community latrines, 23 shallow wells, 11 gravity flow systems, and 2 water filters will be implemented during the second six-month period of 2016. 17. Fourteen Village Health Workshops will be conducted during the second six-month period of 2016.
3) 7th BPHWT Conference The seventh BPHWT Conference was held on 29 September to October 2016 at the BPHWT office in Mae Sot, Thailand and attended by 105 field representatives and headquarters leadership. The BPHWT Conference represents the highest leadership structure of the BPHWT and is held every three years. The Conference reviews the key operations and financials of the BPHWT, elects thirteen Leading Committee members to oversee the BPHWT for the next three years, and otherwise addresses selected key matters pertaining to the BPHWT. As a body of delegates, the Conference functions in a democratic manner, while also promoting the participation of women in leadership positions within the BPHWT. During the seventh BPHWT Conference, the official delegates elected the members of the Leading Committee, who will oversee the governance of the BPHWT for the next three years. While Leading Committee members are elected and not appointed, the election procedures assure that at least eight, or 30%, of the thirty nominees will be women. The other nominees can be of either
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gender. The official delegates are free to vote for any fifteen of the candidates, regardless of gender, to be members of the Leading Committee. After the Conference, the new Leading Committee members appointed eleven members of the BPHWT Executive Board to oversee the finances and day-to-day operations of the BPHWT over the next three years. The eleven members Executive Board now consist of four women.
New Elected Members of the Leading Committee for year 2017-2019
The Election Rules of Leading Group Members:
1. The procedures for the election of the members of the Leading Committee are governed by provisions within the Constitution of the BPHWT. 2. The election of members of the Leading Committee coincides with the BPHWT Conference which is held every three years. The official delegates to the Conference represent the field leadership and members of the current Leading Committee. 3. The election process begins with the vocal nomination of thirty people by the official delegates and seconding vocal recommendations for each nominee by at least two other official delegates. An official delegate can only nominate one person and offer only two recommendations for nominees other than any made by them. All persons nominated as members to the Leading Committee must be present at the Conference at the time of their nomination. 4. To promote the participation of women in leadership positions with the BPHWT, at least 30% of the thirty nominees, that is eight, must be women. To insure that at least eight women are nominated, the first nominations accepted are of women only. Once there are eight women nominees, then the remaining eighteen nominations are accepted regardless of gender.
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5. Ballots are then prepared with the thirty candidates and distributed to the official delegates for voting. Each official delegates votes for only fifteen candidates from the election slate of thirty candidates. 6. Official delegates are free to vote for their preferred candidates without any pressure to vote for any one candidate. Votes are tabulated and the results are announced to the full conference. 7. The new members of the Leading Committee and field in-charges then meet to elect a Chairperson, Secretary, and Treasurer from among themselves. This election will be presented to the official delegates of the Conference for confirmation. Elected Members of the Leading Committee:
Names Sex Positions 1. Dr. Cynthia Maung F Chairperson 2. Nai Aye Lwin M Secretary 3. Saw Chit Win M Treasurer 4. Mahn Mahn M Member 5. Saw Win Kyaw M Member 6. S’ Moe Naing M Member 7. S’ Aung Than Oo M Member 8. Ko Gyi Kyaw M Member 9. Saw Moo Thar M Member 10. Soe Moe Aung M Member 11. Saw Soe Hla Oo M Member 12. Nang Snow F Member 13. Naw Thaw Thi Paw F Member 14. Naw Hser Mu Nar Htoo F Member 15. Naw Leh Nay Say F Member
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