Analysis of Reproductive Health Stakeholders in Myanmar Executive Summary Reproductive Health Stakeholder Analysis Myanmar was done in 2001 and identified over 50 agencies and organizations. However, many agencies and organizations were working with primary focus on HIV/AIDS. Primary data collection focused on 4 areas of RH – birth spacing; maternal and obstetric care; RTI/STI programmes; and ARH activities. This is the second attempt, after five years, to update the information on reproductive health stakeholders in Myanmar. In this analysis, only those organizations that have activities with primary objectives of addressing the reproductive health issues are included. This analysis is undertaken with the objective of updating the information on reproductive health activities - the Minimum Essential Package of Reproductive Health Interventions according to the Life Cycle Approach - implementing by stakeholders. Five semi-structured, self-administered questionnaires were sent to 54 stakeholders and received replies from 39 stakeholders (72.2%). Among the responding stakeholders, 17 stakeholders have no reproductive health programme and 2 organizations are implementing HIV/AIDS programme only. Non-governmental organizations started implementing reproductive health activities as early as 1991 by local NGO and 1993 by International NGOs and more and more NGOs coming into play. All the States/Divisions are covered by one or more stakeholders giving that MMCWA provides RH services in all States and Divisions. The number of stakeholders in State/Division ranges from one in Kayah state to 12 in Yangon division. Northern Shan state has 11 stakeholders and Mandalay and Ayeyarwady divisions have 9 stakeholders each. Among the organizations, MMCWA covers all states/divisions and UNFPA implements in 15, JOICFP in 11, PSI in 10 and MMA in 8 states/divisiosn. Out of 18 organizations, 14 are involved in ‘Adolescent reproductive health’ and ‘RTI/STI/HIV/AIDS’. Thirteen organizations (72.2%) provide/support ‘Antenatl care’. Twelve organizations promote ‘Men’s role in/and reproductive health’. Nine organizations supported ‘Postnatal care’. ‘Birth spacing and contraceptive services’ are provided by 11 organizations. Nine organizations support for ‘Neonatal care’ and ‘Postnatal care’. ‘Delivery care’ is delivered by 7 organizations. Only 4 organizations take care of ‘Post-abortion care’. ‘Post menopausal reproductive health’ and ‘Gynaecological cancers’ are supported by one organization. There is no organization addressing the area of ‘Subfertility’. The number of RH interventions implemented by each organization ranges from 2 interventions (MdM, PSI, YWCA) to 11 interventions (MMCWA). MMCWA engages in all minimum essential package of RH interventions. Malteser implements 9 interventions and AMI, Merlin and UNFPA provide 8 interventions each. There is a wide variety of target population, from newborn to youth, adolescents and married men and women, high risk groups to general community and service providers. Fifteen organizations conducted training, both technical and management support training for improving the skills of the service providers and the quality of services provided to targeted groups as well. Types of trainings could be grouped into 8 groups: - (1) Training of AMW/TBA; (2) Reproductive health; (3) Birth spacing, contraceptives, family planning; (4) Safe motherhood, neonatal care and women and child development; (5) STI/HIV/AIDS; (6) Male involvement; (7) Supporting skills development; and (8) Project management. There were 21 research studies conducted by seven organizations. The number of research study conducted by each organization ranged from 1 to 6 studies. The research areas comprises of KABP of Sexual and Reproductive Health of young people (15 – 24 years), RH services facility assessment / Infrastructure and quality of services, Knowledge and performance of Trained personnel, Behavioural study on male involvement, KPC survey / Formative research, Safe motherhood, PMCT, Anaemia in pregnancy, Antenatal care, and KAP study of Youth-to- Youth peer education for Reproductive Health. There seems to be a strong collaboration among the key players. Almost all the stakeholders were in close cooperation with Department of Health in delivering the RH services. UNFPA was cited by 11 organizations - 2 LNGOs and 9 INGOs - as an implementing partner in reproductive health. Reproductive health activities and geographical coverage are similar in some cases between stakeholders because information was received from both donor and implementer. Most of the organizations showed their interest in reproductive health in Myanmar. Over half of the organizations expressed that their organizations gave priority to reproductive health in a strong manner. The organizations’ interest in health promotion and improved quality and access to services were high (60%). Majority of the organizations were of great interest in partnership and net-working (53.3%), capacity building (73.3%) and sustainability (80%). However, there was necessity to enhance more networking and advocacy to build a closer relationship with public services and other implementing partners with common goal. Most of the organizations expressed their opinions on gaps between capacity of their staff and performance in reproductive health. Two-thirds of the organizations plan to expand/scale up their RH activities and the rest are going to continue their activities. The planned expansion/scaling up activities include birth spacing, male involvement, training, advanced care, quality care, comprehensive sexual reproductive health counseling, emergency obstetric care and expansion in geographical coverage and more support to public health facilities. CONTENTS Executive summary 1. Introduction 1 2. Objectives 1 3. Methodology 2 4. Limitations 4 5. Study Period 4 6. Profile of organizations 4 7. Geographical coverage by stakeholders 5 8. Minimum essential package of reproductive health interventions 7 8.1 Reproductive health activities by stakeholders 7 8.2 Sub-component activities of each RH interventions 7 8.2.1 Adolescent reproductive health 8 8.2.2 Birth spacing and contraceptive services 8 8.2.3 RTI/STI/HIV/AIDS 9 8.2.4 Antenatal care 9 8.2.5 Delivery care 9 8.2.6 Neonatal care 10 8.2 7 Postnatal care 10 8.2.8 Post-abortion care 10 8.2 9 Gynaecological cancers 10 8.2.10 Postmenopausal reproductive health 10 8.2.11 Men’s role in/and reproductive health 10 8.3 Target population 11 8.4 Implementing partners 12 8.5 Future plan 13 9. Capacity Building 13 10. Research 17 11. Opinions, perceptions and attitudes on organization performance 18 12. Conclusions 21 References 22 Annexes Annex A : Profile of organizations Annex B-1 : Geographical coverage of reproductive health interventions Annex B-2 : Township coverage of reproductive health interventions Annex B-3 : Minimum essential reproductive health interventions Annex C : Capacity building Annex D : Research studies Annex E : Opinion, perceptions and attitudes Annex F : Questionnaires ABBREVIATION AIDS : Acquired Immno Deficiency Syndrome AMW : Auxiliary Midwife ARH : Adolescent Reproductive Health BCC : Behavioural Change Communication BHS : Basic Health Services CBO : Community Based Organization CHEB : Central Health Education Bureau CSG : Community Support Group DHP : Department of Health Planning DOH : Department of Health DU : Drug User EC : European Commission ECHO : European Commission for Humanitarian Organization FBO : Faith-based Organization FRHS : Fertility and Reproductive Health Survey GO : Government Organization HIV : Human Immuno-deficiency Virus HRM : High Risk Men INGO : International Non-Governmental Organization KABP : Knowledge, Attitude, Behaviour, Practice LNGO : Local (National) Non-Governmental Organization MANA : Myanmar Anti Narcotic Association MCH : Maternal and Child Health MCHWSA : Medical Christian Health Workers Services Association MNA : Myanmar Nurses Association MOH : Ministry of Health MSM : Men having sex with men MWAF : Myanmar Women Affairs Federation MWRA : Myanmar Women of Reproductive Age NAP : National AIDS Programme NGO : Non-Governmental Organization PH : Public Health PMCT/PMTCT : Prevention of Mother to Child Transmission PPFA-International : Planned Parenthood Federation of America-International RH : Reproductive Health RHC : Rural Health Center RTI : Reproductive Tract Infection SDC : Swiss Development Committee SRH : Sexual Reproductive Health STI : Sexually Transmitted Infection SW : Sex Worker TBA : Traditional Birth Attendant THD : Township Health Department ToT : Training of Trainer TMO : Township Medical Officer VCCT : Voluntary Confidential Counselling and Testing VHV : Village Health Volunteer ABBREVIATION OF ORGANIZATIONS/STAKEHOLDERS AFXB : Association of Francois-Xavier-Bagnoud AMDA : Association of Medical Doctors of Asia AMI : Aide Medicale International CARE : Cooperation Assistance Relief Everywhere JICA : Japan International Cooperation Agency JOICFP : Japanese Organization for International Cooperation in Family Planning Malteser : Malteser International MdM : Medicins du Monde MMA : Myanmar Medical Association MMCWA : Myanar Maternal and Child Welfare Association MRCS : Myanmar Red Cross Society MSI : Marie Stopes International PSI : Population Services International SC : Save the Children UNFPA : United Nations Population Fund WV : World Vision YWCA : National Young Women Christian Association RH Stakeholders Analysis ANALYSIS OF REPRODUCTIVE STAKEHOLDERS IN MYANMAR