The document describes a Coordinated Township Health Plan (CTHP) being implemented in 20 townships in Myanmar. The CTHP focuses on system planning for maternal and child health, immunization, nutrition and environmental health. It establishes monitoring and evaluation frameworks and develops RHC plans with sub-RHC participation. Initial results from January to June 2012 show the CTHP delivered services to 63.4% of the planned population across the 20 townships. The CTHP addresses gaps in coordination, access to health services, and financing while strengthening the health system. Expansion to additional townships is proposed along with more collaborative efforts between agencies.

2. Coordinated Township Health Plan in (20) townships
GAVI HSS

3. Contents of CTHP
1. Conducting a health system assessment
2. Establishing a Monitoring and Evaluation
Framework
3. Developing RHC plans with sub RHC
participation
4. Township Level Activity setting
5. Analyzing Costs and Sources of Finance at
Township level
6. Incorporating all of the above into a
Coordinated Township Health Plan

5. Scope of the Coordinated Health Plan (Package
of Services)
• the focus will be on “system planning” for maternal and
child health, immunization, nutrition and
environmental health.
• the planning is therefore for the coordinated
management and delivery of a “package of services,”
and is not simply a collection of projects and programs.
• Once the system has been designed, tested and
evaluated, consideration should be given to expanding
the package of services to include communicable disease
control, NCDs and hospital service

6. Results of Package Service Delivery from
Jan-June 2012 in (20) townships

7. Package of service from Jan-Jun 2012 in (20) Tsps
s/n Township
Planned
package
Package service
from Jan-Jun
Percent
1
Bamaw
57
43
75.4
2
Shwegu
78
45
57.7
3
Demawsoe
88
46
52.3
4
Hlaingbwe
100
74
74
5
Hakkha
85
78
91.8
6
Ye Oo
159
81
50.9
7
Myeik
79
43
54.4
8
Mudon
132
64
48.5
9
Thaton
102
62
60.8
10
Lewe
137
82
59.9
11
Pyinmana
96
61
63.5
12
Htilin
142
77
54.2
13
Yedarshay
129
84
65.1
14
Thayarwaddy
163
93
57.1

8. Package of service from Jan-Jun 2012 in (20) Tsps
s/ Township
n
Planned
package
Package
service from
Jan-Jun
180
%
15 Maungdaw
253
16 Kyaington
210
198
94.3
17 Nyaungshwe
180
75
41.7
18 Ngaputaw
92
38
41.3
19 Kawthmu
118
66
55.9
20 Hsipaw
101
95
94.1
2501
1585
63.4
Total
71.1

17. s/n
Problem/Gaps
Response
Strengths
Weaknesses
1
Lack of coordinated plan
CTHP
Guideline
Costed
Less
coordination
2
Lack of access to health in
HTR area
• Mapping HTR
• Planned for Package of
service tour together
with BHS for the whole
year
• Provision of TA/DA for
midwives + Supervisors
+ AMW/CHW to move
to additional villages
more frequently with
package service
(MCH+EPI Nutrition +
ES)
•Increase in
service delivery
• Team work
culture created
• Good rapport
with community
Specific•ANC -increased
• improper
arrangement
for health
posts
• EPI- can give
to missed case
•Nutrition
assessment
• Env Sanitation
• HE- a lot can
be done
-Delivery by
SBA ???
-High vaccine
wastage
-Corrective
measures still
needed
-Need P&P
infrastructure
-IEC materials
-Time
-NCD?

18. s/n
Problem/Gaps
Response
Advantage
Disadvantage
3
Lack of coordination with
local authorities/others
Quarterly and annual
review meetings at RHC
levels/Township level
• Successive
packagesbecome
smooth
More positive
collaboration
CHW thou'
motivated
4
Infrequent supervision and Financing supervision
monitoring
Regular supervision at
all levels
Motivated
midwives
5
-Low midwife: population
ratio
-Incorrect skill mix
HR research
Evidence
based policy
making tools
-Poor retention of staff in
HTR
Training of AMW/CHW
Refresher training
6
Lack of operational finance MCH Voucher Scheme
for providers and
(pilot in Yedarshay)
economic barriers in the
community
HEF for all hospitals
Increase
access to
MCH service
Save lives of
poor mothers
and children
Heavy
workload for
hospital staff

19. s/
n
Problem/Gaps
7
Response
Advantage
Disadvantage
Limitations in supplies of ED Essential Drugs to
and equipment (no
TH/SH/ RHC/ sub center
replenishment for 10 years) level
Equipment (RHC kit/HA
kit/MW kit/CDK)
Incremental for 4 years
ED provided
and used
Did not meet
the needs- s/a
Antibiotics,
Multivitamins,
Antacid , Anti hypertensive
8
Lack of training on
management & research
HSR training
HSR grant
S/R level ,
TMO are
equipped
with training
and funds –
motivated
Still cannot give
full time for
research
9
Bicycles- old and inoperable
Motorbikes provided
10
117 midwives are without
sub centers
To build new SC/
refurbish old RHC- this
year –program changed
Cannot give to
all those in need
MOH is
building new
RHC/SC

20. Way forward
• With a national scale up of the HSS Strategy to (40,60,60 to a total
of 180 townships) there is need for
– a strong middle level of management in the health system
– Provision of resources to S/R
– A clear budget allocation for HSS to ensure adequate
governance mechanisms at the State/Regional levels
• More collaborative actions at the central level to become
comprehensive CTHP in future
• More collaborative efforts with UN Agencies & Donors
• Many space for improvement in HSS townships that can be
filled by
different agencies at township operational levels
• Lessons learned can be inputs for sustainability issue of
package of
service delivery by group of BHS
• Policy guidance from evidence based research ----

21. Thank You