Overall Goal (SDC in Myanmar)Contribute to political, social and economic transitions in Myanmar that aim at a peaceful, inclusive and equitable society as well as democratically legitimized institutions

Health, Social Services and Local Governance Domain GoalDisadvantaged people in rural communities, including conflict-affected vulnerable population have access to better basic social infrastructure and services and are enable to hold their local governments accountable for these services.

FACTSHEET

HEALTH

Context: challenges and opportunitiesAfter 50 years of authoritarian rule and more than 60 years of internal conflicts, Myanmar has recently embarked on a transition process which has led to a lifting of international sanctions and on a normalization path with donor countries. The signing of ceasefire agreements with Ethnic Armed Groups (EAG) has also permitted access to conflict affected areas, under the control of EAGs and improved mobility. One of the poorest countries in Asia, despite its plentiful natural resources, Myanmar has long underinvested in social sectors in general and health in particular, resulting in weaknesses in all of the health system pillars. In 2012, government spending on public health was 1.6$ per person per year with out of pocket payments accounting for almost 80% of total health spending. Health indicators show important health needs, in particular with regards to the 3 Health MDGs, namely maternal and child health, as well as communicable diseases (HIV/AIDS, TB and Malaria). At least 2,400 pregnant women and 70,000 children die each year, largely from preventable causes. Access to health services is hampered by difficult transport, cost, availability of staff, infrastructure and equipment, language and traditional beliefs. The quality of public health services is perceived as low which deters demand. The situation is exacerbated in EAG

controlled areas, where the parallel health system based on Ethnic Health Organisations has a low resource base, and from which the access to services is even more complicated. Although still not satisfactory, the situation is improving. According to the 2015 World Bank’s Public Expenditure Review, government spending on public health has increased, from 1.7% in 2009/2010 to 6.4% in 2013/2014 of total expenditures, even if it is driven in big part by capital spending including machinery, equipment and construction of primary care facilities. The wage bill has also tripled to hire more health professionals and pay them better. Drugs and medical consumables have further been purchased in order to decrease out of pocket payments.

SDC strategy:SDC supports health needs in Myanmar through the following strategy:• Participate in strengthening national health

system at Union level and through Ethnic Health Organisations

• Support health service delivery• Support communities and demand for services• Use our involvement in projects to inform Union

level discussions and vice-versa• Follow a conflict sensitive approach to program

management, and facilitate coordination between government and ethnic health systems.

HEALTH, SOCIAL SERVICES AND LOCAL GOVERNANCE

For further info:Embassy of Switzerland

Email: ygn.vertretung@eda.admin.chWebsite: www.eda.admin.ch/yangon

SDC Portfolio1. Three Millennium Development Goal FundThe Three Millennium Development Goals Fund (3 MDG) is a multi-donor Fund that addresses health needs in alignment to government priorities, policies and strategies and in a coordinated way, along three main components:i. Mother, Newborn and Child Healthii. Communicable diseases, i.e.

Tuberculosis, HIV/AIOS and Malariaiii. Health System Strengthening.

In partnership with the Government of Myanmar, local and international NGOs and the private sector, the 3MDG Fund strengthens the national health system at all levels, extending access for poor and vulnerable populations to quality health services. The 3MDG Fund has a significant, timely and nationwide impact improving maternal, newborn and child health (MNCH), combating HIV and AIDS, tuberculosis and malaria, and health system strengthening to deliver sustainable, efficient and responsive healthcare across Myanmar. More specifically, it strengthens MNCH public and private services, with a special attention to conflict affected areas, and supports quality of care. In terms of communicable diseases, it implements Harm reduction projects, the MARC strategy, active case findings and multi-drug resistant TB as well as prison care. On a systems level, it supports governance and stewardship, evidence for policy and strategy, human resources strategy and community engagement.

Donors including Switzerland have committed USD 270M to the Fund, from 2013 to 2017.

The Fund Management Office is UNOPS and its main partners are the Government of Myanmar and health departments, as well as the UN system, international and local NGOs.

2. SDC Primary Health Care ProjectSDC has designed a primary health care project that is implemented in both government controlled and ethnic armed groups areas of Kayin state, targeting a population of about 380,000 people. It has three outcomes:1. Equitable access, use and quality of

basic health services is improved in

rural areas of Kayin State2. Communities are empowered

to improve health and health governance

3. Government and ethnic health systems in southeast Myanmar are coordinated and strengthened More concretely, it plans to achieve the following outputs during its first phase.

• Coordinated township health plans are rolled out in Kawkareik

• 170 health centre based staff are capacitated to provide supportive supervision and teamwork with community health staff

• About 1300 community health cadres are trained to support communities

• Health centres in poor conditions are refurbished

• 300 village health communities are capacitated, with women in decision-making roles

• Referral systems are strengthened and about 2000 patients benefit from referral funds.

• Community feedback mechanisms established

• Exchanges between government and ethnic health organisations increased (process), if context allows.

It has a budget of about USD 10 million for the first phase 2014-2018 and is implemented by two consortia:

In the govemment controlled areas, Phase-M (Save the Children, Christian Aid and Karen Baptist Convention)

In the Ethnic Armed Group controlled areas: Consortiun for Health in Eastern Burma (CHEB) (Communities Partners International, Karean Department for Health and Welfare, Backpacker Health Workers Team, Burma Medical Association, Mae Tao Clinic) (CHEB)

A lady in Pa-O village is sharing her experiences in health education session. © Thet Win Aung/Embassy of Switzerland-Myanmar

Access to, use and public financing of basic public health services has improved. © Thet Win Aung/Embassy of Switzerland-Myanmar

© Thet Win Aung/Embassy of Switzerland-Myanmar

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Population 51.5M 67M 15M 30.55M

Income (GNI per capita) 1270$ 5410$ 1010$ 680$

Human Development index

0.498 0.573 0.584 0.468

Life expectancy 66.8 74 71.9 60.9

Infant mortality rate 62 94.2 11 33 70

Under 5 mortality rate 72 141.9 13 38 97

Material mortality rate 200 721 26 170 400

Health expenditure per GDP

1.80% 4.60% 7.50% 8.10%

Data sources: 2015 population and housing census, 2015 Eastern Burma Retrospective Mortality survey, World Bank, UNDP