A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
other aspects of RTI programmes would serve as an important first step toward concentration
of STD and HIV/AIDS control activities.
The role of STD teams in prevention and management of STDs also needs to be strengthened
considerably. Currently many are understaffed for their responsibilities and plagued by
frequent transfers, vacancies and sabaticals in the existing authorized staff positions. Where
they exist, the STD teams have carried out some limited IEC activities. The quality of STD
team activities is also highly variable. Although their role seems to be more broadly defined,
they often concentrate mostly on treatment services and surveillance activities. Their linkage
with the basic health system also needs to be better operationalized. In Taunggyi the STD
team reported doing training in syndromic STD case management for a number of basic
health staff. These trained staff, however, were based near the STD team and generally only
covered urban areas within the main District Township. Where women and men have a
choice, they tend to consult with private GPs for suspected STD symptoms, hence basic
health staff are only likely to be a significant source of advice for STDs in rural areas, where
private GPs do not reside. In addition to this geographic limit, concern was expressed that
even when basic health staff used the flow charts, they had no access to the appropriate
antibiotics recommended for treatment.
As mentioned, there is a need for standardisation of case management recommendations for
RTI treatment in Myanmar. Experiences in other countries have shown, however, that flow
charts for the standardised case management of RTI syndromes need to be adapted to the
local epidemiological situation, otherwise their use may result in considerable over-treatment
and a consequent waste of resources. Unfortunately, there is little data concerning the
prevalence of most RTIs in Myanmar, hence, some further research concerning the
prevalence of RTIs will be needed. A better understanding of health care seeking behaviour
is needed to complement such data.
There is also an urgent need for more active encouragement and counselling on the use of
condoms. Although widely known, their use is currently very limited. In addition to
developing appropriate IEC materials, the involvement of community leaders will be needed
to support behavioural change. Special outreach efforts are also required to inform and
educate sex workers and the community members who frequent them.
The problem of iatrogenic infection remains largely undocumented. During the assessment
visits it was reported to be rare by most providers interviewed, with the exception of the
problem of septic abortion, which was described as an extremely important cause of
morbidity and mortality in all locations. Some providers were concerned about these
infections, however, and in order to decrease the occurrence of puerperal infections, one
facility - the MCWA maternity shelter in Taunggyi - gave all women antibiotics immediately
following their delivery. Based on observations of facilities that provide delivery services,
however, it can be recommended that further attention to issues of asepsis and supply of
sterile medical equipment should be provided. This is also an important consideration as the
number of IUD insertions increase.
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