A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar Table 22: Reproductive Health Services for Adolescents at Different Levels of the Health Service System Community and sub-centre Provision of information and services in a nonjudgmental and youthfriendly manner Provision of information and services in a nonjudgmental and youthfriendly manner Evaluation of models for peer interventions Health talks on adolescent reproductive health to young people, community leaders, parents and other adults Life skills training in selected townships (69) RHC, MCH centres Health talks on adolescent reproductive health to young people, community leaders, parents and other adults Station, Township, District and State/Division Hospital Provision of information and services in a nonjudgmental and youthfriendly manner Health interventions that are not currently part of the present programme are highlighted 84
A Reproductive Health Needs Assessment in Myanmar AN APPROACH TO PROGRAMME DEVELOPMENT In developing a programme to provide the essential package of services to be delivered in an integrated manner, attention needs to be paid to varying epidemiology of reproductive health problems in Myanmar, and the priority and feasibility of needed interventions. The assessment team observed that all the services in the essential reproductive health care package - maternal health, birth spacing, RTI/STD/HIV/AIDS and adolescent reproductive health - need to be provided. However, secondary data as well as the team’s field visits showed that there were wide variations in the epidemiology of reproductive health problems. Although geography played a major role, other socio-economic and cultural factors also contribute to this variation. For instance, many areas closer to Thai border had higher prevalence of STD/HIV/AIDS. Areas with higher socio-economic status and improved access to health facilities seem to have lower levels of maternal health problems. Use of birth spacing methods, although increasing nearly everywhere, also varies widely depending on the social support for birth spacing, availability of services and people’s ability to afford them. The young men in or those with access to urban areas are more likely to visit commercial sex workers and, therefore, are at higher risk of STDs/HIV infections. A comprehensive set of interventions was presented in the previous chapter to address specific reproductive health problems. After developing the set of recommended interventions, the assessment team conducted an informal prioritization exercise. Each member of the team rated each of the recommendations as high medium or low in terms of four criteria: potential for impact; policy congruence; organizational compatibility; and, operational viability. After giving these ratings a numerical value (3 for high, 2 for medium, and 1 for low), the scores for the four criteria were pooled and each team member’s score pooled. This produced an overall rating score for each recommendation, which were then reviewed by the assessment team. One of the most interesting findings of this exercise was that a number of the recommendations that had been rated very highly for their potential for impact fell to the bottom of the overall list once the four criteria were pooled. These interventions were generally considered by the team to be extremely important in terms of impact, but that they would be difficult to implement because of the low level of policy congruence, organizational compatibility and operational viability. The most striking examples of this were in the area of STDs/RTIs. Condom promotion activities were jointly rated the highest priority (out of a total of 60 intervention recommendations) for potential for impact. However, once the other three criteria were included in the calculation, it fell to 50 th position. Similarly, a recommendation regarding the need for targeted primary prevention interventions such as peer education programmes for high risk groups, dropped from a rank of 19 to 56. Based on the varying epidemiology, and priority and feasibility of interventions, it is clear that a uniform programme would not be an efficient way to address reproductive health problems. An incremental and cost-effective approach to programme development would comprise of implementing (a) a core package of high priority interventions everywhere, and (b) additional interventions to address specific reproductive health problems in the geographic areas where the problem is serious as determined by key indicators of the criticality of the problem. 85
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A reproductive health needs assessment in Myanmar

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