A reproductive health needs assessment in Myanmar

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.
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