A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
centres in cities. At the village tract and village level there are station hospitals, rural health
centres, rural health sub-centres and village health posts. In small towns, MCH activities are
co-ordinated by a lady health visitor with a staff of two or three midwives at the MCH
centres. In cities where there are urban health centres, the MCH activities are conducted
within the larger heath centre setting.
Station hospitals are 16-bedded hospitals situated in strategically selected villages. Such
hospitals run an outpatient clinic for maternal and child health, and usually allocate six to
eight beds for MCH related emergencies. If a station hospital exists in the same village as a
rural health centre, it is referred to as a station health unit. Rural health centres cover a
population of approximately 20,000. Staff of the rural health centre are one health assistant
who acts as team leader, a lady health visitor, five midwives and a number of public health
supervisors who act as multipurpose health workers. Maternal and child health care is the
major activity carried out by the lady health visitor and the midwives. The area served by the
rural health centre is usually divided into five sub-regions, each charged to a midwife from
the rural health centre. These become rural health sub-centres. The midwives usually hold
an open clinic for two days each week, and do home visits on the other days. The lady health
visitors and midwives are responsible for the training and supervision of voluntary health
staff.
A number of health volunteers are active in the provision of MCH services in Myanmar.
Auxiliary midwives are selected from villages in which no midwife resides, and given six
months of training. Her main activities are antenatal care, assistance at normal deliveries,
referral to a higher level of service when required, postnatal care, health education, and the
treatment of minor ailments. There are also a number of traditional birth attendants who have
been given sixty hours of training in how to conduct a safe delivery, and to recognize the
need for referral.
In addition to the reproductive health services being provided in the public sector, a number
of NGOs are active in providing such services, including the grass roots organization the
Myanmar Maternal and Child Welfare Association. A large well developed private sector
also provides reproductive health services throughout Myanmar. This consists of about 8,000
private, general practitioners, and numerous drug shops and public sector staff who provide
private services in their off-duty time.
Services provided
Maternal health
As discussed above, the maternal health care services are provided at all levels of basic health
care. These include all the standard antenatal care services, except for those related to
RTI/STDs. Similarly postnatal services are provided at all levels of the health care system.
Deliveries are generally assisted by TBAs, auxiliary midwives and midwives.
Provisional data from the recently conducted Fertility and Reproductive Health Survey
(FRHS) and the 1991 Population Changes and Fertility Survey (PCFS) show that antenatal
coverage and attended births have been rising. In 1991, 61 per cent of women received
antenatal care by a trained provider (excluding traditional birth attendants), in 1997 this
figure was 76 per cent. Similarly, 46 per cent of births were attended by trained providers
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