Reply To: Topic Discussion 1: Improving health system

[Hteik Htar Tin]

In recent years, the Sexual and Reproductive Health (SRH) service provision improvement in Myanmar is one of the improvement of health system targeting in reduction social barriers about SRH and make behavioral changes among the communities. As Myanmar is one of the developing countries, only governmental system is not enough to provide health services for all communities. Non-governmental organizations (NGOs) and local organizations (Community based organizations (CBO), ethnic health organization (EHO)) are largely participating to get universal health coverage (UHC) perceptively. About 10 years ago, both medical and non-medical communities were reluctant to talk about SRH in public health education and accepted as this was inappropriate according to culture and norms. So, many violations of SRH to girls, women and LGBTQ+ were happened and sexually transmitted diseases were spreading among working aged group and it caused huge impact on health status of country.
Due to these results, both Ministry of Health (MOH) and NGOs were collaborating to change the behavior of Myanmar communities relating the risky behaviors of sexual and reproductive health, to get equitable reproductive health services (fully consent contraception, respectful treatment for sexually transmitted infection, private consultations, safe abortion care, ante-natal care, emergency obstetric care). This brings many changes for health system: trained many basic health staff and community volunteers about SRH, seen the changing behavior about SRH among the community (overcome social norms and beliefs), known their rights and can advocate to get by youths and adolescents. Decentralization of governance in health system is ongoing and it makes evidence-based decision in implanting health projects. These are the current health system improvements.
To sustain this improvement, all dispersed activities and data should be combined and shared among stakeholders. Current challenge is weakness in timeliness of reporting, not widely accessible to standardized data reporting and sensitivity issue of data sharing in some areas. The health information sharing is important in health governance and one of the system barriers. The second barrier is financial support and the current health system required risk pooling or risk sharing practice as health financing sector. The service costs at private health systems are very much higher and the public health system cannot cover all basic health services, the services of NGO cannot reach for all levels, the communities have to pay out-of-pocket expenditures to get health services.