Country presentation on NCDs Myanmar 7 12 March

Country presentation on NCDs (Myanmar) 7 -12 March - 2011 Dr. Than Win National Focal Person

Myanmar INDIA BANGLA DESH KACHIN SAGAING n Area n States / Division n Districts SHAN CHIN RAKHINE CHINA n Townships MANDALAY MAGWE LAOS KAYAH n Wards n Village tracts BAGO n Villages KAYIN AYARWADDY YANGON n Sub Townships THAILAND MON n Population n Growth rate n Urban n Rural TANINTHARYI - 676578 sq. km - 14 - 68 - 330 - 66 - 2781 - 13714 - 64910 - 58 millions - 2. 02% - 30% - 70%

Myanmar Health Care System

District/Township Health Unit Public Health Unit Medical Care District/Township Hospital Urban Health Centre Disease Control Unit Station Hospital Rural Health Centre Leprosy Malaria TB STI, etc; Sub Rural Health Centre Public Health Activities • Primary Health Care • MCH • Nutrition • Water& Sanitation • School Health Disease Control Activities • Disease Surveillance • Leprosy • Malaria • TB • HIV/AIDS/STI • Immunization

Risk factors of non-communicable diseases STEPS - Myanmar, (2009) (Total 7429 respondents) Male Female Smoking (33. 61%) (6. 13%) Alcohol drinking Physical inactivity Hypertension Obesity (31. 17%) (10. 44%) (30. 99%) (17. 74%) (1. 47%) (14. 1%) (29. 34%) (30. 27%) Risk factors for NCDs

Prevalence of diabetes in Myanmar (11. 8%) Prevalence of diabetes in Myanmar Prevalence of diabetes in Male (1994 respondent) Female (2454 respondent) 11. 68% 12. 81% Urban Rural 13. 9% 7. 3% Myanmar WHO STEPwise Approach to NCD Surveillance Myanmar Standard Report (Level 1) 2003 -2004

(I) NCD Situation, Structure & Organization and Resource available • One of the projects ( Prevention and Control of 3 major NCDs – CVD, DM and Cancer) under Hospital Care Programs in NHP ( National Health Plan 20062011) • No established division/program/center, led by clinicians concerned under DOH, Ministry of Health • Very limited budget, from Government (mostly for salary) and WHO (Regular Budget) • Before 2011, No NCD Policy/Strategic Plan, • Limited activities - IEC, Training of health staff, Curative services, Research activities, • Data available only from Inpatient Hospital Statistics, Department of Health Planning, MOH • Few involvement of other sectors, International NGOs, local NGOs and community

(II) Main Achievements • One of the Strategic Areas (total 11 strategic areas) in NHP 2011 -2016, including 5 Programs 1. Chronic Diseases (4 major NCDs - Cardiovascular Diseases, Diabetes Mellitus, Cancer and Chronic Respiratory Diseases, • 2. Accidents and Injuries, • 3. Disabling conditions (Blindness, Deafness, CBR community based rehabilitation), • 4. Mental health and Substance abuse, • 5. Snake bite • National focal person assigned • NCD Policy (draft) and Framework of Action Plan for Prevention and Control of NCDs in Myanmar (draft) in 2011 • 2 STEPS surveys - Chronic Disease Risk Factors Survey (2003 -4 and 2009)

(III) Main Challenges • Political commitment • Resource limitation (Funding, Human, Technical) • Health system reorientation and strengthening

(IV) Main Lessons • Political commitment is critical. • Individual to community approach (Primary health care approach/community based program) is highly important. • Partnership building/ Integrated approach is essential. • Provision of Comprehensive Health care (Promotive, Preventive, Curative and Rehabilitative, Primordial, Primary, Secondary Prevention)

V Future Plan • Development of NHP 2011 -16 addressing NCDs • Development of NCD Policy and 5 years Strategic Plan for Prevention and Control of NCDs in Myanmar • Establishment of NCD Division/Program/Center under DOH Department of Health, Ministry of Health • Capacity building • Strengthening surveillance system (integrated into HMIS - Health Management Information System) • Resource mobilization/Fund raising • Strengthening partnership approach

Risk factors of non-communicable diseases Data from Yangon, Myanmar, (2003 -2004) Risk factors for NCDs Smoking Alcohol drinking Physical inactivity Hypertension Obesity Male (1994 respondent) Female (2454 respondent) (36. 00%) (11. 11%) (25. 96%) (7. 32%) (20. 04%) (25. 98%) (1. 09%) (7. 86%) (27. 54%) (50. 80%)