One-quarter of Myanmar’s estimated 52 million people live on less than $2 per day. In 2013, the United Nations’ Human Development Index ranked Myanmar as 149 out of 186 countries. The health sector has yet to catch up to the rapidly expanding economy: total health spending from all sources is less than 2.5% of the gross domestic product. However, change is in process; a market economy and broad government reforms are emerging since the 2011 transition to a civilian government.
PSI has operated in Myanmar since 1995 and is one of the largest NGOs in the country, delivering significant health impact in nearly all 330 townships. PSI/Myanmar is based in the country’s former capital and its commercial center, Yangon, with eight project offices nationwide.
PSI/Myanmar works to address the largest contributors to Myanmar’s burden of disease: HIV, tuberculosis, malaria, pneumonia, diarrhea, reproductive and maternal health, nutrition, diabetes, and hypertension.
PSI provides primary health services in 220 townships through the Sun Quality Health franchise network. The network is comprised of more than 1,300 private medical doctors that PSI/Myanmar trains and monitors, ensuring that health services are provided in accordance with national guidelines and international quality standards. In addition, PSI supports more than 2,000 village health workers who also provide health products and services to communities in rural areas across Myanmar.
PSI’s Targeted Outreach Program (TOP) operates 18 drop-in centers nationwide, providing counseling and clinical services to populations most at risk of HIV, such as men who have sex with men (MSMs) and female sex workers (FSWs).
PSI’s nationwide network of private retail outlets distributes essential health products using social marketing techniques. These products include condoms, contraceptives, oral rehydration salts, water purifier products, and treatment for STIs and malaria.
PSI/Myanmar creates powerful campaigns utilizing in-depth knowledge of the communities we serve to motivate consumer behavior change. These campaigns are executed through mass media, digital media and interpersonal communication.
PSI/Myanmar estimates that in 2015, its products and services helped avert 451,995 DALYs, including, by health area:
- 62,937 Malaria DALYs
- 92,039 HIV DALYs
- 46,287 FP DALYs
- 143,365 MNCH DALYs
- 107,160 TB DALYs
- 157 WASH DALYs
- 50 NCD DALYs
PSI/Myanmar’s family planning programs also provided 553,885 couple-years of protection.
HIV and Sexually Transmitted Infections
PSI/Myanmar’s HIV and STI program is a comprehensive model that addresses the health and well-being of low-income populations that are at-risk of HIV/STI infection. It consists of a package of services for the prevention, care, treatment and support of HIV positive persons, as well as those at risk of HIV infection.
The Targeted Outreach Program (TOP), is the largest community-led intervention in Myanmar. The project reached more than 37,000 female sex workers and 45,000 men who have sex with men in 2016 and performed more than 31,000 HIV tests for most-at-risk populations. The program also operates 18 drop-in centers across Myanmar for female sex workers and men who have sex with men. The drop-in centers provide an extensive range of free clinical services for key affected populations, including counseling, testing and treatment for sexually transmitted infections, HIV, TB, other opportunistic infections, as well as reproductive health services.
PSI/Myanmar distributes eight condom types via social marketing under the brand name Aphaw (‘companion’ in the Myanmar language). In 2016, it sold more than 16 million condoms at subsidized prices through the private sector, accounting for 83%of the commercial condom market.
PSI/Myanmar provides TB diagnosis and directly observed short-course treatment, the international standard of care for tuberculosis treatment. Tuberculosis drugs are available free of charge from select Sun Quality Health private provider clinics throughout Myanmar. To further promote active case detection, community health workers refer suspected cases to nearby Sun Quality Health clinics and serve as treatment adherence observers. PSI/Myanmar incorporates provider-initiated testing and counseling methods to increase the number of suspected and confirmed tuberculosis cases that are tested for HIV.
PSI/Myanmar also leverages the active case detection rate in urban slum areas through two innovative channels: interpersonal communication and pharmacies.
In 2015, more than 64,000 individuals with suspected tuberculosis were screened for the disease, and more than 18,000 cases were registered for treatment at Sun clinics. Altogether, PSI addressed 15% of the national burden.
A total of 9,000 individuals with suspected tuberculosis were also tested for HIV in 2015; the positivity rate among these clients was 4%.
For more than a decade, PSI has provided a wide range of family planning products and services to women in Myanmar through its network of private health providers, village health workers and pharmacies. In partnership with the government and local organizations, PSI continues to increase access to quality short and long-term contraceptive methods to women in need and to build the capacity of the private sector to offer related products in more than 200 townships in Myanmar. In 2001, when PSI started its Sun social franchise network, the contraceptive prevalence rate in Myanmar was 37%. Private sector provision of family planning services at that time was very limited, with most services provided through public health centers and government extension workers – and only to married women in limited geographical areas. By 2015, contraceptive prevalence had increased to 51.3%. Now, PSI’s program provides millions of family planning products and more than 1.5 million reproductive health consultations annually.
In recognition of the rising mortality rate from cervical cancer, PSI has piloted a cervical cancer prevention program whereby women of reproductive age can be screened using a low-cost, but highly effective method, known as visual inspection with acetic acid. Those with pre-cancerous lesions are referred for appropriate treatment and follow-up.
For children younger than five, PSI/Myanmar addresses the top two causes of death: pneumonia and diarrhea. PSI provides treatment to children for both illnesses through its network of skilled providers. It implements communications campaigns, targeting caregivers on the symptoms of pneumonia and diarrhea and the need to seek appropriate care. PSI also socially markets related products, namely antibiotics for pneumonia and oral rehydration salts and zinc for diarrhea in children.
To reduce diarrhea among children, PSI/Myanmar has begun a household water treatment program and a hand-washing program. In order to address the high levels of undernutrition among children under five in Myanmar, PSI is also supporting the government and partners in the distribution of a 15-micronutrient powder, Sprinkles, to families in townships where undernutrition is highest.
To address under-nutrition, PSI/Myanmar is implementing a behavior change program with women of reproductive age on the benefits of exclusive breastfeeding, as well as providing a maternal vitamin tablet to pregnant and lactating women to address nutrient deficiencies during this critical period.
PSI is at the forefront of Myanmar’s national malaria elimination effort. Targeting populations most vulnerable to malaria, PSI provides quality case management, behavior change communication, applied operational research, and innovative surveillance solutions.
Health impact and quality malaria case management is primarily achieved through four channels:
- A formal network of general practitioners providing health care through their own pre-existing clinics.
- A network of village-level primary health workers who are trained, supervised and directly supplied by PSI.
- A diffuse network of non-formal providers, such as pharmacies, itinerant drug vendors and general retail stores. These non-formal private sector outlets are supplied with subsidized treatment by major pharmaceutical distributors with extensive reach across Myanmar.
- A network of worksite programs. Volunteers are providing an integrated basket of health products, including malaria test and treat services, to the workers. The worksite program was launched in 2015 with a mapping survey to locate all worksites across the country in order to assess the number of workers and the availability of health services onsite. PSI trains and stocks a permanent worker at each site. Worksites that attract mobile-migrant workers include rubber plantations, mines and dams.
In 2016, through PSI/Myanmar’s comprehensive network of malaria health providers, 658,484 febrile cases have been tested and 11,544 confirmed cases have been treated.
The mono-therapy replacement project in the informal private sector has driven a rapid change in quality combination treatment access. From the start of the intervention in October 2012 to 2016, approximately 2 million treatments were delivered through this innovative subsidy mechanism, and 249,000 cases of Plasmodium falciparum malaria were treated.
In 2013 PSI/Myanmar conducted a pilot in six townships to determine the plausibility of utilizing rapid diagnostic tests in the private sector to diagnose malaria. The results of this pilot have informed a nationwide, rapid diagnostic test (RDT) scale-up among informal outlets. The scale-up is expected to reduce drug waste, alleviate drug resistance risk to artemisinin-based combination therapy (the gold standard for malaria treatment) and improve overall case management practices. From 2015 to 2016, the availability of RDTs among informal outlets has greatly increased from 13.4% in 2015 to 36.5% in 2016.
- UK Department for International Development (DfID)
- The Global Fund To Fight AIDS, Tuberculosis and Malaria
- Bill & Melinda Gates Foundation (BMGF)
- Three Millennium Development Goal Fund
- U.S. Agency for International Development (USAID)
- Livelihoods and Food Security Trust Fund
- United Nations Population Fund (UNFPA)
- Danish International Development Agency (Danida)
- Soa Aids
- Procter & Gamble
- Good Ventures
- The Joint United Nations Programme on HIV/AIDS (UNAIDS)
- United Nations Children’s Fund (UNICEF)
- United Nations Office for Project Services (UNOPS)
- Marie Stopes International
- World Vision
- Save the Children
- FHI 360
- Management Sciences for Health
- Malteser International
- Médecins sans Frontières (Holland)
- Medecins du Monde
- The University of Maryland, Baltimore
- Private sector partners: Telenor, Ooreedo, AA Group Limited, PolyGold
- Integrating Cervical Cancer Prevention Services with Voluntary Family Planning Programs
Over 311,000 women die from cervical cancer each year due to limited access to routine screening and early treatment. Many of the same countries struggling with high cervical cancer rates also have high unmet need for family planning (FP). As the global health community has prioritized both the reduction of unmet need for FP and, more recently, the global elimination of cervical cancer, there is an opportunity to review the evidence base and share practical considerations for integration of these services, with a view towards expanded access to products and services that improve women’s sexual and reproductive health.
- FPwatch: Facility‐Based Survey Data for Family Planning Market Analysis in Five FP2020‐Focus Countries
This article describes datasets for the FPwatch Project, a comprehensive facility‐based family planning survey conducted by Population Services International in five countries in Africa and Asia from 2015 to 2017.
- Reducing out-of-pocket expenditure to reach adolescents with Family Planning Services: Experiences from a pilot project in Yangon, Myanmar
Capitation payment is a fixed sum of money pre-paid by the project to the provider to manage the health care needs for all registered individuals.
- Reducing Out-of-Pocket Expenditure Through Strategic Purchasing at Private Clinics In Yangon, Myanmar
At the request of the Ministry of Health and Sports, PSI introduced a pilot to show how strategic purchasing can improve health and family planning outcomes for low-income clients in two peri-urban townships of Yangon
- Costing Malaria Surveillance Systems and Mobile Reporting for Private Sector Providers in Cambodia, Lao PDR and Myanmar: Is it Affordable?
- How Do the Reports Translate into Field Performance? Cross-Validation of Data from Routine Reporting vs. Mystery Client Visits Among Private Sector Malaria Providers in Myanmar
- Lessons Learnt from Deployment of DHIS2-Based Health Network Quality Improvement System (HNQIS) Over 4,000 Private Sector Malaria Providers in Myanmar
- Myanmar Strategic Purchasing Brief Series #6: Improving Medical Record Keeping
This is the sixth in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot aims to
start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and incentivize providers to deliver an essential package of primary care services.
- Quadrupling HIV Case Finding: Social Media Improves HIV Testing and HIV Case Finding Among Key Populations in Myanmar (WEPEC169)
At PSI's TOP clinics serving key populations, there was consistently high HIV yield among peers using social media. Myanmar experienced a digital technology leapfrog. In January 2017, PSI invested in a dedicated social media team at TOP to responded to private messages (on Facebook, Line, Bee-talk, GRINDR and Viber), fielded hotline calls and offered online referral vouchers, which allowed us to track each conversation from online messaging to arrival at the clinic.
- GEMS Q1 Surveillance Bulletin (2018)