Health Service Readiness, Availability, and Utilization of Primary Health Care Facilities for Non-Communicable Diseases in Shan State, Myanmar
Abstract
Background: Non-communicable diseases (NCDs) are increasing in Myanmar. There have been limited studies to assess the health service system for NCDs patients at the primary health care (PHC) level. We aimed to assess and compare the health service readiness, availability, and utilization of PHC facilities for NCDs in districts in Myanmar.
Methods: This cross-sectional study collected data by questionnaires from 242 health care providers working at PHC facilities in three districts in Shan State, Myanmar from January 2020 to January 2021. Differences were calculated with the ANOVA test for NCD capacity readiness and NCD service availability and the Kruskal-Wallis test for NCD service utilization.
Results: PHC facilities had a mean score of greater than 70% for NCD capacity readiness of health workforces, health information systems, and essential medicines and equipment domains, but there were large gaps for improvement in financing and governance of health. Almost all PHC facilities had NCD services available, and the differences were not significant among the three districts. However, the mean scores of NCD services availability for chronic respiratory diseases and cancers were lower in all districts. Regarding NCD service utilization, the screening and new patient rates had significant differences among districts (P-value < 0.05).
Conclusion: We revealed the situation and gaps in managing NCDs in Myanmar’s PHC facilities. These findings can inform policymakers at the state and district levels to implement programs for improving health services for NCDs, particularly in rural areas.
1. WHO (2020). Noncommunicable diseases in the South-East Asia: World Health Organization. Available from https://www.who.int/southeastasia/health-topics/noncommunicable-diseases.
2. WHO (2018). NCD Country Profiles: World Health Organization. Available from: https://www.who.int/publications/i/item/9789241514620.
3. WHO (2010). Global status report on noncommunicable diseases: World Health Organization. Available from: https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf
4. WHO (2010). Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings: World Health Organization. Available from: https://apps.who.int/iris/handle/10665/44260.
5. MOHS (2017). Package of essential non-communicable (PEN) disease interventions, Myanmar: Ministry of Health and Sports. Available from: https://mohs.gov.mm/Main/content/publication/ncd-tot-manual-for-package-of-essential-non-communicable-disease-interventions-pen-2017.
6. Pengpid S, Peltzer K (2018). The impact of chronic diseases on the quality of life of primary care patients in Cambodia, Myanmar and Vietnam. Iran J Public Health, 47(9):1307-1315.
7. Latt T, Aye T, Ko K, Zaw K (2016). Gaps and challenges to integrating diabetes care in Myanmar. WHO South-East Asia Journal of Public Health, 5(1):48-52.
8. Saw YM, Than TM, Thaung Y, et al (2019). Myanmar's human resources for health: current situation and its challenges. Heliyon, 2019;5(3):e01390-e.
9. Swe, EE, Htet, KKK, Thekkur, P, et al (2020). Increasing trends in admissions due to non-communicable diseases over 2012 to 2017: findings from three large cities in Myanmar. Trop Med Health 48, 24.
10. Aye L, Tripathy J, Maung T, et al (2020). Experiences from the pilot implementation of the Package of Essential Non-communicable Disease Interventions (PEN) in Myanmar, 2017-18: A mixed methods study. PloS ONE, 15:e0229081.
11. Wayne WD (1995). Biostatistics: A foundation of analysis in the health sciences. 6th ed. John Wiley & Sons, Inc., 177-178.
12. MIMU (2015). Shan State Census Report: Myanmar Information Management Unit. Available from: https://themimu.info/sites/themimu.info/files/documents/Report_Shan_State_Census_Report_MOIP_May2015.pdf
13. WHO (2010). Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings: World Health Organization. Available from: https://www.who.int/publications-detail-redirect/who-package-of-essential-noncommunicable-(pen)-disease-interventions-for-primary-health-care
14. WHO (2010). Monitoring the building blocks of health systems: World Health Organization. Available from: https://apps.who.int/iris/handle/10665/258734
15. MOHS (2016). National list of essential medicines, Myanmar: Ministry of Health and Sports. Available from: https://mohs.gov.mm/page/5491
16. Mutale W, Bosomprah S, Shankalala P, et al (2018). Assessing capacity and readiness to manage NCDs in primary care setting: Gaps and opportunities based on adapted WHO PEN tool in Zambia. PloS ONE, 13(8):e0200994.
17. Paromita P, Chowdhury HA, Mayaboti CA, et al (2021) Assessing service availability and readiness to manage Chronic Respiratory Diseases (CRDs) in Bangladesh. PLoS ONE, 16(3): e0247700.
18. Rovinelli RJ, Hambleton RK (1977). On the use of content specialists in the assessment of criterion-referenced test item validity. Netherlands: Tijdschrift voor Onderwijsresearch. Available from: https://files.eric.ed.gov/fulltext/ED121845.pdf.
19. Kuder GF, Richardson MW (1937). The theory of the estimation of test reliability. Psychometrika volume 2, pages151–160.
20. WHO (2013). Global action plan for the prevention and control of NCDs 2013-2020: World Health Organization. Available from https://www.who.int/nmh/events/ncd_action_plan/en/#:~:text=The%20WHO%20Global%20NCD%20Action,the%20challenge%20of%20NCDs%20and.
21. Haque M, Islam T, Rahman N, et al (2020). Strengthening primary health-care services to help prevent and control long-term (chronic) non-communicable diseases in low- and middle-income countries. Risk Manag Healthc Policy, 13, 409–426.
22. Varghese C, Nongkynrih B, Onakpoya I, et al (2019). Better health and wellbeing for billion more people: integrating non-communicable diseases in primary care. BMJ; 364 :l327 doi:10.1136/bmj.l327
23. Xiong S, Cai C, Jiang W, et al (2022). Primary health care system responses to non-communicable disease prevention and control: A scoping review of national policies in Mainland China since the 2009 health reform. The Lancet Regional Health - Western Pacific. doi:https://doi.org/10.1016/j.lanwpc.2022.100390
24. Alhassan RK, Nketiah-Amponsah E (2016). Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana. Health Econ Rev, 6(1):39.
25. WHO (2014). The Republic of the Union of Myanmar health system review: World Health Organization. Regional Office for the Western Pacific. Available from: http://iris.wpro.who.int/handle/10665.1/11354
26. Macha J, Kuwawenaruwa A, Makawia S, et al (2014). Determinants of community health fund membership in Tanzania: a mixed methods analysis. BMC Health Serv Res, 14(1):538.
27. Saengow U, Phenwan T, Laohaprapanon A, et al (2019). Challenges in implementation of community health fund in Thailand. Paper presented at Prince Mahidol Award Conference 2019 “The Political Economy of NCDs: A Whole of Society Approach”; Bangkok, Thailand. Available from: https://pmac2019.com/uploads/poster/A035-UDOMSAKSAENGOW-f446.pdf
28. Mtei G, Mulligan JA (2007). Community health funds in Tanzania: A literature review. Consortium for research on equitable health systems (CREHS). Available from: http://www.crehs.lshtm.ac.uk/downloads/publications/Community%20health%20funds%20in%20Tanzania.pdf
29. WHO (2019). Report of the global conference on primary health care: From Alma-Ata towards Universal Health Coverage and the Sustainable Development Goals: World Health Organization. Available from: https://www.who.int/publications/i/item/report-of-the-global-conference-on-primary-health-care-from-alma-ata-towards-universal-health-coverage-and-the-sustainable-development-goals.
30. MOHS (2020). Prevention of major NCDs and preventive cardiology (Evidence based treatment protocol for basic health staffs): Ministry of Health and Sports Press. Myanmar.
31. Duong DB, Minh HV, Ngo LH, et al (2019). Readiness, availability and utilization of rural Vietnamese health facilities for community based primary care of non-communicable diseases: A Cross-Sectional Survey of 3 Provinces in Northern Vietnam. Int J Health Policy Manag, 8(3):150-7.
32. Htet, AS, Bjertness, MB, Sherpa, LY et al (2016). Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25–74 years old citizens in Yangon Region, Myanmar: a cross sectional study. BMC Public Health, 16, 1225.
2. WHO (2018). NCD Country Profiles: World Health Organization. Available from: https://www.who.int/publications/i/item/9789241514620.
3. WHO (2010). Global status report on noncommunicable diseases: World Health Organization. Available from: https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf
4. WHO (2010). Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings: World Health Organization. Available from: https://apps.who.int/iris/handle/10665/44260.
5. MOHS (2017). Package of essential non-communicable (PEN) disease interventions, Myanmar: Ministry of Health and Sports. Available from: https://mohs.gov.mm/Main/content/publication/ncd-tot-manual-for-package-of-essential-non-communicable-disease-interventions-pen-2017.
6. Pengpid S, Peltzer K (2018). The impact of chronic diseases on the quality of life of primary care patients in Cambodia, Myanmar and Vietnam. Iran J Public Health, 47(9):1307-1315.
7. Latt T, Aye T, Ko K, Zaw K (2016). Gaps and challenges to integrating diabetes care in Myanmar. WHO South-East Asia Journal of Public Health, 5(1):48-52.
8. Saw YM, Than TM, Thaung Y, et al (2019). Myanmar's human resources for health: current situation and its challenges. Heliyon, 2019;5(3):e01390-e.
9. Swe, EE, Htet, KKK, Thekkur, P, et al (2020). Increasing trends in admissions due to non-communicable diseases over 2012 to 2017: findings from three large cities in Myanmar. Trop Med Health 48, 24.
10. Aye L, Tripathy J, Maung T, et al (2020). Experiences from the pilot implementation of the Package of Essential Non-communicable Disease Interventions (PEN) in Myanmar, 2017-18: A mixed methods study. PloS ONE, 15:e0229081.
11. Wayne WD (1995). Biostatistics: A foundation of analysis in the health sciences. 6th ed. John Wiley & Sons, Inc., 177-178.
12. MIMU (2015). Shan State Census Report: Myanmar Information Management Unit. Available from: https://themimu.info/sites/themimu.info/files/documents/Report_Shan_State_Census_Report_MOIP_May2015.pdf
13. WHO (2010). Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings: World Health Organization. Available from: https://www.who.int/publications-detail-redirect/who-package-of-essential-noncommunicable-(pen)-disease-interventions-for-primary-health-care
14. WHO (2010). Monitoring the building blocks of health systems: World Health Organization. Available from: https://apps.who.int/iris/handle/10665/258734
15. MOHS (2016). National list of essential medicines, Myanmar: Ministry of Health and Sports. Available from: https://mohs.gov.mm/page/5491
16. Mutale W, Bosomprah S, Shankalala P, et al (2018). Assessing capacity and readiness to manage NCDs in primary care setting: Gaps and opportunities based on adapted WHO PEN tool in Zambia. PloS ONE, 13(8):e0200994.
17. Paromita P, Chowdhury HA, Mayaboti CA, et al (2021) Assessing service availability and readiness to manage Chronic Respiratory Diseases (CRDs) in Bangladesh. PLoS ONE, 16(3): e0247700.
18. Rovinelli RJ, Hambleton RK (1977). On the use of content specialists in the assessment of criterion-referenced test item validity. Netherlands: Tijdschrift voor Onderwijsresearch. Available from: https://files.eric.ed.gov/fulltext/ED121845.pdf.
19. Kuder GF, Richardson MW (1937). The theory of the estimation of test reliability. Psychometrika volume 2, pages151–160.
20. WHO (2013). Global action plan for the prevention and control of NCDs 2013-2020: World Health Organization. Available from https://www.who.int/nmh/events/ncd_action_plan/en/#:~:text=The%20WHO%20Global%20NCD%20Action,the%20challenge%20of%20NCDs%20and.
21. Haque M, Islam T, Rahman N, et al (2020). Strengthening primary health-care services to help prevent and control long-term (chronic) non-communicable diseases in low- and middle-income countries. Risk Manag Healthc Policy, 13, 409–426.
22. Varghese C, Nongkynrih B, Onakpoya I, et al (2019). Better health and wellbeing for billion more people: integrating non-communicable diseases in primary care. BMJ; 364 :l327 doi:10.1136/bmj.l327
23. Xiong S, Cai C, Jiang W, et al (2022). Primary health care system responses to non-communicable disease prevention and control: A scoping review of national policies in Mainland China since the 2009 health reform. The Lancet Regional Health - Western Pacific. doi:https://doi.org/10.1016/j.lanwpc.2022.100390
24. Alhassan RK, Nketiah-Amponsah E (2016). Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana. Health Econ Rev, 6(1):39.
25. WHO (2014). The Republic of the Union of Myanmar health system review: World Health Organization. Regional Office for the Western Pacific. Available from: http://iris.wpro.who.int/handle/10665.1/11354
26. Macha J, Kuwawenaruwa A, Makawia S, et al (2014). Determinants of community health fund membership in Tanzania: a mixed methods analysis. BMC Health Serv Res, 14(1):538.
27. Saengow U, Phenwan T, Laohaprapanon A, et al (2019). Challenges in implementation of community health fund in Thailand. Paper presented at Prince Mahidol Award Conference 2019 “The Political Economy of NCDs: A Whole of Society Approach”; Bangkok, Thailand. Available from: https://pmac2019.com/uploads/poster/A035-UDOMSAKSAENGOW-f446.pdf
28. Mtei G, Mulligan JA (2007). Community health funds in Tanzania: A literature review. Consortium for research on equitable health systems (CREHS). Available from: http://www.crehs.lshtm.ac.uk/downloads/publications/Community%20health%20funds%20in%20Tanzania.pdf
29. WHO (2019). Report of the global conference on primary health care: From Alma-Ata towards Universal Health Coverage and the Sustainable Development Goals: World Health Organization. Available from: https://www.who.int/publications/i/item/report-of-the-global-conference-on-primary-health-care-from-alma-ata-towards-universal-health-coverage-and-the-sustainable-development-goals.
30. MOHS (2020). Prevention of major NCDs and preventive cardiology (Evidence based treatment protocol for basic health staffs): Ministry of Health and Sports Press. Myanmar.
31. Duong DB, Minh HV, Ngo LH, et al (2019). Readiness, availability and utilization of rural Vietnamese health facilities for community based primary care of non-communicable diseases: A Cross-Sectional Survey of 3 Provinces in Northern Vietnam. Int J Health Policy Manag, 8(3):150-7.
32. Htet, AS, Bjertness, MB, Sherpa, LY et al (2016). Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25–74 years old citizens in Yangon Region, Myanmar: a cross sectional study. BMC Public Health, 16, 1225.
| Files | ||
| Issue | Vol 51 No 6 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i6.9675 | |
| Keywords | ||
| Non-communicable diseases Primary health care Readiness Availability Utilization | ||
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How to Cite
1.
Aung WH, Kitreerawutiwong N, Keeratisiroj O, Jariya W. Health Service Readiness, Availability, and Utilization of Primary Health Care Facilities for Non-Communicable Diseases in Shan State, Myanmar. Iran J Public Health. 2022;51(6):1303-1312.
