Myanmar mortality registration: an assessment for system improvement

Background

The vital registration system in Myanmar has a long history and geographical coverage is currently high. However, a recent assessment of vital registration systems of 148 countries showed poor performance of the death registration system in Myanmar, suggesting the need for improvement. This study assessed the quality of mortality data generated from the vital registration system with regard to mortality levels and patterns, quality of cause of death data, and completeness of death registration in order to identify areas for improvement.

Methods

The study used registered deaths in 2013 from the vital registration system, data from the 2014 Myanmar Population and Housing Census, and mortality indicators and COD information for the country estimated by international organizations. The study applied the guidelines recommended by AbouZahr et al. 2010 to assess mortality levels and patterns and quality of cause of death data. The completeness of death registration was assessed by a simple calculation based on the estimated number of deaths.

Results

Findings suggested that the completeness of death registration was critically low (less than 60%). The under-registration was more severe in rural areas, in states and regions with difficult transportation and poor accessibility to health centers and for infant and child deaths. The quality of cause of death information was poor, with possible over-reporting of non-communicable disease codes and a high proportion of ill-defined causes of death (22.3% of total deaths).

Conclusion

The results indicated that the vital registration system in Myanmar does not produce reliable mortality statistics. In response to monitoring mortalities as mandated by the Sustainable Development Goals, a significant and sustained government commitment and investment in strengthening the vital registration system in Myanmar is recommended.

     

Performance of Thailand’s universal health coverage scheme: Evaluating the effectiveness of annual public hearings

BackgroundLegislative provisions in Thailand''s National Health Security Act 2002 mandate annual public hearings for providers, beneficiaries and other stakeholders in order to improve the performance of the Universal Health Coverage Scheme (UCS).ObjectiveThis study aims to explore the annual public hearing process, evaluate its effectiveness and propose recommendations for improvement.MethodIn‐depth interviews were conducted with 29 key informants from various stakeholder groups involved in annual public hearings.ResultsThe evaluation showed that the public hearings fully met the criteria of influence over policy decision and partially met the criteria of appropriate participation approach and social learning. However, there are rooms for improvement on public hearing''s inclusiveness and representativeness of participants, adequacy of information and transparency.ConclusionsThree recommendations were proposed a) informing stakeholders in advance of the agenda and hearing process to enable their active participation; b) identifying experienced facilitators to navigate the discussions across stakeholders with different or conflicting interests, in order to reach consensus and prioritize recommendations; and c) communicating policy and management responses as a result of public hearings to all stakeholders in a timely manner.     

Equity in maternal and child health in Thailand

Objective

To assess equity in health outcomes and interventions for maternal and child health (MCH) services in Thailand.

Methods

Women of reproductive age in 40 000 nationally representative households responded to the Multiple Indicator Cluster Survey in 2005–2006. We used a concentration index (CI) to assess distribution of nine MCH indicator groups across the household wealth index. For each indicator we also compared the richest and poorest quintiles or deciles, urban and rural domiciles, and mothers or caregivers with or without secondary school education.

Findings

Child underweight (CI: −0.2192; P < 0.01) and stunting (CI: −0.1767; P < 0.01) were least equitably distributed, being disproportionately concentrated among the poor; these were followed by teenage pregnancy (CI: −0.1073; P < 0.01), and child pneumonia (CI: −0.0896; P < 0.05) and diarrhoea (CI: −0.0531; P < 0.1). Distribution of the MCH interventions was fairly equitable, but richer women were more likely to receive prenatal care and delivery by a skilled health worker or in a health facility. The most equitably distributed interventions were child immunization and family planning. All undesirable health outcomes were more prevalent among rural residents, although the urban–rural gap in MCH services was small. Where mothers or caregivers had no formal education, all outcome indicators were worse than in the group with the highest level of education.

Conclusion

Equity of coverage in key MCH services is high throughout Thailand. Inequitable health outcomes are largely due to socioeconomic factors, especially differences in the educational level of mothers or caregivers.     

中、低收入国家卫生智囊团的实践经验影响政策改变

近年来,中、低收入国家独立卫生政策研究机构的数量与日俱增,原因在于政府研究能力有限和民主化进程中的压力。本研究的目标是：（1）调查中﹑低收入国家中卫生政策研究机构对卫生政策的议程设置﹑制定﹑执行、监管和评估所作的贡献;（2）评估包括组织形式和结构在内的哪些因素支持中﹑低收入国家的卫生政策研究机构对卫生政策发挥积极作用。本研究在孟加拉﹑加纳﹑印度﹑南非﹑乌干达和越南选取了6家卫生政策研究机构开展案例研究,研究对象包括两个非政府组织、两所大学和两个政府办政策研究机构。案例研究通过文献查阅、财务信息分析、对工作人员和其他利益相关人员进行半结构式访谈,以及对结论草案进行多次反馈等方式开展。其中有些机构对他们各自国家的政策发展作出了巨大贡献。这些机构都积极建言献策,多数从事与政策相关的研究,而开展政治对话﹑系统评价或委托性研究的机构则相对较少。这些机构所开展的工作大多以政府或出资人的需求为导向,多数机构的主要成果一般为研究报告,经常与面向政府官员的口头汇报相结合。在支持对政策的有效参与方面,有几个关键因素,其中包括支持性的政策环境﹑管理和财务的相对独立性,以及与决策者建立可增进信任和影响的密切关系。当研究机构与政府之间的正式关系未处在重要位置时,政府内部单位则面临相当大的困难。     

Prevalence of VDRL Seroreactive in Myanmar Migrators in a Rural Area of Thailand

Although the prevalence of VDRL seroreactive in the Thai population has decreased in the recent years, migration of Myanmar laborers as carriers into Thailand may increase the prevalence of VDRL seroreactive. Screening is one of the recommended screening tests for the Myanmar migrators. In interest, epidemiology of VDRL seroreactive in Myanmar migrators has not been precisely determined. In this study, we reported the prevalence of VDRL seroreactive in Myanmar migrators in a rural community in the southern region of Thailand with high density of Myanmar migrators as fishermen. We analyzed the data of screening for VDRL seroreactive among 250 Myanmar migrators (169 males and 81 females) who have just stayed in Thailand for less than 1 month. The VDRL seroreactive rate among these Myanmar migrants was 3.2. The rates in males and females were 4.1% and 1.2%, respectively. Since these migrants can carry the disease to Thailand, screening test as one of the prevention strategies is necessary.     

Male Rape,Some Notes on the Laboratory Investigation

The incidence of sexual assault continues to escalate, and it is under-reported. Recent literature discusses the medical, legal, and psychological management of the female sexual assault victim, but little has been written regarding appropriate management of male sexual assault. This article focuses on the laboratory investigation in male rape case.     

Innovation and participation for healthy public policy: the first National Health Assembly in Thailand

Aim This paper aims to describe and disseminate the process and initial outcomes of the first National Health Assembly (NHA) in Thailand, as an innovative example of health policy making. Setting The first NHA, held in December 2008 in Bangkok, brought together over 1500 people from government agencies, academia, civil society, health professionals and the private sector to discuss key health issues and produce resolutions to guide policy making. It adapted the approach used at the World Health Assembly of the World Health Organization. Method Findings are derived from a literature review, document analysis, and the views and experiences of the authors, two of whom contributed to the organization of the NHA and two of whom were invited external observers. Results Fourteen agenda items were discussed and resolutions passed. Potential early impacts on policy making have included an increase in the 2010 public budget for Thailand’s universal health coverage scheme as total public expenditure has decreased; cabinet endorsement of proposed Strategies for Universal Access to Medicines for Thai People; and establishment of National Commissions on Health Impact Assessment and Trade and Health. Discussion The NHA was successful in bringing together various actors and sectors involved in the social production of health, including groups often marginalized in policy making. It provides an innovative model of how governments may be able to increase public participation and intersectoral collaboration that could be adapted in other contexts. Significant challenges remain in ensuring full participation of interested groups and in implementing, and monitoring the impact of, the resolutions passed.