Evidence-informed policy formulation: the case of the voucher scheme for maternal and child health in Myanmar

Introduction: In 2010, with financial support from the Global Alliance for Vaccineand Immunization’s Health System Strengthening programme, the Governmentof Myanmar established a scheme to improve coverage of maternal and childhealth (MCH) services. Employing qualitative approaches, this article reviewsthe processes through which this scheme was devised, focusing on evidencegeneration and the use of such evidence to inform policy formulation. To address theproblem of high mortality rates among mothers and infants, collaborative researchwas conducted by Myanmar’s Ministry of Health, the World Health Organization,and a research arm of Thailand’s Ministry of Public Health, between March 2010and September 2011. In the early phase of this study, key barriers to governmentprovided MCH services were identified. Based on a comprehensive review ofthe literature, the introduction of a voucher scheme was raised for considerationby ministry of health decision-makers and respective stakeholders. Despite thesuccessful experience of this financing strategy in low-income countries, a seriesof surveys, an economic evaluation, and focus group discussions were carriedout to assess the feasibility and potential health and economic implications of thisscheme in the Myanmar context. The research findings were then used to guidethe design and adoption of the newly established initiative.

Threat of HIV/AIDS in children: social, education and health consequences among HIV orphans and vulnerable children in Myanmar

Background: There is very limited information available on HIV related orphansand vulnerable children (HIV-OVC) in Myanmar. Hence, the objective of this studywas to identify and compare the social, education and health consequencesamong HIV‑OVC and children from the families not related to HIV in the sameneighbourhoods (neighbouring children).Materials and Methods: A cross‑sectional, comparative survey was carried out inthree geographical locations. Face‑to‑face interviews were conducted with guardiansand children using a pretested structured questionnaire including Strength andDifficulties Questionnaire (SDQ) for behavioural problems. Outcome measureswere compared using Chi‑squared test or ‘t’ test or ‘Rank‑sum’ test.Results: A total of 300 HIV-OVC and 300 neighbouring children were included. Agreater number of HIV-OVC than their neighbouring children have experienced familydisplacement from their original homes (27% and 1%), child/sibling displacement(20%and 2.7%) and family dispersion (20.3% and 1.3%) (P < 0.001). More guardians ofHIV‑OVC reported that the disease affected their children’s education (28.2% and16.3%; P < 0.05). Fifteen per cent of HIV‑OVC and 10.5% of neighbouring childrenhad to work for their families (P < 0.05). Psychological condition was assessedon emotional, conduct, hyperactivity/inattention, peer relationship and prosocialbehaviour. A greater number of HIV‑OVC were noted in the abnormal category withregard to hyperactivity and prosocial behaviours (P < 0.05).Conclusions: Higher incidence of social and psychological consequences amongHIV‑OVC call for more community support programmes and creation of jobopportunities to minimize social impact in the affected families. Future programmesshould focus on counselling of HIV‑OVC and providing psychological support.