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

Myanmar Area - 676578 sq.km States / Division - 14 Districts - 68 CHINA LAOS THAILAND INDIA BANGLA DESH KACHIN SHAN SAGAING CHIN RAKHINE MANDALAY MAGWE BAGO AYARWADDY YANGON KAYIN KAYAH MON TANINTHARYI Myanmar Area - 676578 sq.km States / Division - 14 Districts - 68 Townships - 330 Sub Townships - 66 Wards - 2781 Village tracts - 13714 Villages - 64910 Population - 58 millions Growth rate - 2.02% Urban - 30% Rural - 70% Myanmar and Thailand have long border distance, about 1800 Kilometer in length and Myanmar side comprising 4 States & one Division with 16 districts, directly bordering with 10 provinces of Thailand. Total area is about 75 thousand sq.Km with 2400 villages there. About 1.7 million populations are residing there.Health facilities are strengthened up to the border areas.

Myanmar Health Care System

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

Risk factors of non-communicable diseases STEPS - Myanmar, (2009) (Total 7429 respondents) Risk factors for NCDs Male Female Smoking (33.61%) (6.13%) Alcohol drinking (31.17%) (1.47%) Physical inactivity (10.44%) (14.1%) Hypertension (30.99%) (29.34%) Obesity (17.74%) (30.27%)

Prevalence of diabetes in Myanmar (11.8%) Male (1994 respondent) Female (2454 respondent) Prevalence of diabetes in Myanmar 11.68% 12.81% Urban Rural Prevalence of diabetes in Myanmar 13.9% 7.3% 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 2006-2011) 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

Thank You

Risk factors of non-communicable diseases Data from Yangon, Myanmar, (2003-2004) Risk factors for NCDs Male (1994 respondent) Female (2454 respondent) Smoking (36.00%) (11.11%) Alcohol drinking (25.96%) (1.09%) Physical inactivity (7.32%) (7.86%) Hypertension (20.04%) (27.54%) Obesity (25.98%) (50.80%)