By Dr. Than Lwin Tun, Dr. Phyu Phyu Aye, Dr. Nang Naing Naing Shein, Dr. Nyein Aye Tun, Dr. Le Thandar Soe, Dr. Zar Ni Lwin (Ministry of Health and Sports, Myanmar)
The Union Minister for Health and Sports highlighted the concept of community health clinic (CHC) model for strengthening community health services to meet the changing health needs and to utilize limited resources efficiently. Over the last decade, the health needs of the population had altered considerably because of changes in dietary intake pattern and disease patterns, increased life expectancy and increased aging population. According to STEPS survey, which had investigated the prevalence of non-communicable diseases (NCDs) in 25- to 64-year old population in Myanmar (2014), 26.4% had hypertension, 10.5% had diabetes mellitus and 22.4% had been categorized as overweight. Another national survey on the causes of death using verbal autopsy in Myanmar (2016-2017) showed that 74% of total deaths were due to NCDs. These data indicate the growing need to provide health care in local community setting.
A meeting titled, “From concept to implementation of CHC Model” was held at the meeting hall of Mingalar Thiri Hotel, Nay Pyi Taw, on 31 August. The Union Minister for Health and Sports, the Union Deputy Minister, directors general, deputy directors general, state and regional health directors and deputy directors attended the meeting. The Union Minister gave instructions for effective implementation of CHC model and the attendees actively discussed regarding this issue.
The operational definition of the CHC is the action orientated public health care activity providing health care services focusing on health literacy promotion, screening for hypertension and diabetes mellitus, and treatment of uncomplicated NCD cases and elderly health care on every Wednesday at rural health centers (RHC) and urban health centers (UHC).
The goal of the CHC is to ensure improved accessibility to effective and efficient health care in community, which contributes to reduction of NCDs morbidity and mortality. The three main objectives of CHC model are: 1) to promote health literacy through motivation and supporting community members; 2) to provide screening, proper treatment and appropriate referral of people with NCDs, such as hypertension and diabetes mellitus through provision of essential medicines; 3) to serve the health needs of the vulnerable and under-privileged people, including the aging population. The CHC model is set up with six principles: quality, partnership, equity, effectiveness, efficiency and community involvement. From the aspect of community involvement, the CHC will be supported by community support group (village health committee), including local NGOs and voluntary health workers. The RHC and UHC are the main structural focus involved in providing and facilitating CHC.
The activities of CHC includes: 1) measuring body mass index (BMI-kg/m2); 2) measuring blood pressure; 3) measuring blood sugar level; 4) treatment of uncomplicated cases of hypertension and diabetes mellitus; 5) referral to higher centers according to Package of Essential NCD interventions (PEN) guideline; and 6) promoting health literacy according to Health Literacy Promotion guideline.
The accomplishment of the Union Minister’s concept to implementation of CHC will improve the health status of rural population by promoting health literacy, including raising awareness of NCDs. Early detection and treatment of NCD cases and timely referral will reduce complications of NCDs and its related deaths. Moreover, effective primary and preventive health care for elderly people can prolong their life with better quality of life.
In addition, the Department of Public Health plays the role of coordination and support for the implementation of CHC in every state and region, together with the contributions of community-based organizations, civil society organizations, international non-governmental organizations, donor agencies and the private sector. The CHC is expected to support achieving Universal Health Coverage by accessing good quality health services without financial hardship and improving quality of life, which is also in line with the National Health Plan of Myanmar (NHP, 2017-2021).