Family Planning in Asia and the Pacific - International Council on ...

equirements. The M<strong>in</strong>istry of Health also discussedwith UNFPA, <strong>the</strong> major provider of birth-spac<strong>in</strong>gcommodities, to exp<strong>and</strong> its coverage of project townshipsas much as possible <strong>in</strong> order to exp<strong>and</strong> <strong>the</strong> coverage <strong>and</strong> toachieve universal access, even though it has not allocatedany budget for contraceptives 52 .In <strong>the</strong> public health facilities <strong>the</strong>re is a mechanism forbirth-spac<strong>in</strong>g commodity susta<strong>in</strong>ability by provid<strong>in</strong>gbirth-spac<strong>in</strong>g services through a cost-shar<strong>in</strong>g system,whereby <strong>the</strong> client pays a m<strong>in</strong>imal amount for birthspac<strong>in</strong>gcommodities. The funds thus generated areaccumulated <strong>in</strong> <strong>the</strong> Health Facility OA head<strong>in</strong>g account(OA-O<strong>the</strong>r Accounts) as a revolv<strong>in</strong>g fund, which is to beutilized if <strong>and</strong> when UNFPA funds are not available 53 .However, this system needs policy direction as to how <strong>the</strong>funds should be managed <strong>and</strong> utilized effectively, as <strong>the</strong>substantial amount of fund<strong>in</strong>g is accumulated without<strong>in</strong>terest <strong>in</strong> township banks.Relationship of <strong>the</strong> reproductivehealth <strong>and</strong> birth-spac<strong>in</strong>gprogrammes to health,communities <strong>and</strong> women’sempowermentCommunity volunteers such as Community supportgroups (CSG) <strong>and</strong> MCH promoters <strong>and</strong> Male frontl<strong>in</strong>ehealth promoters are tra<strong>in</strong>ed <strong>in</strong> selected townships toact as a bridge between health-care providers <strong>and</strong> people<strong>in</strong> communities. This programme is a jo<strong>in</strong>t <strong>in</strong>itiative<strong>in</strong>volv<strong>in</strong>g UNFPA, <strong>the</strong> Central Health Education Bureauof Department of Health, M<strong>in</strong>istry of Health <strong>and</strong> <strong>the</strong>Japanese Organization for <strong>International</strong> Cooperation<strong>in</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> ( JOICFP) 54 . The ma<strong>in</strong> aims ofcommunity volunteers are to dissem<strong>in</strong>ate RH knowledge<strong>and</strong> birth spac<strong>in</strong>g <strong>and</strong> to support <strong>the</strong> community <strong>in</strong><strong>the</strong> behavioural change process for healthy liv<strong>in</strong>g. Theobjectives of mobiliz<strong>in</strong>g community volunteers are todissem<strong>in</strong>ate RH knowledge to <strong>the</strong> relevant population <strong>in</strong>townships <strong>and</strong> provide means of transport <strong>and</strong> referrals tohospital <strong>in</strong> times of obstetrical emergencies so that proper<strong>and</strong> timely referral could be provided.Start<strong>in</strong>g <strong>in</strong> 2002 members of CSG were selected from eachcommunity by <strong>the</strong> local midwife <strong>and</strong> <strong>the</strong> village healthcommittee, accord<strong>in</strong>g to criteria for selection: persons<strong>in</strong>terested <strong>in</strong> <strong>the</strong> health <strong>and</strong> welfare of <strong>the</strong> community,<strong>and</strong> active males <strong>and</strong> females between 18 <strong>and</strong> 50 years ofage. Each CSG member is given tra<strong>in</strong><strong>in</strong>g on reproductivehealth, is given a record booklet <strong>and</strong> is put <strong>in</strong> charge of30 households. The CSG members give health educationto <strong>the</strong>ir assigned households, provide help <strong>and</strong> supportwith transport when a person needs to be referred to adistant hospital or health-care provider, raise funds from<strong>the</strong> community if <strong>the</strong>re is a need <strong>in</strong> emergency situations,<strong>and</strong> assist midwives or health-care providers <strong>in</strong> healthactivities. CSGs work very closely with village healthcommittee members <strong>and</strong> basic health staff; <strong>the</strong>y havebeen successful <strong>in</strong> provid<strong>in</strong>g timely referral <strong>and</strong> support <strong>in</strong>obstetric emergencies.CSG was implemented as a model project <strong>in</strong> DalahTownship <strong>in</strong> Yangon Division, <strong>and</strong> Sarmalauk village <strong>in</strong>Nyaung Done Township. When <strong>the</strong> model communityRH project was assessed, it was found that CPR roseby 50 per cent over exist<strong>in</strong>g levels <strong>and</strong> that awareness ofreproductive tract <strong>in</strong>fections, sexually transmitted diseases<strong>and</strong> HIV/AIDS had <strong>in</strong>creased by about 50 per cent.CPR <strong>in</strong> Sarmalauk raised from 31 per cent <strong>in</strong> 2001 to42.6 per cent <strong>in</strong> 2003 55 , <strong>and</strong> was later exp<strong>and</strong>ed to reach64 townships by <strong>the</strong> end of 2010 56 . The Situation AnalysisTeam members also observed success stories dur<strong>in</strong>g <strong>the</strong>irvisits to rural health centres <strong>and</strong> felt that this programmehad <strong>the</strong> potential to br<strong>in</strong>g about better RH outcomes <strong>in</strong>rural areas 57 .PSI/Myanmar’s mission is to serve <strong>the</strong> poor <strong>and</strong>vulnerable groups <strong>in</strong> <strong>the</strong> country, <strong>and</strong> all programme<strong>and</strong> service deliveries are targeted towards <strong>the</strong>se groups.All Sun providers have been tra<strong>in</strong>ed <strong>in</strong> counsel<strong>in</strong>g skills.Women are empowered to select a method of <strong>the</strong>ir choice<strong>and</strong> considerable progress has been made <strong>in</strong> reach<strong>in</strong>gcommunities nationwide.Role of youth volunteers <strong>and</strong>Youth Information Centres 58UNFPA-supported youth programmes <strong>in</strong> collaborationwith <strong>the</strong> MSI, AFXB, MMA, DOH <strong>and</strong> DHP are successstories with regard to reproductive <strong>and</strong> sexual heal<strong>the</strong>ducation <strong>and</strong> services through youth programmes. YouthInformation Centres (YIC) have become a good modelfor young people to learn about ASRH; <strong>the</strong>y furnisha socially friendly environment for behavioural changecommunication <strong>and</strong> for <strong>the</strong> adoption of positive habitstowards safe sex <strong>and</strong> abst<strong>in</strong>ence from <strong>the</strong> tobacco, alcohol<strong>and</strong> betel-chew<strong>in</strong>g habits. The “Leadership development<strong>and</strong> healthy happy adolescent life programme” had muchsuccess <strong>in</strong> engag<strong>in</strong>g youth to adopt healthy behaviouralchanges. The YIC programme, which is supported byMMA, AFXB <strong>and</strong> <strong>the</strong> Central Health Education Bureau-JIOCFP, has been successful <strong>in</strong> engag<strong>in</strong>g youth but willneed fur<strong>the</strong>r expansion <strong>and</strong> quality assurance whenfranchised. It is not enough simply to furnish young peoplewith <strong>in</strong>formation on health; youth also need support for<strong>the</strong>ir personal <strong>and</strong> professional development <strong>in</strong> order toachieve holistic growth 59 .274