COUNTRY UPDATE : MYANMAR Aung Sann Oo| Department of Medical Oncology | Mandalay General Hospital I Ministry of Health and Sports l Myanmar

GEOGROPHICAL AND POLITICAL FEATURES

• Bounded by Bangladesh, India, China, Laos and Thailand

• Andaman Sea and Bay of Bengal

• Area - 676,577.2 square km

• Delta region, central plain, mountains

• Divided administratively, Nay Pyi Taw Council Territory and 14 States & Regions

• Districts – 74, Townships - 330

POPULATION PYRIMID

AGING POPULATION

• Population of people over 60 years old ~ 4.5 million (nearly 9% of the total population)

• Expected to be ~20% of the total population by the year 2050

VITAL STATISTICS

1988 1999 2006 2007 2008 2009 2010 2011

Population

growth rate (%

per annum)

1.96 2.02 2.02 1.75 1.52 1.29 1.10 1.01

CRUDE

DEATH

RATE

URBAN 8.9 6.0 5.3 5.3 7.6 5.1 5.2 5.1

RURAL 9.9 7.8 6.3 5.9 8.7 5.8 6.1 6.0

Average Life Expectancy (Years)

URBAN Male 59.0 61.0 62.9 64.0 65.1 65.5 65.8 65.92

Female 63.2 65.1 67.3 69.0 70.5 70.7 70.8 70.89

RURAL Male 56.2 60.3 62.5 63.2 63.9 64.1 64.3 64.45

Female 60.4 62.7 65.4 67.1 67.4 67.5 67.8 67.88

Source: Health in Myanmar 2014

HUMAN RESOURCES:

• Four Main Hospitals taking care of cancer with Medical Oncologists/ Radiation Oncoligists and Radiatherapy facilities • Yangon General Hospital/ North Okkalapa General Hospital

• Mandalay General Hospital

• Nay Pyi Taw General Hospital

• Taung Gyi General Hospital

CANCERS: MANDALAY GENERAL HOSPITAL

CANCERS: MANDALAY GENERAL HOSPITAL

CANCERS IN ELDERLY

33% over age 60 45% over age 60

CANCER CONTROL/ NCD PROGRAMME

NON-COMMUNICABLE DISEASES CONTROL

• Ministry of Health and Sports(MoHS) focused on addressing Non-Communicable Diseases (NCDs)

• A dedicated unit for NCDs was established in 2015 • to accelerate NCD prevention and control activities in country with

public health approaches reaching up to grass root level.

• NCDs have been recognized as public health priority in NHP (2017-2021)

NCD : NATIONAL STRATEGIC PLAN

• National Strategic Plan for Prevention and Control of NCDs (2017-2021) was launched in 2017 with the following objectives: • Raise the priority accorded to the prevention and control of NCDs in national

agenda through sustained advocacy to governments, partners and other stakeholders.

• Strengthen national capacity on leadership, governance and partnership development to accelerate multi-sectorial action through advocacy and dialogue.

• Reduce modifiable risk factors for NCDs in the population through health promotion.

• Achieve universal health coverage with key NCD related services by strengthening health systems through a people-centered primary health care approach.

• Generate and synthesize evidence to support decision making for prevention and control of NCDs through strengthening national capacity to conduct high quality prioritized research.

• Monitor the trends and determinants of NCDs and its risk factors through establishment of sustainable surveillance and evaluation mechanisms.

NCD

• The strategies adopted to achieve objectives can be grouped into four thematic areas: • Advocacy and Leadership for Multi-sectorial Action Plan,

• Health Promotion,

• Health System Strengthening and

• Evidence generation for decision making.

NCD PROJECTS 1. Diabetes Prevention and

Control project

2. Cardiovascular diseases

project

3. Cancer Control Programme

4. Chronic Respiratory Diseases

project

5. Tobacco Free Initiative project

6. Epilepsy control programme k(Myanmar Epilepsy Initiative)

7. Injury prevention project

8. Community Based

Rehabilitation project

9. Snake Bite Control project

10. Mental Health project

11. Deafness prevention project

NATIONAL CANCER CONTROL PLAN

NCD : PEN

• Package of Essential NCDs Interventions (PEN) • Package of Essential NCD interventions (PEN) has been started to

implement in May 2017.

• These interventions include

• screening of Hypertension, Diabetes, CVD risk and treatment of uncomplicated cases,

• early detection and referral of oral, breast and cervical cancers by BHS and mainly target to people especially living in rural areas.

NCD: PEN

• Training manuals, treatment guidelines, records and reporting formats of package of essential NCDs interventions (PEN) in both Myanmar and English languages have been developed for medical doctors and basic health staff (BHS).

NCD: PEN

• Activities

• Trainings of trainers (TOT) for PEN were conducted for State/Regional training teams and township training teams comprised of Township Medical Officers or township health officers, township health assistant and township health nurse by central training teams.

• Then multiplier trainings for BHS in respective townships were conducted by state/regional and township training teams.

• First evaluation meeting with (20) PEN implemented townships was held in August 2018

NCD : PEN

Achievements

• PEN has been introduced in 177 townships out of 330 townships by the end of 2018.

Future Plan

• PEN will be expanded to the rest townships to cover almost all townships in country by the end of 2019.

ELDERLY HEALTH CARE PROGRAMME

BACKGROUND

• Elderly Health Care Program has been launched in Myanmar since 1994: starting in 6 pilot townships and expanding yearly

• At the end of 2011, it covered 102 townships

• After 2011, Training was conducted at the State and Regional level and now covered 164 townships

ACTIVITIES

• IEC Production for Older people and social mobilization activities for promotion of elderly health

• provision of essential drugs and medical equipment

• Commemoration of international day for elderly

• Training of trainer to Basic Health Staff (BHS)

• Advocacy meeting

• Evaluation on Elderly health care

• Collection of base line data of Elderly population (Elderly Survey form)

ELDERLY CLINICS IN RURAL AND URBAN HEALTH CENTRES

Every Wednesday Clinic for Elderly

Quarterly reporting from township to Elderly Care Project Managet at Ministry of Health and Sports

POLICIES/PROGRAMMES FOR ELDERLY PEOPLE

Policy/Programme Ministry/ Department

(Division) in-charge

Target Year

1 Social security law (2012) MSWRR1 population > 60 years old 2012

2 Myanmar National Social

Protection Strategic Plan MSWRR

population > 60 years old

Developed

in 2014

3 Social pension provision MSWRR population > 80 years old 2017

4 Older People Law MSWRR population > 60 years old Enacted 2016

5 Developing the National

Policy for older people

MSWRR population > 60 years old Processing

6 Strategic plan for elderly

health care

MoHS2 population > 60 years old 2018- 2019

Biennium with

WHO support

1. Ministry of Social Welfare, Relief and Resettlement 2. Ministry of Health and Sports

Source: Ministry of Health and Sports, Elderly Health Care Project

STATISTICS/SURVEY (DATABASE) ON ELDERLY PERSONS’ SITUATION

No Name of statistics/survey (database) Available data from the

statistics/survey (database)

1 The key statistics on Myanmar

population of older people

Help Age International

2 Myanmar Demographic and Health

Survey

Ministry of Health and Sports

(2014-2016)

3 The 2014 Myanmar Population and

Housing Census

Ministry of Immigration and

Population

Source: Ministry of Health and Sports, Elderly Health Care Project

HEALTHY AGEING (2018-2019) BIENNIUM PROJECT

• Development of standardized physical exercises for elderly and distribution with DVD which will be used in Urban and Rural Health Centres and Sub-centres

• Training to BHS on elderly health care in Mon and Tanninthari Region

• Funded by WHO

• Published Manual for Elderly health care for BHS (Revised 2018)

INTERNATIONAL COLLABORATION

• Member country of the ASEAN Center for Active Ageing and Innovation(ACAI)

DEPARTMENT OF GERIATRIC MEDICINE • Department of Geriatric Medicine

• Yangon General Hospital

• Established 2016, February

• Part of Department of General Medicine

• One professor, one associate professor

• Five registrars, nine Medical officers

• Thirteen House Officers

• Two nurse sisters

• Four senior nurses, five trained nurses

28

CANCER REGISTRY

• Nay Pyi Taw Cancer Registry : 2017

• Yangon Cancer Registry: 2018

• Mandalay Cancer Registry: 2019

RESEARCH • Department of Medical Research,

MoHS

• Complied research papers 1958-2014

• 1052 papers, Thesis, Dissertations, presentations

• NONE targeted to elderly populations

WAY FORWARD

• Activation of National Cancer Control Plan

• Cooperation between Elderly Health Care Project and NCD Control Department

• Dedicated research for Cancer in older people

• Cancer Registry in Main Hospitals with Cancer Care Services

THANK YOU