Sunday, August 13, 2008

Mah ido l Univ er si ty Facul ty of Public

He alt h

Group 5

DRAFT STRATEGIC HEALTH PLAN

HYPOTHETICAL COUNTRY
APATI

Master of Public Health (International

Program)
Academic Year 2008-09

Reported By:

Mr.Boun Leuane Douang deuane Lao

Ms, Houy Chandy Cambodia
Dr.Thu Zar Tin Maung Myanmar
Dr.Mie Mie Han Myanmar
Dr.Aye Aye Aung Myanmar
Dr. soomar khan Pakistan
Md Mozammel karim
Bangladesh

1
 Conten t
Section Page

1.0. Executive Summary 3, 4

2.0 .APATI Map 5

3.0 .Internal Environment Analysis 6, 7, 8, 9

4.0 .External Analysis 10.11.12 .13

5.0 .Public Health Strategic Plan 14

6.0 .Objective 1.1 15

7.0 .Objective 1.2 16

8.0 .Objective 2.1 17

9.0 .Objective 2.2 18

10.0 .Objective 2.3 19

11.0 .Objective 2.4 20

12.0 .Objective 2.5 21

13.0 .Objective 2.6 22

14.0 .Objective 2.7 23

15.0 .Objective 2.8 24

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1.0 >E xecuti ve summa r y:
As in most of the countries of the world, APATI has also adopted National development plan of five years,
coinciding with the annual financial years.
APATI began formulating a series of National five years plans during the late 1970s, the first plan taking effect
in 1983. The first, second, third and fourth plans (1983-02) emphasized the economic aspects of development by aiming at
achieving a sustained level of high growth for national and per capital income. In the fifth five year plan (2002- 06), a number of key
social issues were included to address exiting social as well as economic problems of the country.

This plan must be accountable to public through clearly stated

measurable goals and objectives and to fine the action plan in response to regular
evaluation of the outcomes.

APATI is presently faced with a lot of health problems. The aim of our
plan is to enable people understand why change is necessary.
These challenges need to be considered in order to strive for a
healthy society.
This National Strategic plan has been formulated for the Sixth of the fifth year plan(2008-2012) with goals and
objectives.

In order to achieve the goals of this health plan, it will require the use
of information and communication technology to improve access to primary health
care services, adequate supply of professionals needs also be addressed to
achieving this plan.

Bac kg round

APATI is a tropical country in Southeast Asian with an approximate area of 513,000 Square kilometer and a
population of 44 million.

The majority of the people (84%) lives in rural areas and mainly engages in farming and other agricultural
activities. The country is government by a constitutional monarchy with a highly centralized government administrated by a cabinet
council.

The policies are framed by the Central Government and different ministries at provincial level take up the
implantation part.

The actual implementation at the provincial level is administered through governors and district chief officers
appointed by the ministry of Interior.

The sub-districts and villages are led respectively by chiefs and headmen elected by the community and
approved by the Ministry of interior.

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 The country is administratively divided into six regions, 600 provinces, 600 districts, 6000 sub-districts and 60000
villages with an average population density of 80 persons per square kilometer.

There are two main ethnic groups the APATIAN (85%) and Chinese (10%) and the remaining (5%).

The majorities (95%) are Buddhists, followed by Moslems (4%) and remaining (1%) are Christians, Hindus, Sikhs
and other.

The main sources of income are agriculture, Industries and tourism. The taxes collected from different sources
accounts for almost 90% of the total government revenue. The main source of government revenue is from taxes.

APATI began formulating the National five years Development plans since 1983. the last fifth five year plan was
for the years 2002-2006, in which, a number of key social issues were included to address existing social as well as economic
problems of the country.

The health services are provided by privates and public sectors, the ratio being 3:1 – private over public. The
private sector is mainly concentrated in the capital city and other municipalities. APATI has an established health care deliver
system at different levels and standardized pattern for delivery of rural health services. However, a large portion of the rural
population and the low-income groups in the urban areas still do not have access to adequate medical and health services.

2.0 >A PATI M AP

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5
3 .0 >Inte r nal En vir on ment Ana l ysi s
Strength

1. Politic :

• Stable government and well established governmental

organization.
• Health Policy (HFA2000) using intervention Design based on health data
• Development of National health plan (5 yr plan).
• Well defined health administrative structure and consists of two functional levels- the central and
provincial administration.
• Existing of national family planning program.

2. Demographic:

• Age distribution working age groups 56.5 %d

• family size 5.2( less ;burden)
• climate: good for farming and agriculture.
• Having natural resources of various economics.
• Decrease in inter-regional 5 yrs migration rate.

3. Economic

• Strong Buddhism influence on society and there was 30,000 temples lead to attract tourism.
• Major income from agriculture and industrials and tourism
• Fishing for food is common among villagers
• 5 % economic
Increase income 1% per capita per year and economical growth rate of
growth rate and natural resources for various economies.

4. Education

• literacy rate is gradually increasing among female(79.5%)

• School systems are available and high demand for university education.
• Encouragement of government for appearing private universities.

5. Health

• Having community based human resources and trained health

personals
• Population group rate reduced from 2.3% to 2%( good practice in family planning ),
• Health standard high for advanced technologies for diagnosis
• High number of community health workers…VHV 36,000and VHC 360,000
• TBA Capacity building by midwives
• Public health 11% of total GNP ,debt service 20.7% of GNP
• Reduced crude death rate shows increase in life expectancy and better curative services.
• government hospital and private hospital
• sub distinct medicine – provide medical care in some of the remote areas
• The percentage of households worth proper toilets and safe water supply has increased from 42% 45%.

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 • The rate of immunization coverage is increased.
• Increased life expanse of people
• MOPH has standardized pattern for delivery of rural health service.
• The current fifth-year national plan focusing on growth of rural health at village level.
• There are provincial hospitals in every province to provide specialized medical.

6. Transportations and communication

• Most household have Radio (87%) and television.

• Expansions of state highways and provincial highways and roads.

Weakness
Policy:
1. Highly centralized government and governed by constitutional monarchy.
2. Appointments of people at intermediate decision making level by government causing stakeholders to have
less/ no decision making power.

Health:

A. Health manpower and resources

1. Health Infrastructure and manpower insufficient in relation to population 1.6 beds/ 1,000
2. Population (government); 0.2 beds/1,000 population (private).
3. Insufficient human resources in health sector (only health paramedic is responsible for health center which
covered 5000 or more population).
4. At grass root level population to community hospital ratio is 1:1000 (30,000 populations to 10 to 30 bedded
community hospitals).
5. Unequal between geographical population distribution and health services.
6. Private hospital and public hospital ratio is 3:1.
7. TBA and traditional healers are still a favorite choice in village level for medical care.
8. Inequity in country budget allocation for health is quiet lower than the Ministry of Interior and defense.
9. 5% engaged in professional, technical and managerial works.
10. Less expenditure for health promotion and disease prevention services because of the uncontrollable escalating
health expenditure for curative services.
11. For 2000 people there is only 1 midwifery centre and sometimes each village don’t have midwifes.

B. Health services

1. Preventive services lag behind curative medicine.

2. No specific health care facilities for elderly population.
3. Rural area-only 15 % coverage by government health services.
4. There is unequal access to adequate medical and health services between rich and poor.
5. Traditional healers are still dominant in rural com.

C. Health problem
1. Dental caries rates increase fourfold per year
2. Infant mortality rate is still high.
3. Irrational drug use (over consumption-self treatment).
4. Drugs store are available easily and still practicing self-remedy.
5. Immunization coverage is only 79%.
6. Unhealthy lifestyles prevalent among rural areas where most of the people live, indicated by relatively high
expenditure on alcohol and tobacco versus medical care (Health Consciousness).
7. Health problems:

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 (a). Communicable diseases (vaccine preventable)- DPT, Polio, Measles, TB, -Respiratory tract
infection.
(b). Non-communicable diseases: poor nutrition, PEM, Fe deficiency, cardiovascular diseases, d/s of
nervous system, chronic d/s, CA etc.
(c). Diseases related to hygiene and sanitation- GE, Diarrhea
(d). Food contaminated by chemical substances like insecticides.
(e). Injuries, other accidents and homicide.
(f). Poor ANC- low birth weight children.
(g). Poor dental care in rural areas and increase dental care in urban.
8. Though BCG vaccination has increased, other EPI immunization goals are not achieved.

D. Health expenditure
Household expenditure on health care services is inadequate.

E. Environmental health problem

• Sanitary pit latrine is only 45% and safe drinking water is only 49%.
• Less safe water supply and waste water disposal and weak sanitation practice.
• Weakness in safety food control.
• Drinking water source are adjacent to toilet.
• Garbage is dumped on the river side and poor people stay in overcrowded house.
• There are refugee camps in this country; these are environment and health burdens.

Educa tion
1. Unequal distribution of vocational training facilities and higher education facilities. (70% are piling in capital
cites state) and insufficient resources’ to fulfill the demand for university education.
2. No sufficient university for higher education.
3. State universities mainly emphasize on bachelor degree (no empowerment of researched based education).
4. Decreased public fund for education and increasing cost lead to less university graduate and
smaller proportion of people with high degree above Bachelor level, resulting inadequate
number of professionals and technical workers.
5. Unequal distribution of vocational training facilities and higher education facilities.
6. Reductions in national budget allocation on education sector (19.5 in 2000and 18.9% in
2004).

Demographic
1. Unequal population distribution of capacity and state.

Economy

1. 11 years old and above are components of work forces (69% of employee persons).
2. Less professional and administrative level workers among labor resources.
3. Major sources of national income ( 90 % ) is from tax and3.Major sources of national income (
90 % ) is from tax and only 3 % from services, which make the country economy vulnerable
to competition.
4. Unequal distribution of wealth, 3 out of 6 regions’ income are below the national average
income and the most populated North-East region is poorest.

Transportation and communication

1. Communication facilities in rural area are inadequate. (84% of rural population)
2. Main river is only used for irrigation and not for transportation. Incomplete facilities of railway
transport throughout the country (no railway transport to east and west state, plateau area).
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4.0 >Ex ter na l A nal ysi s
Opportunity
Politic
1. Opportunity for collaborations with all UN organizations such as UNDP, UNICEF, UFA,
WHO, UNHCR, IOM etc
2. Participatory decision making at peripheral level(community leaders elected by
community members)

Demographic
1. Having chance of border trade, educational development exchange with neighboring
countries
2. Have regional networks with neighboring countries such as ASEAN (Association of
Southeast Asia Nations), ASEAN plus three (China, Japan, and South Korea).

Economic
1. chance for country development and improvement for bright market
2. Having chance of bilateral tie with neighboring countries in various aspects (border economy,
educational exchange and tourism) for facilitating the country growth
3. People have opportunity to get work in industrial and agricultural field.
4. Chance of increasing GNP from export of agricultural products.

Education
1. Great demand for study and have private university from foreign countries.

Health
1. Advanced technology can be used in diagnosis and treatment
2. Allocation of manpower like the availability of a critical mass of people in leadership position not only in
health sector but throughout other sectors of government, nongovernmental institution, business,
academic and private health area.

Transportations and communication

1. Most households have Radio and Television Government policy of encouraging the
private part in health and education sector.

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T hr ea ts
1. Political
Increase in wars and terrorism in the world can reflect peace and development of
country.
Unstable of political condition in neighbouring country (refugee camp)

2. Demographic
Global warming and environmental changes in neighboring countries can threat upon
country’s climate.

3. Economic
Yearly economic crisis, fluctuating currency and
Increasing fuel price. Threats upon input and export of products.

4. Health
Global warming threatens on developing natural
disaster. Illegal dumping of dangerous substances from other countries.

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 STRENGTH WEAKNESS

1. Development of 1. Highly centralized government

5 years National 2. Health infrastructure, resources and
plan. manpower are insufficient in relation to
population
2. Well defined 3. Preventive services lag behind curative
health medicine.
administrative 4. Immunization coverage is only 79%
structure & consist 5. MMR, IMR and nutritional problem is
of two functional still high
levels. 6. No specific health care facilities for
elderly.
3. A developing 7. Dental caries rates increase fourfold
country with more per year
than 5 % economic 8. Weakness in sanitary latrine and safe
growth rate and drinking water
natural resources 9. Inequity in country budget allocation in
for various health.
economies. 10.Irrational drug use ( over
consumption )
4. Having advanced 11.Having refugee camp in this country,
technology & well causing health burden and problems.
equipped facilities 12. Leading causes of death are due to
of curative respiratory and heart diseases.
medicine.

5. Having
community based
human resources
and trained health
personals.

6. Demand for
higher education
and increasing
literacy rate.

7. Stable
government and
well established
governmental
organization.

OPPORTUNITY S–O W–O

1.Collaboration S2 O1 W2 O1 Improve health infrastructure

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with all UN strengthens the including in rural and remote area
organization existing technical
5.0 >Pub lic Heal th Str ate gic p lan
VISION
Good health and well being for all Apatian by the
year 2012.

Mission
Deliver a comprehensive and sustainable health system
that aims to ensure healthier, longer and better lives for all
Apatian at the end of 2012.

Goals
1. Improve well organized health system, infrastructure
and health services and better quality of life.
2. Promote health status of each and every citizen by
reducing health problems.

Objectives
1. To develop and improve health manpower and equal distribution
of resources.
2. To improves rural health services and increase number of
community health volunteers in rural area.
3. To Reduce the burden of TB and diarrhea from current situation
4. To reduce the incidence and impact of cardiovascular disease.
5. To Reduce the country’s burden of maternal and infant and
children morbidity and mortality rate.
6. To Improve nutritional status especially in under 5 children
7. To gets more than 90% coverage of immunization for children
under one year.
8. To promote dental heath service and reduce the dental heath
problem
9. To Reduce 50% of the incidence and impact of road traffic
accidents.
10.To Reduce the adverse health effects of environmental hazards.

Values:
a. High quality
b. Transparency
c. Commitment
d. Honesty
e. Dedication

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 f. Good teamwork
g. Harmony
h. Self-reliance
i. Confidentiality and privacy

6.0 >Objective 1.1

To develop and improve health manpower and equal distribution of
resources.

KPI

1) Health personnel, population ratio.

2) Number of medical universities.
3) Allocation of government budget expenditure for health.

Strategies

1. Increasing the number of midwives and strengthening the

capacity and skills of midwives.
2. Providing effective treatment of prevailing diseases.
3. Strengthening human resources by reducing improper allocation
of health personnel and type of work.
4. Upgrading the skills of health professionals (Physicians, dentists,
Pharmacists and nurses) by providing on job training.
5. Allocation of resources from the central level to the provincial
level homogeneously.

Programs

1. Program on proper training and capacity building on PHC

activities by basic health workers, CHW and VHW.
2. Installing facilities (drugs, medical instruments and laboratory
equipments) in hospitals and health centers for diagnosis.
3. Improving referral system in sub district and rural health
centers.
4. Establish more station hospitals and community hospitals and
rural health center.
5. Provision of medical cards to the community for seeking medical
service.
6. Program on upgrading health related institutions.
7. Program on Country essential Drugs.

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 Projects
1. Project on vocational training and refresher training
course to basic health workers, VHW and CHW by the
aids of WHO, UNICEF, UNAIDS and World Bank.
2. Health system research and development project.
3. Project on improving hospital beds’ strength.
4. Projects on Country essential Drugs.

7.0 >Objective 1.2

To improve rural health services and increase number of community
health volunteers in rural area.

Strategies:

1. Development of free medical services and facilities for rural residents.

2. Capacity building and increase of the community health volunteers at
midwifery centers.
3. Development of human resources and sufficient health centers.

Programs:

(1) Develop primary care facilities.

(2) Promote the use of herbal medicine and traditional medicine.
(3) Develop a system or network for the surveillance, prevention and control
and monitoring of health problems.
(4) To establish mobile health clinic for rural population.

Projects

(1) Project on development or recruitment of CHW in village level.

(2) Project on strengthening of primary health activities.
(3) Domiciliary health care services in rural areas.
(4) Projecton capacity building of Health Volunteers

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8.0 >Objective 2.1
To reduce the burden of TB and diarrhoea from current situation by the year
2012.

Key performance Indicator

1. GE and acute diarrhea disease rate not to exceed 10 per 100,000

populations
2. Pulmonary tuberculosis death rate not to exceed 7 per 100,000
populations

Strategies

1. Intensification of health education activities by using multi-media to

increase community awareness about TB cases among community.
2. Implementing effective diagnosis, treatment and care of active TB cases
by using DOTS.
3. Regular supervision and monitoring of TB program activities at all levels.

4. To access the safe drinking water and increase of sanitary latrine

coverage in all level of communities to reduce the water related GE
problem.

Program

1. Health education program for TB among communities.

2. Disease control program for TB
3. Integrated HIV care program collaborate with TB program for provision of
HIV counseling and testing services at TB clinic and TB hospital.
4. National diseases surveillance program.
5. Program on population access to sanitary latrine and also collaborate with
other sectors
6. Program on water quality surveillance and monitoring to access clean and
safe water.

Projects
1. Project on TB routine surveillance system.
2. Training of trainers on referral, case finding and case management on TB
to physicians, health care providers and volunteers.
3. Project on nationwide TB prevalence survey for evaluation and monitoring
of effectiveness of TB control activities.
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 4. Project on multi-sectored collaboration and cooperation with WHO, UN
agencies, International NGO and local NGO to get technical inputs on
each projects.

9.0 >Objective 2.2

To reduce the incidence and impact of cardiovascular diseases.

Strategies

1. Strategy on prevention of risk factors and promotion of healthy life style.

2. Strategy on effective and good quality medical care.

Program

1. Integrated approach for prevention and control of CHD as a part of PHC

system.
2. Life style changes should be educated to public by mass media.
3. Screening and early effective treatment program on prevention of disease.
4. Legislate smoking free zone in public area and prohibit the cigarette
advertisement and increase tax on nicotine products.

Projects

1. Cardiovascular disease project.

2. Project on risk behavior modification.
3. Public exercising project
4. Anti smoking project

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10.0 >Objective 2.3
To reduce the IMR and MMR to half of 2004 by the end of 2012.

Key Performance Indicators

1. To reduce the maternal mortality rate to 0.5/1000 LB

2. To reduce infant mortality rate 20/1000 LB
3. Immunization coverage should be increased to 90%.
4. Exclusive breast-feeding rate should be 80% among pregnant
mother.

Strategies

1. Improve MCH activities.

2. Providing the essential package of reproductive health interventions
emphasizes emergency obstetric care and new born care.
3. Promoting Health Education for all women at reproductive age.
4. Provide easy access to family planning service for all eligible couple.
5. Increasing the numbers of efficient midwifery centers in the rural area
with the proper referral system.

Program

1. Program on primary health care activities and training: health education,

antenatal, intranasal and postnatal care.
2. Strengthening on national family planning program.
3. Training and refresher training, on-job training, curriculum and training materials development.

Project

1. Project on PMCT (prevention of mother to child transmission) HIV/AIDS

prevention.
2. Reproductive Health promotion Project
3. Continuous training for TBA and midwives for safe delivery using clean
delivery kits.
4. Nutrition and vitamins supplementation project to mothers.
5. Project on nutrition and child care training and counseling centers in
antenatal and post natal care facilities.
6. Project on TT2 immunization in all pregnant mothers during antenatal care.
7. TT5 immunization project for reproductive age group women.

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11.0 >Objective 2.4
To reduce nutritional deficiencies (PEM) among under 5 yrs old and
school children.

Key performance indicators

1. To reduce severe 3rd degree PEM children percent to 0.5%.

2. Exclusive breast-feeding rate should be 80 % among pregnant mother.

Strategy

1. Nutritional care and monitoring by regular weighing of children.

2. Education of mothers and community on importance of nutrition.
3. Enhancing nutritional deficiencies prevention activities.

Program

1. Having practice of exclusive breast feeding up to six months of new-born as a first initiative
action.
2. Encouraging of proper infant feeding practice (proper and safe weaning diet practicing) among
parents.
3. Implementing of nutritional and child caring training and counseling centers in antenatal and
post natal care facilities.
4. Training of health staffs and volunteers in nutrition program and establish of Community
Nutrition Centers.
5. Empower the school settings to initiate school meal support for primary school children.
6. Establishing of basic nutritional trainings for school teachers as a part of school meal time
activities.

Projects

1. Exclusive Breast Feeding project

2. Family food security project
3. School Meal project
4. Research project on nutritional promotion.
5. Supplementary feeding and Vit A distribution.
6. Public health project- under 5 clinics.

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12.0 >Objective 2.5
To get more than 90% coverage of immunization for children
under one year.

Key Performance Indicators

1. BCG coverage should be increased to 90 %.
2. DPT coverage should be increased to 90%.
3. OPV coverage should be increased to 90 %.
4. Measles coverage should be increased to 90 %.

Strategies

1. Implementation of immunization program for BCG, DPT,

Measles, Polio, and other vaccines.
2. Conduct National immunization day effectively.
3. Monitoring and evaluation (Surveillance) of the result of the
immunization program.

Program

1. Strengthening of immunization team by providing cold chain

materials and other essential facilities.
2. Increasing awareness rising on immunization through different media and
immunization activities.
3. National immunization day activities, mopping up immunization, regular
immunization scheme with the collaboration of international and local NGOs.

Projects

1.Expanded Immunization Project.

2. Health education project for immunization.
3. Surveillance on EPI

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13.0 >Objective 2.6
To promote dental heath service and reduce the dental
heath problem.

Key Performance Indicators

Dental problems should be reduced at least 50 % by making

available of dental care service.

Strategies

(1)Awareness raising of dental health.

(2)Upgrading routine oral health services and contributing oral well
being of people

Programs

1. To establish the dental clinics in each and every districts.

2. To raise the awareness on important of dental health education
program.

Projects

(1)Primary school dental health project.

(2) Dental care and behavior project.
(3) Oral health research project.

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14.0 >Objective 2.7
To reduce the 50% of incidence and impact of RTA.

Strategy

1. Strategy on strengthening and collaboration of the management,

implementation and close monitoring of activities with other related
Ministries.
2. Promoting and providing first aid treatments.

Programs:

1.Program on improve safety in traffics and in work places.

2. Program on health education on life saving emergencies like first
aid treatment.

Projects:

1. Project on road traffic and work places accidents prevention.

2. Project on reinforcement of laws and regulations on traffic.
3. Project on psycho-social assistance and life skills development.
4. Project on rehabilitation services for disabled persons.

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15.0 >Objectives 2.8

To promote and create health-supportive environments.

Key Performance Indicators

1. Percentage of population access to safe water (urban) 100 % and

(Rural) 90 % at the end of 2012.
2. Percentage of population access to sanitary (proper latrine) should be
100 % at the end of 2012.

Strategies:

To attain continuous safe water supply and sanitation up to

village level with community participation.

Programs:

(1) Program on strengthening of environmental health program.

(2) Program on public education, awareness and community participation in
environmental hazards management.

Projects:

1. National sanitation and safe water project

2. Water quality Surveillance and monitoring system
3. Diarrhea reduction project through sanitary latrine.
4. Community participation in environmental health sanitation together
with CHW and volunteer health workers.
5. Healthy City Project.

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БУ ĆℓøŰĐ

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