3MDG Annual Report Web 2015.06.03

2014
ANNUAL
REPORT
January to December 2014
ANNUAL
REPORT
January to December 2014
3MDG Annual Report - January to December 2014
ACRONYMS
3DF
Three Diseases Fund in Myanmar
3MDG
Three Millennium Development Goal Fund
ACF
Active Case Finding
ACT
Artemisinin-based Combination Therapy
(malaria)
ART
Anti-Retroviral Therapy (HIV)
ARVs
Anti-Retroviral (drugs HIV)
AMW
Auxiliary Midwives
BHS
Basic Health Staff
CCDAC
Coordinating Committee for Drug Abuse
Control
CfP
Call for Proposal
CBO
Community-Based Organization
CFM
Community Feedback Mechanism
CHD
Child Health Department
CHDN
Community and Health Development Network
CHW
Community Health Worker
CME
Continuing Medical Education
CTHP
Comprehensive Township Health Plan
CYP
Couple Years of Protection
DALY
Disability-Adjusted Life Year
DANIDA
Danish International Development Agency
DFAT
Department of Foreign Affairs and Trade
(Australia)
DfID
Department for International
Development (UK)
DIC
Drop-In Centre
DMS
Department of Medical Science
DoA
Description of Action
DoH
Department of Health
DOT
Directly Observed Treatment
DTC
Drug Treatment Centre
ECC
Emergency Child Care
EmOC
Emergency Obstetric Care
EPI
Expanded Programme on Immunization
FB
Fund Board of the Three Millennium

Development Goal Fund
FFM
Fund Flow Mechanism
FMO
Fund Management Office
GAVI HSS
The GAVI Alliance Health Systems
Strengthening
GF
The Global Fund to Fight AIDS,

Tuberculosis and Malaria (GFATM)
GPARC
Global Plan for Artemisinin Resistance
Containment
HIV
Human Immunodeficiency Virus
HMIS
Health Management Information System
IEG
Independent Evaluation Group
INGO
International Non-Governmental
Organization
IRC
International Red Cross
ITN
Insecticide Treated Net
JHPIEGO
Johns Hopkins Program for International

Education in Gynecology and Obstetrics
JIMNCH
Joint Initiative for Maternal, Newborn and
Child Health
LIFT
Livelihoods and Food Security Trust Fund
in Myanmar
LNGO
Local Non Governmental Organization
LLIN
Long-Lasting Insecticidal Net
LTA
Long-Term Agreements
M&E
Monitoring and Evaluation
MARC
Myanmar Artemisinin Resistance
Containment
MDG
Millenium Development Goal
MDR-TB
Multi-Drug Resistant Tuberculosis
MIS
Malaria Indicator Survey
MNCH
Maternal, Newborn and Child Health
MNMC
Myanmar Nursing and Midwifery Council
MoH
Ministry of Health
MRH
Maternal and Reproductive Health
Programme
MMT
Methadone Maintenance Therapy
MoHA
Ministry of Home Affairs
MOU
Memorandum Of Understanding
NAP
National AIDS Programme
NGO
Non-Governmental Organization
NMCP
National Malaria Control Programme
NTP
National TB Control Programme
ORT
Oral Rehydration Therapy
OST
Opioid Substitution Therapy
PHS
Public Health Supervisor
PLHIV
People Living With HIV/AIDS
PNC
Pre-Natal Care
PPP
Public Private Partnership
PWID
People Who Inject Drugs
RAR
Rapid Appraisal and Response
SBA
Skilled Birth Attendant
SCI
Save the Children International
SDC
Swiss Agency for Development and
Cooperation
SOP
Standard Operating Procedure
SR4
Special Region 4
STI
Sexually Transmitted Infection
TB Tuberculosis
TB-ACF
Tuberculosis Active Case Finding
TMO
Township Medical Officer
TSG
Technical Strategy Group
UHC
Universal Health Coverage
UNAIDS
Joint United Nations Programme on HIV/AIDS
USAID
United States Agency for International
Development
VHW
Voluntary Health Worker
VfM
Value for Money
VCCT
Voluntary Confidential Counselling
and HIV Testing
All costs are in United States Dollars ($) unless

otherwise stated.
1
CONTENTS
HEALTH OUTREACH ACTIVITIES IN AYEYARWADY REGION / INTERNATIONAL ORGANIZATION FOR MIGRATION
Foreword
Results at a glance
Coverage Map
Executive Summary
About the 3MDG Fund
HIV, TB and Malaria Introduction
HIV
TB
Malaria
Health Systems Strengthening
Fund Status
Monitoring and Evaluation
Annexes
COVER: HEALTH STAFF REVIEWING DATA AT A MOBILE OUTREACH FOR TB ACTIVE CASE FINDING / 3MDG
3
4
5
6
10
14
26
28
34
38
42
52
54
56
FOREWORD
THE THREE MILLENNIUM DEVELOPMENT GOAL FUND (3MDG) MADE SIGNIFICANT PROGRESS IN
IMPROVING HEALTH OUTCOMES AND STRENGTHENING MYANMARS HEALTH SYSTEM IN 2014.
The Fund was launched in 2012 by a group of bilateral
donors to support transformational improvement in
the health of the poorest and most vulnerable people
in Myanmar, particularly women and children. Since its
launch, 3MDG has helped to significantly expand access
to critical health services to more than 3.5 million people.
Key achievements include vaccinating over 80,000
children against measles, reaching nearly 27,000 people
who inject drugs with HIV prevention programs, screening
about 50,300 people for tuberculosis and treating almost
110,000 people for malaria.
In 2014 the Fund significantly scaled up access to
maternal, newborn and child health services, particularly
in conflict-affected areas in Myanmar. Access to HIV/AIDS,
tuberculosis and malaria prevention and treatment across
the country was also significantly expanded, including
commencement of active tuberculosis case finding
across 75 townships. Key health system strengthening
initiatives also supported by the Fund during the year
were improving public financial management as well as
expanding training for midwives and auxiliary midwives
across the country.
During 2014 3MDG also initiated a strategic review

process to maximise the impact of the Fund, strengthen
national ownership and improve the sustainability of
critical health services. The recommendations of the
review were welcomed and strongly endorsed by the
3MDG Fund Board and have resulted in fundamental
shifts in the way the Fund does business, including the
Ministry of Health joining the Fund Board, a stronger
focus on conflict affected areas and the establishment of a
national health impact fund.
Despite these successes, the health challenges faced
by the people and Government of Myanmar remain
significant, including achievement of the Millennium
Development Goals and Universal Health Coverage.
Ongoing support from the Fund, and other development
partners, will be critical in addressing these challenges
and continuing to improve the health of the poorest and
most vulnerable in Myanmar.
AMBER CERNOVS
3MDG Fund Board Chair
3MDG RESULTS AT A GLANCE

Performance against 2014 targets

3.5
MILLION
PEOPLE
COVERED
46,569
CHILDREN
VACCINATED
AGAINST MEASLES
30,276
BIRTHS ATTENDED
BY A SKILLED
PERSON
8,007
PREGNANT WOMEN
USED EMERGENCY
REFERRALS
31,395
WOMEN VISITED
FOUR TIMES FOR
ANTENATAL CARE
HIV
25,000
PEOPLE
COVERED
26,661
PEOPLE WHO INJECT

DRUGS REACHED BY
PREVENTION PROGRAMME
5,950
6,956,394
PEOPLE WHO INJECT DRUGS

GIVEN COUNSELLING AND
TESTING FOR HIV
NEEDLES AND SYRINGES

DISTRIBUTED
9,912
4,262
Tuberculosis*
9
STATES &
REGIONS
covered by
mobile
outreach
50,294
PEOPLE SCREENED FOR

TUBERCULOSIS
Malaria
REFERRALS TO
TUBERCULOSIS CLINICS BY
COMMUNITY HEALTH WORKERS
* Programme behind targets due to delay in start up in October 2014
1.9
MILLION
PEOPLE
COVERED
469,714
PEOPLE TESTED FOR

MALARIA
** Cases of malaria falling faster than predicted.

4
NOTIFIED CASES FOR TB

TREATMENT (ALL FORMS)
15,729**
PEOPLE TREATED FOR

CONFIRMED MALARIA
WITHIN 24 HOURS
OF ONSET OF FEVER
MEASURING PERFORMANCE
AGAINST TARGET
Achieving
(above 90%)
Moderate achievement
(80 to 90%)
Underachievement
(below 80%)
The full table of 2014 results
and 3MDG Logframe
are available in the Annexes.
COVERAGE MAP
HEALTH SERVICE COVERAGE

FINANCED BY 3MDG
As of December 2014
at December 2014
Kachin
Sagaing
Chin
Mandalay
Rakhine
Magway
Shan
Nay Pyi
Taw
Kayah
Bago
Kayin
Ayeyarwady
Yangon
HEALTH SYSTEM STRENGTHENING
Mon
3MDG/CU/Catalogue Maps/December 2014 Updated: 30/03/2015
In addition to this map 3MDG funds nationwide

projects such as:
National TB Program for active case finding
covering 321 townships
PSI for contraceptive procurement nationwide
Training of over 5,000 Auxiliary Midwives
Strengthening of Midwifery education and
training, working with 20 midwifery schools
nationwide
Tanintharyi
Tuberculosis (ACF, MDR-TB)

HIV (Harm Reduction)
Malaria (as part of MARC)
HIV, TB, malaria (integrated projects)
Dots indicate townships where more than one type of
project is being implemented
EXECUTIVE SUMMARY
The 3MDG Fund accelerates progress towards the health
Millennium Development Goals and universal health
coverage in Myanmar. In partnership with the Government
of Myanmar and others, it strengthens the national
health system at all levels, extending access for poor and
vulnerable populations to quality health services.
The 3MDG Fund aims to have a significant, timely and
nationwide impact, improving maternal and newborn
child health, and combating HIV and AIDS, tuberculosis
and malaria. It will also strengthen the structures
and institutions that deliver sustainable, efficient and
responsive healthcare across Myanmar.
By pooling the contributions of seven bilateral donors
- Australia, Denmark, the European Union, Sweden,
Switzerland, the United Kingdom and the United States
of America, 3MDG promotes the efficient and effective use
of development funds. With commitments totalling more
than $330 million for the period 2012-16, it is currently the
largest development fund in Myanmar. It is managed by
the United Nations Office for Project Services (UNOPS).
In 2014, the Fund took major strides towards delivering
on its goals, bringing real benefits to women, newborns,
children, and people suffering from communicable
diseases. The Fund also moved to adapt to the changing
context in which it operates with the support of a
Strategic Review conducted by independent experts. The
review provided recommendations on how to maximize
impact, strengthen national ownership and ensure the
sustainability of critical health services. The Fund has
acted to implement the recommendations and grasp new
opportunities available to support the Ministry of Health to
bring real changes to healthcare throughout the country.
2014 PROGRESS AND ACHIEVEMENTS
As of the end of 2014, 3MDG has achieved significant

results through its support to:
3MDG support has enabled three and a half million
people who live in remote and hard-to-access areas to
access essential Maternal, Newborn and Child Health
(MNCH) services. During 2014, services were extended
to conflict-affected areas (across Kayah State and within
areas of Shan State). The 3MDG Fund now supports
MNCH service provision in Magway and Ayeyarwady
regions and the states of Chin, Kayah and Shan.
In 2015, through work undertaken in 2014, health service
coverage will be extended across additional conflictaffected areas in Shan State, bringing maternal, newborn
and child health services to a total population of four
and a half million people. An innovative programme will
deliver health benefits to people living in Special Regions
(Wa and SR4). It will bring together the Ministry of
Health and Special Region health authorities to scale-up
maternal, newborn, child health and TB services for people
living in the areas.
6
Key maternal, newborn and child health targets set by

the Fund to benchmark its performance were largely met.
Around 30,000 pregnant women, or 65% of all expected
pregnancies within the defined coverage areas were
able to access skilled care for childbirth delivery; almost
doubling 2013 achievements. Almost 47,000 children
were vaccinated against measles, bringing the total since
the Fund began to almost 80,000. In areas where the
programmes are well-established, 30% more women are
opting to deliver in clinics and 15% more babies are being
delivered by midwives compared to 2013.
In areas where 3MDG is active, 8,000 women, or 15% of
pregnant women, were supported through emergency
referrals to hospitals after developing a complication
during pregnancy or childbirth. In these areas, both
maternal mortality ratio and newborn mortality rates
continue to decline year-by-year.
Beyond the benefits brought to three and a half million
people through the scale-up of MNCH services, and
with an additional $35 million of financing, work began
in 2014 on large scale initiatives to support improved
MNCH outcomes across the country. These principally
comprise a $10 million programme to strengthen
midwifery schools and midwifery services nationwide, a
$15 million infrastructure programme to construct health
facilities, training of over 5,000 auxiliary midwives, and
strengthening the cold chain for vaccines and other health
commodities across 200+ Townships in Myanmar.
HIV, tuberculosis and malaria
HIV and AIDS: Thirty-six townships are now being financed
for harm reduction services under 3MDG, following a 2014
expansion to 12 additional townships. This programme
prioritizes activities in areas with large numbers of people
who inject drugs. In 2014, it reached 26,661 people
through drop-in-centres, community outreach and mobile
activities.
The 3MDG Fund contributed to 44% of the national target
for prevention activities for people who inject drugs in
Myanmar. The number of sterile needles and syringes
distributed to people who inject drugs increased from 5.7
million in 2013 to 6.9 million in 2014, equalling 35% of the
national target.
Tuberculosis: During the early part of 2014, design,
planning and contracting for a substantial programme
focusing on active TB case finding was completed.
Activities were delayed beyond the expected start date
of April 2014 due to the complexity and scale of the
programme, in particular the time required to recruit
new staff and to procure mobile X-ray units needed for
programme start-up. However by the last quarter of 2014,
activities under this programme were being rolled out
across 75 hard-to-reach townships across seven states
and regions. During the last quarter of 2014 alone, more
than 4,200 TB patients were identified and enrolled on
treatment with a rapid acceleration of activities.
Multi-Drug Resistant Tuberculosis (MDR-TB): MDR-TB is a

major public health concern in Myanmar. Addressing the
challenges posed by MDR-TB require a concerted effort
by government, donors and communities. In late 2014,
the Fund agreed to support and began the planning with
the MoH for a $19 million programme to address gaps in
the national response to MDR-TB. This will finance the
enrolment of at least 2,200 patients onto the current
20-month course of treatment, the improvement of MDRTB priority infrastructure, better patient data management
and the piloting of a shorter course (nine-month)
treatment regimen to cure MDR-TB.
Whilst containment programmes remain vital as part of

the effort to control the spread of artemisinin-resistant
malaria, there is an emerging consensus that resistance
can only be addressed through malaria elimination
strategies which will require a concerted and massive
effort at the national, regional and global level. Evidence
to guide policy and planning is incomplete and as
such, during 2014, 3MDG continued to finance work for
innovation. This includes studies to model best options
for containment/elimination, studies to optimize use
of therapies as well as a nationwide survey to measure
prevalence.
Malaria: During 2014, almost 500,000 people suspected

of having malaria received testing, which brings the
number tested since 3MDG began to almost one million.
Thirty thousand new cases of malaria were treated,
bringing the total number of malaria patients who have
been treated through 3MDG support to almost 100,000.
Malaria prevalence is declining in the areas of the country
where malaria containment programmes are established,
resulting in lower numbers of people treated than earlier
foreseen.
FIGURE 1: 3MDG KEY PROGRAMMATIC AREAS
COMPONENT 1
MATERNAL, NEWBORN & CHILD HEALTH
Scale up of services in conflict

affected areas
Support to health care in Special
Regions
Strengthening service delivery
both public and private (MRH,
CHD, EPI, Nutrition, Health
Promotion)
Support to the MoHs Human
Resources for Health (HRH)
strategy
COMPONENT 2
HIV, TUBERCULOSIS & MALARIA
Support to the National Strategic

Plan on HIV and AIDS (harm
reduction)
Support to the National TB
Strategy (TB-ACF & MDR-TB)
Support to the MARC strategy
Strengthening of prison health
care
COMPONENT 3
HEALTH SYSTEMS STRENGTHENING
Governance and stewardship

Support to evidence based
strategy and policy
HRH strategy
Systems support
Community engagement
MNCH quality improved

Evidence base for national MNCH
strategies
RIGHTS BASED APPROACH: GENDER, ACCOUNTABILITY, COMMUNITY ENGAGEMENT
FIGURE 2: 2014 KEY RESULTS AGAINST TARGETS

FOR MATERNAL, NEWBORN AND CHILD HEALTH
Ante-natal care
(4 visits per woman)
37,500
31,395
Births attended by
a skilled person
30,838
30,276
Post-natal and newborn care

less than 3 days after birth
34,306
Referrals for emergency

obstetric care
Children immunized
against measles
Diarrhoea treated with
Oral Rehydration Therapy
2014 Target
2014 Achievement
(84%)
(98%)
17,033
(201%)
MILLION
PEOPLE
COVERED
7,500
(107%)
8,007
36,894
46,569
3.5
(126%)
9,905
17,445
(176%)
Target (100%)
FIGURE 3: 2014 KEY RESULTS AGAINST TARGETS

FOR HIV, TUBERCULOSIS AND MALARIA
People who inject drugs reached by
prevention projects
25,000
26,661
Needles and syringes

distributed
8,000,000
6,956,394
People who inject drugs given

VCCT for HIV
5,306
5,950
Nbr of referrals to TB clinics

by community health workers
25,187
9,912
Number of MDR-TB
patients supported
524
372
Number of people
tested for malaria
483,300
Number of confirmed malaria

cases treated within 24h
of onset fever
44,300
15,729
2014 Target
2014 Achievement
(106%)
25,000
PEOPLE
(87%)
COVERED
(112%)
9 STATES
& REGIONS
(39%)
COVERED BY MOBILE OUTREACH

(71%)
469,714
(97%)
1.9 MILLION
PEOPLE COVERED
(36%)
Target (100%)
Contributions to health systems strengthening are

being made across all three components of the Fund
with a focus on supporting efforts to accelerate health
service delivery while strengthening the delivery systems
themselves. Programmes include support to improve
capacity for evidence-based policy making, strengthening
of midwifery schools and to better coordinate supply
chains in Myanmar.
WORKING TOGETHER TOWARDS UNIVERSAL

HEALTH COVERAGE
Since 3MDG was designed in 2010 there have been
extensive changes in the context in which the Fund
operates. New opportunities enhance 3MDGs ability
to have a significant, timely and nationwide impact,
improving maternal, newborn and child health and
combating HIV and AIDS, tuberculosis and malaria. They
open up prospects for a much deeper partnership with
the Ministry of Health, greater national ownership and the
chance for 3MDG to have a transformational impact on
the provision of healthcare across the entire country.
In response to this changing context, in late 2014 a wideranging Strategic Review undertaken by independent
experts was commissioned. Answers were sought to two
questions alongside recommendations for changes in
direction. The first question asked whether the Fund is
delivering results in line with the Funds Description of
Action . The second question asked whether changes
within the operating context open up opportunities for
new ways of working.
The 3MDG Fund Board has accepted the reviews

recommendations which called for a more comprehensive
and nationwide approach to achieving maternal, newborn
and child health impact, as well as health system
strengthening. There was also a strong recommendation
to better align the Funds efforts with national health
priorities and strategies, and promote greater coordination
across development partners.
These changes come at the same time as the 3MDG
is working to develop a widely shared strategic vision
which will articulate how the 3MDG Fund will work in
partnership with all other stakeholders in order to be able
to provide coordinated and strategic support to the health
sector. This involves providing resources to address critical
gaps and bottlenecks to scale-up services and support the
Governments goal of universal health coverage.
maternal, newborn and child health as well as health

system strengthening nationwide. Working with the
Ministry of Health, it will enable the 3MDG Fund to better
support the Ministry across key programmatic areas as
depicted in Figure 1.
In 2014 the 3MDG Fund supported healthcare initiatives
that are making a real difference to the lives of poor
and vulnerable communities in Myanmar. Through
continuation of ongoing work as well as new initiatives,
the 3MDG Fund looks forward to the opportunity to have
even greater impact in 2015 and to make a substantial
contribution towards Myanmars longer-term goal of
reaching universal health coverage.
2014 FINANCIAL STATUS

$160.5 million in disbursements
received from donors since the inception
of the Fund and through to the end of
2014
A year of significant acceleration in
programming: from $25.8 million total
funds expended in 2013 to $62.7 million
in 2014; representing a 240% increase in
delivery.
32 new grants were awarded in 2014 to
23 implementing partners
A total 66 grants were managed by the
3MDG Fund at the end of 2014
See the Fund Status chapter (page 52)
and the accompanying financial report
documents.
In light of the Strategic Review the 3MDG Fund Board

has been reconstituted to include the Ministry of Health
along with donors and independent experts. 3MDG will
continue to support and improve successful township
level interventions, especially in areas which are or have
been affected by conflict, but also bring best practices to a
national level and support the harmonisation of township
planning under Ministry of Health leadership. As a major
new initiative, the 3MDG Fund has now established a new
financing window to take advantage of these opportunities
and changes in ways of working. The National Impact
Facility will be resourced with up to $50 million to support
AN AUXILIARY MIDWIFE CONDUCTS A HEALTH CHECK ON A CHILD IN AYEYARWADY REGION / 3MDG
10
ABOUT THE 3MDG FUND

3MDG FUND BACKGROUND
Design work on the 3MDG Fund commenced in 2010 with

a goal to improve maternal, newborn and child health
and to reduce the burden of communicable disease in
the areas of highest need in Myanmar. At that time, there
were fewer opportunities to work with the Government
of Myanmar, and an urgent need for expanded access to
health services.
The 3MDG Fund is the largest development fund in
Myanmar. It pools contributions from seven bilateral
donors - Australia, Denmark, the European Union,
Sweden, Switzerland, the United Kingdom and the United
States of America - with commitments totalling more than
$330 million for the period 2012-16. It is managed by the
United Nations Office for Project Services (UNOPS).
The Fund is structured around three components,
underpinned by a rights-based approach:
Component 1: Maternal, newborn and child health
Maternal, newborn and child health (MNCH) is the largest
component of 3MDGs activities, covering maternal and
newborn health, child health, immunization, nutrition
and health promotion. When the Fund was established in
2012, the focus of this investment was to support township
health planning and service delivery in order to scale-up
and strengthen access to health services.
The design of the Fund is underpinned by a strategy to
deliver an essential package of MNCH services through
a continuum of care approach. Working through and in
partnership with the Ministry of Health as well as state
and region health departments, 3MDG is supporting the
work of basic health staff across hundreds of clinics in
Myanmar.
Alongside support to strengthen facility-based healthcare
services, the Fund is providing significant financing for
community-based work as well as quality service provision
through the private sector. Economic modelling and early
design work undertaken by the Fund clearly demonstrated
that support to all these aspects of the health sector is
critical if the 3MDG is to reach targets set for lives saved.
In areas where this approach to MNCH is supported, the
Fund therefore provides financing support to the public
sector, to international and local non-governmental
organizations and to health care providers that use a
social franchising approach.
All elements of work are brought together under
a township health plan in order to promote good
governance and oversight, to ensure that resourcing
is targeted towards those who need it and for greater
efficiency.
Additional areas of work launched since the 3MDG
was first designed include: improving the quality of
MNCH services; supporting the Ministry of Health in
the implementation of their health workforce strategy;

and generating evidence through supporting research
and sector-wide assessments to inform national policies
and strategies. The 3MDG Fund is now financing
the training of more than 5,000 volunteer auxiliary
midwives nationwide and providing technical assistance
to the Ministry of Health to strengthen midwifery across
Myanmar. These additional areas of work reflect a change
of strategy underpinning how 3MDG will have the most
beneficial impact.
Component 2: HIV and AIDS, TB and malaria
The 3MDG Fund works closely with Myanmars national
disease control programmes to support national strategies
to combat HIV and AIDS, TB and malaria, complementing
investment from the Government, the Global Fund to
Fight AIDS, TB and Malaria and other partners.
This involves a focus on harm reduction, expanding HIV
prevention among people who inject drugs; addressing
policy and legal barriers for effective HIV prevention;
management of multi-drug resistant TB and acceleration
of TB active case finding; improving service provision
in prisons; promoting integrated HIV, TB and MNCH
services; advancing malaria prevention and improving
case management to contain drug resistance, in support
of the Myanmar Artemisinin Resistance Containment
Framework.
Component 3: Health systems strengthening (HSS)
The Fund provides sector wide support across a broad
range of areas, especially initiatives to strengthen the
institutions and systems of the Ministry of Health to deliver
quality health services. During 2014, major areas of work
have included support to develop the countrys health
financing policy; strengthening of the supply chain that
will make medicines available at all levels of the health
system; improving health workforce training and the
construction and renovation of health facilities.
3MDG FUND APPROACH AND PRINCIPLES
Building partnerships and aligning strategies

The Ministry of Health is central to planning and
implementation across all aspects of the 3MDG Fund,
and is a direct beneficiary of the Fund's capacity building
and systems strengthening activities. Financing is
aligned to the Ministry's sector strategies, with technical
interventions based upon the specific interventions
endorsed. Other core partners include United Nations
health bodies, local and international NGOs and
beneficiary communities.
Conflict sensitivity
Across areas of Myanmar, issues related to ethnicity and
conflict affect the delivery of health services. Starting in
2014, 3MDG undertook further analytical work to build
upon the Funds existing Conflict Sensitivity Action Plan
in order to gain a fuller appreciation of preconditions for
successful programme delivery. Also, the 3MDG Fund has
11
begun to provide capacity building support for partners

who deliver programmes in some parts of the country
where conflict has existed until recently, or is ongoing.
and evaluation unit supports the gathering and analysis

of data in order to improve upon the effectiveness and
sustainability of 3MDG-supported programmes.
RIGHTS-BASED APPROACH
The Fund Board appointed an Independent Evaluation

Group (IEG) to ensure a high quality evaluation that will
encourage learning and programme improvement. The
IEG reports to the Fund Board and is precluded from any
implementation role under the 3MDG Fund to avoid any
conflict of interest.
3MDG follows an overarching goal to contribute to

national progress towards the health MDGs through a
rights-based approach. This means ensuring equitable
access to health services, empowering women, engaging
communities in decision making and implementation,
ensuring the voices of minorities and other vulnerable
groups are heard, and more.
3MDG FUND GOVERNANCE AND

MANAGEMENT
Governance Structure
Design work on the 3MDG Fund commenced in 2010 with
a goal to improve maternal, newborn and child health
and to reduce the burden of communicable disease in
the areas of highest need in Myanmar. At that time there
were fewer opportunities to work with the Government
of Myanmar, and an urgent need for expanded access to
health services. Following a strategic review in 2014, the
3MDG Fund has reconstituted its Fund Board to include
the Ministry of Health, donors and independent experts.
This will strengthen governance and stewardship of the
health sector and also the delivery of the 3MDG Fund.
Monitoring and evaluation
The Fund is committed to the promotion of a culture of
transparency, accountability, evidence-based learning and
efficient knowledge management. 3MDGs monitoring
Evidence-based programming
The Fund believes in supporting and promoting an
evidence-based approach to health care. In 2014, 3MDG
worked with key partners to commission research projects
that identify best practices from existing health projects in
Myanmar and similar settings.
Value for money
The 3MDG Fund works within a Value for Money
Framework, which takes a practical approach to
measuring 3MDG support. 3MDG has integrated value for
money concepts within procurement, planning, budgeting
and reporting, which will enable the Fund to gain a better
understanding of health service costs.
Transparency
Information about 3MDG can be found on www.3mdg.org
in English and the official language of Myanmar. As part
of the Fund's commitment to transparency, project-level
information and financial information about the Fund are
published on data.unops.org on a quarterly basis. Regular
information sessions are also held in Yangon.
FIGURE 4: 3MDG GOVERNANCE AND MANAGEMENT STRUCTURE
GOVERNANCE AND STEWARDSHIP OF THE HEALTH SECTOR

3MDG
FUND
GOVERNANCE
3MDG FUND
MANAGEMENT
OFFICE
WORKING
THROUGH
PARTNERSHIP
COMPONENT 1
Maternal, Newborn
and Child Health
Ministry of Health
COMPONENT 2
HIV, TB and Malaria
Local NGOs
COMPONENT 3
Health Systems
Strengthening
UN Agencies
International NGOs
Community Based
Organizations (CBOs)
Civil Society
Organizations (CSOs)
Research
Institutions
12
HEALTH
MDGs
Millennium
Development
Goals
UNIVERSAL
HEALTH
COVERAGE
HEALTH OUTREACH ACTIVITIES IN LABUTTA, AYEYARWADY REGION / MARIE STOPES INTERNATIONAL
13
CHILD AND NURSE DURING A POST-NATAL CHECKUP / 3MDG
14
MATERNAL, NEWBORN & CHILD HEALTH

TABLE 1: MNCH RESULTS AND TARGETS 2014
Ante-natal care
(4 visits per
woman)
Births attended
by skilled
person
Post-natal and
newborn care
provided less
than 3 days
after birth
Referrals for
emergency
obstetric care
Children
immunized
against
measles
Diarrhoea
treated
with Oral
Rehydration
Therapy
2014
achievements
31,395
30,276
34,306
8,007
46,569
17,445
Project-to-date
achievements
(2013-2014)
51,668
47,703
52,119
13,754
80,154
23,446
Project-to-date
targets (20132014
65,500
53,771
23,846
12,906
65,433
26,187
KEY DEVELOPMENTS

Population coverage reached 3.5 million people in five states and regions throughout Myanmar
Geographical coverage expanded to include conflict-affected areas in Kayah and Shan states
Nationwide support to the Ministry of Health for its Human Resources for Health (HRH) strategy through
support to midwifery schools and the training of more than 5,000 auxiliary midwives
Number of emergency referrals continued to rise, with maternal referrals close to the globally-recommended
rate of 15% of all pregnancies
CONTEXT AND POLICY ENVIRONMENT
Myanmar has been undergoing considerable changes

during the life of the Fund. Government spending on
health has greatly increased in line with its commitment
to achieve universal health coverage as part of its 2030
vision. More donors have arrived, leading to an increased
need for collaboration and coordination. The Ministry of
Health will use a $200 million World Bank loan to work
towards universal health coverage, a majority of which will
be allocated to health facilities at the township level. This
offers an opportunity for the 3MDG Fund to align with and
complement the Ministry of Health to support township
health departments. In order to fully support the ministry
in its work, 3MDG has agreed on the following six priority
areas to advance progress towards universal health
coverage:
1. Scale up of services in conflict-affected areas
2. Support to healthcare in Special Regions
3. Strengthening service delivery in both the public and
private sectors
4. Support to the Ministry of Health on its Human
Resources for Health strategy
5. Service quality improvement for maternal, newborn
and child health
6. Evidence base for national maternal, newborn and
child health strategies
In 2012, under the leadership of the Ministry of Health,
the Fund ranked the health situation in Myanmars states

and regions, using existing survey data. The Fund went
through in-depth consultations with state and regional
health authorities to select the specific townships within
these areas that require priority support.
PROGRESS
By the end of 2014, the Fund was providing support to

maternal, newborn and child health services for 3.5 million
people in selected townships in Ayeyarwady and Magway
regions as well as Chin, Shan and Kayah states. Eleven
additional grants were signed in 2014, raising the total
number of grants to 18 and the total value to $96 million.
A total of $15.6 million was spent during 2014.
The programme overachieved against 3MDG targets
in several areas, including immunizations for children,
referral of emergency obstetric cases, and newborns who
received care within three days from their birth.
Following the recommendations of the Strategic Review to
allow swifter implementation of activities, the 3MDG Fund
Board decided that new grants will start rolling out some
activities during their early planning phase. In 2014, this
was applied to grants in Kayah and Shan states.
The township health departments and implementing
partners reported a total of over 13,500 emergency
referrals of children and pregnant mothers that were
15
directly supported by 3MDG funds. This reflects a 50%

increase from 2013. In 2014, a total of 30,276 births were
attended by skilled birth attendants compared to 17,000
in 2013. In 2014, 13% (6,213) of births in 27 townships
supported by 3MDG were attended by auxiliary midwives,
a decline from 17% (4,498) in six townships in 2013. More
than 1,300 basic health staff were trained, up from 350 in
2013. A total of 46,569 children were vaccinated against
measles, a 39% increase from 2013.
SCALE UP OF SERVICES IN CONFLICTAFFECTED AREAS
The 3MDG Fund is financing health care in conflictaffected areas to address the health needs of underserved
populations. These are areas where the Ministry of Health
has identified challenges to serve the population through
the public health system.
In agreement with the Ministry of Health and other
stakeholders, an implementing partner works with the
township health departments, ethnic health organizations
and civil society groups that may have access to areas not
accessible to basic health staff.
Kayah State
Work in Kayah State began in July 2014. The International
Rescue Committee (IRC) received a 3MDG grant to
support maternal, newborn and child health service
provision across all seven townships in the state. IRC
worked closely with the state health department and also
partnered with the Community and Health Development
Network (CHDN), a local organization consisting of
representatives of ethnic health organizations that are
active in Kayah.
Recognising that the development of seven
comprehensive township health plans in partially conflictaffected areas would take time in order to ensure the
active participation of all stakeholders, IRC was granted
funds to support priority service delivery activities
alongside the planning phase. This included supporting
the Ministry of Healths crash campaigns to bring
immunization services to previously unreachable areas.
As part of the 3MDG Funds monitoring of the roll out
of its conflict sensitivity strategy, visits were undertaken
throughout 2014, including by Fund Board members
and conflict advisers. These highlighted the key role
an implementing partner can play in mediating and
facilitating between government health structures and
ethnic health organizations. They emphasized the need
to reinforce this coordination role first, before ambitious
service delivery targets are set and implemented.
Shan State
In June 2014, 3MDG issued a call for proposals for a
total of nine conflict-affected townships in Shan State.
Applications for only seven townships were received.
The review panel, which included the Ministry of Health,
selected three implementing partners. Recognizing the
challenging operational environment in Shan, the 3MDG
Fund management office held preparatory meetings
with the selected implementing partners and visited the
townships in Northern Shan to assess the situation and
16
collaborate with health authorities.

A grant to the three southern Shan townships of Hsihseng,
Mawkme and Laikha with Relief International was
finalized in December. In line with the recommendations
of the Strategic Review, with this grant it was agreed that
the partner would immediately support ongoing efforts
by the Ministry of Health and others in activities such as
outreach, immunization crash campaigns, emergency
referrals, and assessments in addition to supporting the
township planning process. Security conditions vary to a
great extent in these three townships, which is likely to
result in different approaches being applied to each.
The implementing partners in the Northern Shan
townships started their contracts on the first day of 2015.
SUPPORT TO HEALTH CARE IN SPECIAL

REGIONS
The 3MDG Fund will provide funding for health care

services in Myanmars Special Regions to support
integrated services for minorities and hard to reach
populations. This support addresses the need to expand
service coverage and improve the quality of service
delivery. The implementing partners act as a bridge
between the Ministry of Health and the Special Region
health departments to maximize ministry support.
In June 2014, a team of Ministry of Health officials
and 3MDG staff visited Monglar in Special Region 4
and the Wa Self-Administered Region. The mission
explored ways to improve service delivery for a range of
maternal, newborn and child health and disease control
interventions.
This visit was followed up by a ministry-organized
workshop with participants from the Ministry of Health,
the health departments of Wa and Monglar, 3MDG and
non-governmental organizations operating in the area.
The participants agreed to develop a proposal for an
integrated approach to expand maternal, newborn and
child health, tuberculosis, malaria and HIV services to the
townships in Wa and Special Region 4. At the end of 2014,
workplans, budgets and proposals had been submitted by
Health Poverty Action to the Fund Management Office and
were being reviewed prior to submission to the Ministry of
Health.
STRENGTHENING PUBLIC AND PRIVATE

SERVICE DELIVERY
Across Ayeyarwady, Magway and Chin regions and states,

supply and demand side interventions are being used to
address the challenges people face in accessing essential
services. On the supply side, the 3MDG Fund is providing
financial and capacity building support to the public sector
to strengthen service delivery. An essential part of the
approach to improve service provision for hard to reach
areas is through enhancing the planning capacity of the
township health departments. On the demand side and
through the public sector as well as the implementing
partners, the 3MDG Fund is strengthening communitybased health services, the referral of emergency cases and
private sector health care services.
Ayeyarwady Region
In the Ayeyarwady Region, five partners whose work was
extended from the Joint Initiative on Maternal, Newborn
and Child Health (JIMNCH) were awarded new grants
that harmonize with 3MDGs approach. In 2014, these
partners supported the townships in the assessment and
prioritization of needs and the planning of activities for the
period 2014 to 2016.
FIGURE 5: COMPARISON OF ACHIEVEMENTS

IN SIX AYEYARWADY TOWNSHIPS BETWEEN
2013 AND 2014
6,001
8,005
6,338 5,626
2013
Diarrhoea Tx
2014
with ORT
20,273
Pneumonia Tx
with a/b
21,510
Penta3
21,925
Measles
23,866
22,166
17,813
Antenatal care at
least 4 times
The townships in the Ayeyarwady Region saw an

encouraging 29% increase in facility-based deliveries from
2013 to 2014. This was accompanied by a general increase
of deliveries attended by skilled medical staff. This
suggests that the increases in maternal referrals to health
facilities contributed towards an increase in facility-based
deliveries.
33,585 32,360
27,647
2014
The progress made by the partners shows the benefits

of a sustained engagement with the townships and
communities. Referrals of mothers for emergency obstetric
care was at an average of 19% of all expected births, the
target being 20%1. The increase also reflects the effects
of harmonization of referral guidelines and the removal of
any poverty linked criteria for referral2 .
The increase in referral cases coincides with a reported
decrease in the deaths of mothers who delivered at
facilities as well as a decrease in deaths of newborns.
There are several factors that could contribute to this. For
example, community health workers have been trained
to recognize early danger signs of obstetric emergencies,
which should lead to more timely referrals to health
facilities. Basic health staff have also been re-trained in
the provision of basic emergency obstetric care.
32,649
2013
Delivered by SBA
and AMW
Newborn care within

3 days
FIGURE 6: CHANGES IN PERCENTAGE FOR

SELECTED INDICATORS FROM 2013 TO 2014
AYEYARWADY
At the same time, a decrease in the number of births

assisted by auxiliary midwives was reported. Auxiliary
midwives perform an important role in following pregnant0%
29.5%
15.5%
Deliveries
attended by
AMWs
Deliveries
attended by
skilled staff
Deliveries
in health
facilities
1
15% of all births need Basic Emergency Obstetric Care Centre [BEmOC]
and 5% of all the pregnancies considered as high risk
2
With population weighting, the Integrated Household Living Conditions
Survey (IHLCS) finds high numbers of people living in poverty in Ayeyarwady,
Mandalay and Shan, with low (absolute) numbers in Kayah, Kayin, and Kachin.
Analysis of the IHLCS data shows that a high percentage of the population is clustered
around the poverty line, i.e., they are extremely vulnerable to minor risks and shocks
that can place them below the poverty line. This clustering suggests that more universal approaches to benefit provision are preferred to ones targeted by income, which
would risk excluding many people living in poverty or close to poverty (chronic poor
and transient poor). IHLCS 2009-2010
-16.8%
TABLE 2: REFERRALS REPORTED IN SIX TOWNSHIPS IN AYEYARWADY REGION 2014

Townships
Children under five

years old: number of
referrals
Percentage of children
< 5 years old
Pregnant women:
number of referrals
Percentage of
pregnant women
Bogale
332
0.90%
1341
17%
Dedaye
247
1.50%
529
15%
Labutta
1539
4.60%
1149
15%
Mawlamyinegyun
476
1.90%
1945
30%
Ngapudaw
1263
4.50%
1236
19%
Pyapon
328
1.10%
782
11%
17
FIGURE 7: TOTAL NUMBER OF MATERNAL REFERRALS AND REPORTED

DEATHS - AYEYARWADY 2014
8000
Foe
tal /
newbo
rn deaths
2.00%
1.50%
7000
6000
2014
5000
2013
4000
1.00%
3000
2012
(JIMNCH)
2000
0.50%
Maternal dea
ths
1000
0.00%
Total referrals
women through their pregnancies, notably in areas that
cannot easily access health facilities staffed with qualified
midwives. The decrease in deliveries carried out by
auxiliary midwives could be due to the following:

More women recognize that they should seek skilled

birth care
The increased number of maternal emergency
referrals demonstrates early recognition of the danger
signs and referral of these women to facilities for
delivery with skilled birth attendants
Chin State
In Chin State, support to the four townships of Mindat,
Madupi, Tedim and Falam began at the end of 2013.
Support to the remaining five townships of Hakha,
Tonzang and Thantlang and Paletwa and Kanpetlet
started in 2014. In all areas, support began with an
inception and planning period of three to five months,
followed by the implementation of activities. Some
delays were experienced due to access issues during the
rainy months and the high turnover of township health
department staff.
In 2014, emergency referrals for mothers in Chin were still
at 5% of expected births compared to a target of 20%.
TABLE 3: REFERRALS REPORTED IN NINE TOWNSHIPS OF CHIN STATE 2014
18
Townships
Children under five

referrals
< 5years old
Pregnant women:
number of referrals
Percentage of
pregnant women
Falam
166
4.00%
91
9%
Tedim
218
2.00%
170
8%
Matupi
50
0.70%
1%
Mindat
241
5.00%
125
10%
Hakha
65
2.40%
54
9%
Kanpetlet
49
3.00%
27
8%
Paletwa
13
0.20%
23
2%
Thantlang
45
1.30%
46
6%
Tonzang
12
0.60%
1%
Emergency Maternal referral
% Deaths amongst referrals
2.50%
A CHILD BEING WEIGHED IN A LONGYI DURING A POST-NATAL CHECKUP / 3MDG
19
TABLE 4: REFERRALS REPORTED IN FIVE TOWNSHIPS OF MAGWAY STATE 2014

Townships
Children under five

referrals
< 5 years old
Pregnant women:
number of referrals
Percentage of pregnant
women
Gangaw
346
7.20%
243
22%
Myaing
11
0.20%
66
5%
Ngape
32
1.40%
77
13%
Pauk
25
0.50%
51
5%
Seikphyu
68
2.20%
22
3%
The proportion of under-fives referred for emergency care

was 2% compared to a target of 5%. However, as this was
the first year of engagement these figures reflect start-up
issues and to a degree the geographical challenges of
Chin. Emergency referrals from some remote eastern parts
of Paletwa cannot access the township hospital, but these
mothers and children will in the future be more effectively
referred to Sittwe in Rakhine. The infrastructure in Chin
is also poor and many rural health centres and subrural health centres are constructed with materials that
deteriorate easily in local weather conditions, and some
are not within easy access to the target population. Under
the health infrastructure project, joint assessments of
health infrastructure in Chin State have been carried out.
Possible construction of Rural Health Centres and SubRural Health Centres are being discussed with the MoH.
Magway State
In February 2014, awards to support the three townships
of Seikphyu, Pauk and Myaing were granted to Marie
Stopes International (MSI) and the two townships of
Ngape and Gangaw to Save the Children (SCI). Activities
began in July 2014 in the two SCI-supported townships,
but in the other three did not start until September 2014
due to delays in the start-up of those programmes.
There are areas of Gangaw, Myaing and Pauk townships
that are geographically difficult to access and it will be
particularly difficult to implement activities during the
monsoon season.
Maternal referrals from some areas of Myaing and
Pauk are closer to Pakkoku Township and agreement
was reached that cases should be referred there. In the
absence of a township medical officer in Myaing in 2014,
patients requiring emergency obstetric care had to be
referred to Pakkoku. This situation had an impact on the
expense and complexity of referrals in this particular
township. There was no township medical officer in Myaing
for 2014 and though there was an assistant surgeon, she
was not confident of performing surgery so patients were
referred to Pakkoku. In spite of the short period over which
actual activities were supported, an average of 10% of
all expected births for the period (target = 20%) and 2%
of under-fives (target = 5%) were referred for emergency
care.
Construction of health facilities
Across many remote areas of the country, there is a need
for new and improved health facilities, particularly for rural
20
health centres and sub-rural health centres. Wherever a

health facility is to be constructed, housing is also built for
basic health staff. Through this approach, a wider range
of services can be provided and health staff can be better
motivated and retained.
The 3MDG Fund supports the construction of health
facilities via an infrastructure team established as a
separate unit within UNOPS Myanmar. The project is
managed by a project board that includes the Ministry of
Health.
In 2014, the infrastructure team held extensive discussions
with the Ministry to agree on the design of rural health
centres and sub-rural health centres. The team also
undertook assessment visits to Kayah and Chin states
and Magway Region. Together with the regional and state
health departments, they identified an initial 28 health
facilities to be built.
Following a tender, the construction of 17 facilities in
Magway region is expected to start in the second quarter
of 2015. The construction of health facilities in remote and
sparsely populated areas of Chin and Kayah states poses
some challenges to identify cost-effective solutions. There
may be some changes to the standard design needed for
these areas.
EMERGENCY REFERRAL: HOW DOES IT

WORK?
New referral guidelines have been agreed
with implementing partners and the Ministry
of Health. Implementing partners work
with the public health system and health
volunteers to disseminate knowledge about
danger signs and how to seek emergency
care to the community. Mothers and children
requiring emergency care are identified by
the midwife or the auxiliary midwife. They
contact the Village Health Committee who
arrange the transport for the patient and
one attendant to the nearest appropriate
hospital. The implementing partner later
reimburses the cost for travel, food, certain
medical tests and drugs to the patient
and obtains the intervention and outcome
information from the Ministry of Health.
PRIVATE SECTOR: STRENGTHENING SERVICE

DELIVERY
In Myanmar, many people currently access health care
services through the private sector. The 3MDG Fund
supports interventions that both improve the quality
and availability of private sector services and are
complementary to public health services.
Population Services International (PSI) and Marie

Stopes International (MSI) both reported that in the
3MDG-supported townships, the uptake of short-term
contraception through their social marketing activities is
low, as there is plenty of free short-term contraception
available in the public health system. As a result, their
achievements are lower than their targets for the reporting
period. Regular discussions have been held with both
partners to explore how the programme will adapt to this
situation and to ensure coordination between stakeholders
from the private sector and the public sector.
TABLE 5: 2014 ACHIEVEMENT AGAINST DALY

AND CYP TARGETS FOR PSI AND MSI
Implementing partner
PSI
MSI
Disability-adjusted life years

averted (1)
87%
48%
Couple-Years of Protection
(CYP) (2)
46%
30%
(1)The disability-adjusted life year (DALY) is a measure of overall disease burden,

expressed as the number of years lost due to ill-health, disability or early death.
(2) Couple-Years of Protection (CYP) is the estimated protection provided by
contraceptive methods during a one-year period, based upon the volume of all
contraceptives sold or distributed free of charge to clients during that period.
Population Services International

PSI was contracted to provide complementary support
for maternal and child health to the townships. This
includes a franchised network of local doctors called the
Sun Quality Network. PSI also uses a network of health
care volunteers who sell quality-assured products at
subsidized prices. Products for maternal and child health
are made available through retail points. Finally, trained
staff members work to create demand in 3MDG supported
townships. PSI is also engaged in a public-private
partnership with township health departments to support
them in the provision of long term contraceptives and
cryotherapy for cervical cancer.
Marie Stopes International
MSI was awarded a grant to support 15 townships with
static and mobile clinics, where they provided a full
range of sexual and reproductive health services, as well
as short-term contraceptives through retail outlets and
demand creation. MSI also stated that they found that
the demand for short-term contraceptives is lower than
anticipated while the demand for long-term methods is
higher than planned. Due to these challenges as well as
difficulties in staffing the offices in the remote townships,
MSI achievements have also been lower than their targets.
SUPPORT TO THE MINISTRY OF HEALTHS

HUMAN RESOURCES FOR HEALTH
STRATEGY
Well-trained health workers are essential to a wellfunctioning health system. The 3MDG Fund is supporting
the Ministry of Health in the strengthening of its health
workforce, and is financing the training of midwives and
auxiliary midwives. This support will lead to more and
better quality health services across the country.
Support to pre-service and in-service training of
midwives nationwide
The Ministry of Healths Department of Health and the
Department of Medical Science are supported through
a multi-year grant totalling US$10 million to Jhpiego, an
affiliate of John Hopkins University. The support has been
strengthening midwifery nationwide since July 2014.
This is a significant health system strengthening
programme that supports the Ministry of Health in
the improvement of the existing policy and regulatory
framework guiding high-quality pre-service education
and in-service training. The programme will support
improvements in midwifery education in up to 20
midwifery schools by 2016. Additionally, it strengthens
the continuing professional education system, including
in-service training, which leads to optimal performance by
midwives and provides support structures for midwives in
facilities and communities.
In 2014, Jhpiego organised a multi-stakeholder meeting
on midwifery to discuss ways to improve the availability,
accessibility, acceptability and quality of midwifery
services in Myanmar. It also undertook a first round of
midwifery school assessments in five midwifery schools in
Pyay, Hpa-An, Magway, Taunggyi, Monywa and one Lady
Health Visitor School in Yangon in close collaboration with
the Department of Medical Science. In addition to the
Ministry of Health, Jhpiego supports the Myanmar Nursing
and Midwifery Council (MNMC), a key body that sets
standards for midwifery training and practice. A workshop
was conducted to share general findings of the midwifery
school assessments with the MNMC and to envision plans
to help improve regulation, governance and oversight.
Jhpiego also provided technical support on accreditation,
a code of ethics and core competency materials in
consultation with MNMC.
Auxiliary midwife training by Ministry of Health
The Ministry of Health has set a national target to deploy
at least one trained health care provider to every village,
and to train 9,660 auxiliary midwives in the 2014-15
financial year. In October 2014, 3MDG committed to
support the ministry in the training of over 5,000 auxiliary
midwives in nearly 200 townships. During November and
December 2014, a total of 1,588 auxiliary midwives were
enrolled in training programmes, covering 77 townships.
Trainings were conducted by the township health
departments.
This training support uses the managed cash flow system
designed by UNOPS for the disbursement of Global
21
Fund-related expenses to TB, HIV and malaria activities.

This is the first time that the public health section of the
Department of Health has planned, implemented and
reported directly to 3MDG using the managed cash flow
system. The 3MDG Fund management office found that a
substantial amount of time and resources were required
to support the public health section in planning for a
programme with such a large spread.
SERVICE QUALITY IMPROVEMENT FOR

MATERNAL, NEWBORN AND CHILD HEALTH
Across Myanmar, there is a need both to get more out

of limited resources for health, and to scale up existing
health services to reach more people. The process of
improvement and scaling up of services needs to be based
upon sound local strategies for quality so that the best
possible results are achieved from new investment.
Following a review of 3MDG financing for maternal,
newborn and child health services, the Ministry of Health
and the 3MDG Fund have agreed to focus on improving
quality within the health sector as an explicit area of work.
This will build upon work already being undertaken by the
Fund. Examples of such work include:

Financing to improve quality of midwifery services

Strengthening of township health department
supervision and monitoring of services across areas
where 3MDG is providing financing support
On-the-job training and capacity building of basic
health staff
Strengthening linkages between skilled midwives and
auxiliary midwives to enhance quality and strengthen
the continuum of care
The Fund will be working with the Ministry of Health to

identify resourcing requirements to expand upon this
work.
EVIDENCE BASE FOR NATIONAL MATERNAL,

NEWBORN AND CHILD HEALTH STRATEGIES
The Ministry of Health and the 3MDG Fund are generating
an evidence base to inform national strategies, guidelines
and policy. Evidence-based public health means applying
the best available evidence to set policies and practices.
The 3MDG Fund and its partners are collecting systematic
information through routine monitoring systems and
specific operational studies. Initial work in 2014 included
a number of interventions that will lead to a more
substantive body of work in 2015 and beyond:

22
Maternal death audit: The 3MDG Fund supported

the Ministry of Health to develop and publish a
comprehensive maternal death audit.
Referral guidelines for emergency maternal and
child referral: The Ministry of Health hosted a
workshop where guidelines for emergency referrals
from the secondary to tertiary levels of health
care were discussed with experts from townships,
implementing partners and the 3MDG Fund
management office.
Township health planning review:: The experiences

of different implementing partners in developing
township plans were reviewed. The reporting of
implementing partners enables the establishment
of unit costs for key interventions and the creation of
value for money analyses.
Community health volunteer recording and
reporting system: A system was developed jointly
with all implementing partners to enhance the
recording and analysis of services provided by
community health workers. The system will be
implemented in 2015.
Monitoring and Evaluation Technical and Strategy
Group (M&E TSG): The TSG met twice in 2014 with
the 3MDG Fund management office as secretariat.
The TSG agreed to develop a national research
agenda that will lead to funding opportunities
for 3MDG. The TSG will also be used for the
dissemination of information relevant to public health
and policies.
Work in conflict-affected areas: The 3MDG Fund and
its partners started the systematic assessment and
recording of work in conflict-affected areas to better
understand health programming in conflict-affected
areas and the application of do no harm principles.
VOICES
Ma San Hmwe is a 33-year-old mother of one living in Baw Sa Kaing Village, NgaPuDaw Township, Ayeyarwady Region.
A number of years ago, Ma San Hmwe lost her first child shortly after delivery. She did not receive any antenatal care
and delivered at home. Since then, I was afraid of bearing another child, she said. But then Ma San Hmwe attended a
Save the Children health education session. I realized that not knowing how to take proper care of myself and not having my child delivered by a skilled attendant was the problem so I decided to consult with a health worker in the future,
she said.
When she suffered from high blood pressure during her second pregnancy, it was detected by her midwife who tried to
bring it down with anti-hypertensive drugs, but when that failed Ma San Hmwe was referred to a local hospital where
they had the equipment to ensure a successful delivery. 3MDG funding for emergency referrals meant that she was
reimbursed via Save the Children for her travel, food and medical expenses.
When I returned from the hospital, the midwife provided care for me and care for my baby. Without their support, I do
not think that I could have delivered my baby safely and be alive right now.
23
VALUE FOR MONEY FOR MNCH

INTERVENTIONS
The Funds ongoing reporting system has allowed for

cost-effectiveness analyses in an increasing number of
townships. The DALYs averted were calculated using the
Global Burden of Disease (WHO1) as central reference.
For 2014, an analysis of the referrals supported in the six
Ayeyarwady townships indicated that the MNCH support
had been very cost-effective.
The average cost of a referral2 amounted to $64. This
corresponds to $0.40 per capita of the total population
in the six townships. The cost-effectiveness analysis was
conducted with the total expenditure reported by the
partners, which included activities that were not directly
linked to referrals. Despite including these additional
costs, the total costs of township interventions remained
cost-effective. The estimated direct cost per death averted
ranges from $1,465 to $5,399 and the direct cost per
DALY3 averted ranges from $28 to $109. This range was
calculated using several scenarios of maternal deaths that
would have occurred in the absence of a referral service.
The likelihood of each scenario was measured against
the expected maternal mortality ratio in the population
covered. It demonstrates that referrals are highly costeffective interventions, whatever the scenario.
Moreover, and this is the most surprising result, referrals
remain cost-effective even in terms of total cost per
DALY averted (from $259 to $1,0154 ) i.e. the total 2014
actual expenditure for all implementation activities and
all management costs divided by DALYs averted though
referrals.
The direct cost (or even the total cost) per death averted
obviously does not reflect the total actual cost which
includes the cost of the health system itself (supply side)
(e.g. the cost of providing a lower segment Caesarean
section). Referrals can only be effective if there is a health
system functioning (i.e. health facilities with skilled staff
and appropriate equipment). Nonetheless, the
1
A simpler form of DALY, used by the Global Burden of Disease study (GDB
2010) has been adopted. Age-weighting and time discounting are dropped.
2
An emergency obstetric referral is defined as a women with direct
obstetric complications, who require emergency obstetric care at Station, Township or
District Hospitals, during pregnancy, delivery and postnatal period that are supported
for referrals during this reporting period. Support includes financial assistance for
transportation costs and/or meal costs and/or medicine costs and/or investigation
costs and/or operation costs. Costs are covered for patients only or both patients and
a caregiver. An emergency child care referral is defined as the total number of children
under 5 that require emergency child care at Station, Township or District Hospitals
that are supported for referrals during this reporting period. Support includes financial
assistance for return transportation costs and/or meal costs and/or medicine costs
and/or investigation costs and/or operation costs. Costs are covered for patients only
or both patients and a caregiver.
3
The disability-adjusted life year (DALY) is a measure of overall disease
burden, expressed as the number of years lost due to ill-health, disability or early
death.
4
Myanmar GDP per capita varies from $800 to $2,000 according to
various sources. The most common approach for cost-effectiveness, promoted by the
World Health Organizations Choosing Interventions that are CostEffective (WHOCHOICE) project, involves the use of thresholds based on per capita gross domestic
product (GDP) : an intervention that, per disability-adjusted life-year (DALY) avoided,
costs less than three times the national annual GDP per capita is considered cost
effective, whereas one that costs less than once the national annual GDP per capita is
considered highly costeffective. But see also: Elliot Marseille,a Bruce Larson,b Dhruv
S Kazi,c James G Kahnd & Sydney Rosenb, Thresholds for the costeffectiveness of
interventions: alternative approaches, Bull World Health Organ 2015;93:118124
24
TABLE 6: REFERRALS AND COST FACTORS IN

SIX TOWNSHIPS OF AYEYARWADY FOR 2014
Ayeyarwady 2014 (six townships)
Total population
1,788,340
Maternal referrals (MR)
6,982
Under five referrals (<5)
4,185
US$
484,087
Direct cost for under five referrals (actual

US$
expenditure 2014)
231,457
Direct cost for maternal referrals (actual

expenditure 2014)
Average cost per referral (direct cost)
US$
64
Average cost per capita (direct cost)
US$
0.4
Total actual expenditure 2014
US$
6,669,255
FIGURE 8: PLANNED AND ACTUAL UNIT

COSTS FOR MATERNAL EMERGENCY
REFERRALS
Budgetted costs
$209
Actual unit costs
$148
$108
$102
$69
Ayeyarwady
$69
Magway
Chin
FIGURE 9: PLANNED AND ACTUAL UNIT

COSTS FOR CHILD EMERGENCY REFERRALS
Budgetted costs
$209
Actual unit costs
$148
$108
$102
$69
Ayeyarwady
$69
Magway
Chin
referral approach brings out the importance of having

interventions at both sides of the health system: supply
and demand side. In terms of effectiveness, one cannot go
without the other.
Data analysis for planning and budgeting
The implementing partners report to the 3MDG Fund
management office on the quantities delivered and actual
costs of a number of important services, such as referrals
and outreach sessions supported. This allows the 3MDG
Fund management office to calculate the actual unit costs
for different types of referrals as well as routine and hard
to reach outreach sessions.
An analysis revealed that many partners achieved their
intended targets while underspending their budgets. This
leads to the conclusion that referral costs and to a lesser
extent outreach costs were systematically budgeted too
high.
CHALLENGES AND LESSONS LEARNED

A harmonization of the different approaches and tools

used for township health planning is needed. The
Ministry of Health has taken leadership and plans to
steer the development of a unified process and set of
tools.
The township health departments still rely on the

implementing partners for some aspects of planning
and support to implementing routine activities. There
is a need for a transition towards greater involvement
of the township health departments in managing all
aspects of the township health system.
The situation in some conflict-affected areas changes

very quickly. This requires flexible arrangements in the
budgets and work plans. The fund management office
will identify appropriate approaches with the partners
that are contracted in Kayah and Shan states.
This finding will be used to guide the planning process for

budget amendments to be undertaken for 2015.
TABLE 7: MATERNAL, NEWBORN AND CHILD HEALTH MONITORING AND QUALITY

ASSURANCE MEASURES
The 3MDG programme monitoring assessment and routine data quality assurance provide a framework to assess standard benchmarks of programme and data quality of implementing partners at the community level. The following is a summary of key findings and recommendations from 2014.
Programme monitoring assessment

Findings
Recommendations
Routine data quality assurance
In townships where the programme is still in the early

phase, activities were delayed.
Some townships received referral support from other
programmes as well which had different eligibility
criteria and different costs.
In the 3MDG supported townships unit costs for
referral cases were set very high and the actual cost
was lower.
Limited availability of trainers led to large numbers of
participants per training.
Some activities were not properly documented and
follow up actions of meetings/supervision visits were
not always taken.
Realistic planning and budgeting based on past actual

cost is recommended.
Coordination among different programmes and stakeholders is essential in order to share responsibility and
tasks in the township.
It is important to apply only one rate for referral reimbursement in the township to avoid confusion in the
community.
The 3MDG referral guideline and standard operation
procedure including reimbursable cost should be
shared among different stakeholders.
Under the leadership of the health authorities, ways
to improve the quality of training and other activities
should be explored.
Common data challenges were due to data entry errors, discrepancies between reported data and source documents,
lack of proper guidelines for M&E focal points in some
townships, and limited sharing of information between
headquarters and field offices. Limited data management
training for township M&E staff.
Lack of standard forms for volunteers at community level
led to data inconsistencies and discrepancies when reporting.
The 3MDG fund management office is only able to conduct
data quality assurance assessments on community based
programmes.
Further training on the 3MDG MNCH indicator definitions

is needed.
Further develop capacity for partner M&E focal points in
field offices.
Proper data management needs to be practiced. The fund
management office suggests keeping source documents
and checking data regularly with programme and M&E
staff.
Written data management guidelines from partner headquarters to field offices is necessary.
Standardized community-based reporting system was
developed in 2014 and should be implemented in 2015.
Proper documentation of feedback provided should be in
place for easy referencing, audit purposes and for new staff.
25
PATIENTS WAITING FOR A FREE SCREENING AT A MOBILE OUTREACH FOR TB ACTIVE CASE FINDING / 3MDG
26
HIV, TB & MALARIA

Introduction
BENEFICIARY PROFILE POOR,

UNDERSERVED AND DIFFICULT TO REACH
3MDG funds partners that provide HIV, tuberculosis (TB)

and malaria related services to mostly disadvantaged
people, often in hard-to-reach, rural and urban slum areas
across Myanmar.
These partners also provide harm reduction services
for people who inject drugs - a population with diverse
ethnic, religious and social backgrounds in project areas
characterized by conflict and high physical vulnerability,
including gold prospecting and jade mining sites.
Mobile team operations carry out active case finding
and are reaching poor, underserved and marginalized
communities living in slums and remote areas, industrial
zones, mining areas, prisons and migrant construction
sites. National prevalence surveys from 2010 showed
exceptionally high TB prevalence in urban slum areas.
3MDG implementing partners also engage with local
non-state actors and community-based organizations
to provide malaria, TB and harm reduction services in
the non-state and mountainous areas in Kokang SelfAdministered Region, Kayin, Kachin and Kayah areas.
These reach internally displaced persons in conflictaffected ceasefire zones, vulnerable mobile populations,
and forest dwellers with little or no access to health
facilities.
CONTRIBUTING TO NATIONAL STRATEGIES

3MDG directly engages with the three national disease
control programmes in all aspects of partner selection,
coordination and management as well as programme
development and implementation in strategic priority
areas not covered by current Global Fund grants.
INTEGRATING RESPONSES TO THE THREE

DISEASES
3MDG expects partners to provide integrated health

care packages to beneficiaries instead of running vertical
disease control programmes. Integrated health care
services for HIV, TB and malaria are sensible when the
priority populations include underserved, difficult-to-reach
and remote communities in resource-limited settings.
This means that several 3MDG partners provide integrated

services including TB plus malaria or TB plus malaria plus
HIV harm reduction.
In mid-2014, 3MDG supported Ministry of Health
leadership of two joint scoping missions to Wa Region,
Shan Special Region 4 and Kokang Self-Administered
Region. Currently, 3MDG is in the process of developing
a proposal to implement an integrated MNCH primary
health care programme that also includes HIV prevention,
malaria surveillance and TB diagnosis and treatment.
In 2014, 3MDG contributed to health system

strengthening by focusing on harmonization and
coordination of multi donor activities through national
disease control programmes.
3MDG also channelled funds to national disease
programmes by using the managed cash flow system
supported by UNOPS. This strengthens the government
workers understanding of financial accountability, risk and
control and helps prepare the public system for receiving
funds directly from international donors.
INFORM EVIDENCE BASE FOR POLICY AND

NATIONAL STRATEGIES
3MDG supports activities contributing to the evidence
base for the development of policy and national strategies.
3MDG and the Presidents Malaria Initiative plan to cofund the Malaria Consortium to conduct a nationwide
malaria indicator survey in 2015.
This survey should provide information, such as malaria
prevalence data, that is crucial for the programming of
the artemisinin resistant malaria containment programme
and moving to pre-elimination of Plasmodium falciparum
malaria.
Similarly, 3MDG is in discussion with the National
TB Programme to support the strengthening of data
management for MDR-TB patient support. This will
strengthen the programmes capacity to detect, diagnose
and manage the timely treatment of MDR-TB.
27
DESTROYING USED NEEDLES AND SYRINGES NEAR MANDALAY / MYANMAR ANTI NARCOTICS ASSOCIATION
28
HIV
TABLE 8: HIV RESULTS AND TARGETS 2014
People who inject drugs
reached by prevention
programmes

distributed

given voluntary confidential
counselling and testing for
HIV
2014 achievements
26,661
6,956,394
5,950
Project-to-date achievements
(2013-2014)
26,661
12,701,591
5,950
Project-to-date target
(2013-2014)
25,000
15,800,000
5,306
2014 was a mixed experience of positive changes and

increasing challenges for 3MDGs HIV harm reduction
partners. The year started with encouraging additional
support from the Government for harm reduction in
the form of supplementary funding from the Ministry of
Health for methadone for opioid substitution therapy and
the active engagement of the Ministry of Home Affairs
in the review process of legal barriers for harm reduction
services. However, the continuing war on drugs campaign,
along with escalating negative reactions of some faithbased organizations towards people who use drugs, made
it harder for the people who need harm reduction services
to hear about and access them.
Within this changing context, 3MDG implementing
partners are working together through the national
coordination mechanisms1 to create a more effective
and supportive enabling environment addressing
policy, legal and social barriers in order to expand and
improve HIV prevention for people who inject drugs.
UNAIDS is funded to work more comprehensively on the
improvement of this enabling environment. This will be
achieved by increasing understanding of the context of
vulnerability through the preparation of situation reports
on key affected populations (people who use and inject
drugs, men who have sex with men and female sex
workers); the promotion of policy initiatives and legal
reform, and the training of law enforcement officers.
KEY DEVELOPMENTS
One of the most significant developments in 2014 was

the review of legal barriers to remove some of the major
obstacles to harm reduction interventions. With the active
involvement of different partners including members of
national coordination bodies and international experts,
the Coordinating Committee for Drug Abuse Control
under the Ministry of Home Affairs led a collective review
of the 1993 Narcotic Drugs and Psychotropic Substance
1
The TWG Harm Reduction and the TSG HIV membership includes the
Ministry of Health: National AIDS Program, Drug Treatment Centres; Ministry of Home
Affairs: Coordinating Committee for Drug Abuse Control; UNAIDS, UNODC, WHO
INGOs and NNGOs. Donors including 3MDG - are also members of the Expanded
TSG HIV.
Law which requires mandatory registration for drug

treatment. A legal review workshop will be organized in
early 2015 to draft a bill to amend the 1993 law.
An in-service training curriculum on drug use and HIV
was developed to strengthen the critical role of law
enforcement in public health. A local organization
conducted the training for police and staff from the
General Administration Department at state and regional
levels in 2014.
Another development in 2014 was the introduction of
the one-stop service model in five townships with 3MDGfunded harm reduction partners and one township
supported by the Global Fund. The Drug Treatment Centre
and the Coordinating Committee for Drug Abuse Control
organized community - based harm reduction treatment,
where as many services as possible are offered under
one roof, adopting a one-stop-shop model and closer
coordination between drug treatment centres and dropin-centres for people who inject drugs.
PROGRESS
In 2014, there was a significant scale-up in harm reduction

services through 3MDG implementing partners. During
2014, an additional 16 service delivery points were
launched, making a total of 35 delivery points (dropin centres and mobile clinics) across 27 out of 36 harm
reduction townships. The Asian Harm Reduction Network
(AHRN), the Myanmar Anti-Narcotics Association
(MANA) and the Substance Abuse Research Association
(SARA) continued to provide and scale-up services
and a new partner, the Burnet Institute, started service
provision in April 2014. Full service implementation by
the United Nations Office on Drugs and Crime (UNODC)
started in October 2014. Overall budget utilization for
implementation for all partners reached 81% of the 2014
approved budget.
A total of 26,661 people who inject drugs benefitted from
HIV prevention and harm reduction services through dropin-centres, community outreach and mobile activities,
reaching 107% of 3MDGs target and contributing 44% to
the annual national target.
29
The number of sterile needles and syringes distributed to

people who inject drugs increased from 5.7 million in 2013
to 6.9 million in 2014, which is 35% of the national target.
An average of 260 needles and syringes were distributed
per client in 2014. Harm reduction services were upgraded,
for example through the expansion of services to include
testing and vaccines for Hepatitis B, and testing for HIV in
drop-in-centres, Hepatitis C testing and increased referral
for TB screening and treatment.
In 2014, the 3MDG Fund supported efforts by UNAIDS to
create an enabling environment for prevention, treatment
and care services to key affected populations. This
addressed barriers arising from Myanmars current policy
and legal frameworks and its social context.
The planned project activities for 2014 were fully
implemented and made a number of key contributions
to national HIV prevention work. UNAIDS conducted
three situation assessments on key affected populations
including people who use and inject drugs, sex workers,
and men who have sex with men, to identify programmatic
gaps and priority actions. To address policy barriers to
harm reduction, a collective legal review of the 1993
Narcotic Drugs and Psychotropic Substances Law was
initiated in collaboration with the Ministry of Home Affairs,
the Ministry of Health and international and national
partners.
Engagement with the law enforcement sector was
strengthened in 2014 through the development of
training curriculum on drug use and HIV and provision of
training for police and staff from general administrative
departments.
FIGURE 10: JAN-DEC 2014 HIV SERVICES ACHIEVED VERSUS TARGETS

107%
102%
95%
100%
87%
87%
85%
65%
35% of
national
target
44% of
national
target
30
26,661
14,761
786
6,956
8,181
412
1,000
PWID
reached
PWUD
reached
Condoms
distributed
(thousands)
Needles
distributed
(thousands)
VCCT tested
and know
results
STI tested
Methadone
FIGURE 11: NEEDLE DISTRIBUTION AND PEOPLE WHO INJECT DRUGS REACHED BY SERVICES
IN 2013 AND 2014
120%
26,661
100%
18,934
80%
6,956,394
Needle distributed
PWID Reached
5,745,197
60%
40%
20%
0%
2013
2014
VOICES
When I was a drug user I stole a lot of goods without letting my family and my parents know about it. My life was an
absolute hardship, and I started to face isolation by my family and my neighbourhood. To overcome this misery, with the
help of Myanmar Anti-Narcotics Association, I started taking methadone liquid. Since then, my fitness has improved and
my drug use has significantly reduced. Now I no longer need to worry about my health. I can now work properly and am
not concerned with money. I am able to sleep soundly. Moreover, I am now accepted by my community and have gained
back their trust. Anonymous
31
A SUN DOCTOR EXPLAINS TO AN STI PATIENT ABOUT CONDOM USE / POPULATION SERVICES INTERNATIONAL
32
CHALLENGES
There were increased police crackdowns, armed conflict

and negative reactions from faith-based organizations
towards people who use and inject drugs reported in
Kachin State and Shan North.
This significantly affected implementing partners, making
it more difficult for them to reach out to clients, as well
as creating obstacles in the daily lives of people who use
drugs and their access to harm reduction services.
PLANNED ACTIVITIES
Through advocacy and sensitization efforts, agreement

was reached to enable 3MDG to fund Population Services
International during 2015/16 for the pilot distribution of
syringes that reduce disease transmission (low dead space
syringes) through community-based outlets.
HIV MONITORING AND QUALITY ASSURANCE

The 3MDG rapid service quality assessment and routine
data quality assurance provide a framework to assess
standard benchmarks of programme and data quality of
implementing partners at the community level.
PHOTOS (top to bottom)- Methadone dispensation by Township Medical Officer

on the opening day of Lonekhin MMT Site, Kachin State (source: MANA); Targeted
Information, education and behaviour change communication session provided at
MANA Drop-In-Center, Kyaukme Township, Shan State (source: MANA)
TABLE 9: HIV MONITORING AND QUALITY ASSURANCE MEASURES
The 3MDG programme monitoring assessment and routine data quality assurance provide a framework to assess standard benchmarks of programme and data quality of implementing partners at the community level. The following is a summary of key findings and recommendations from 2014.
Rapid service quality assesment
Recommendations
Findings
HIV counselling and on-site testing services are now

available as a result of good collaboration with the
National AIDS Programme (NAP) leading to reduced
patient waiting times.
Strengthened referral linkage with NAP for
confirmation of HIV results and anti-retroviral
treatment (ART) initiation had been expanded.
Hold regular coordination meetings and sharing

information for strengthening implementation.
Implementing partners should regularly conduct
advocacy and community education about harm
reduction activities.
In some of the service delivery points, source documents and

reporting forms were not kept systematically for auditing
purposes.
There was inconsistent understanding among outreach
workers on data collection definitions and completing the
forms to ensure consistent reporting.
Share and implement indicator definitions at all levels.

Ensure availability of all source documents during assessment
visits.
Establish a recording and reporting system to avoid double
counting among service providers where there are shared
service delivery areas.
33
REGISTERING PATIENTS DURING TB ACTIVE CASE FINDING MOBILE OUTREACH IN YANGON / 3MDG
34
TUBERCULOSIS
TABLE 10: TB RESULTS AND TARGETS 2014
People screened for
TB by 3MDG-funded
activities
Notified cases for TB

treatment (all forms)
Number of MDR-TB
patients supported
Number of referrals
to TB Departments
by Community Health
Workers/Volunteers
2014 achievements
50,294
4,262
372
9,912
Project-to-date targets
(2014)
383,848
14,147
524
25,187
Most 3MDG implementing partners were only able to

start implementation in the last quarter of the year,
thus meeting 25% of the target reflects a successful
achievement. The delayed start was due to the signing
of contracts in April and significant time required to clear
customs and to deliver the project start up equipment and
materials to project sites.
KEY DEVELOPMENTS
From the target of 384,000 TB suspected cases to be

examined, a total of 50,294 suspected TB cases were
screened, within which 4,262 TB cases were detected and
offered voluntary confidential counselling and testing for
HIV.
Coordination
With 3MDGs support, the national programme also
focused on coordinating programme development
with the newly selected implementing partners. This
contributed to NTP ownership and responsibility for
programme planning and implementation.
Confirmed TB cases were treated by the National TB

Programme and partners. Trained community volunteers
provided directly observed treatment (DOT) every day to
ensure that patients stayed the course until cured.
FIGURE 12: 2014 ACHIEVEMENT OF 3MDG

FUNDED ACTIVE TB CASE FINDING
PROGRAMME
16000
Target
14000
Achievement
12000
In 2014, the major objective for 3MDG support to the

National TB Programme (NTP) was to find hidden or
unidentified TB cases in the community by using active
case finding strategies and screening for multi-drug
resistant tuberculosis (MDR-TB) among newly diagnosed
cases.
Another key mechanism to support coordination was the

establishment of nine mobile teams jointly with the NTP
and six other partners, based in seven states and regions.
This field operation is led by NTP regional TB officers who
provide technical guidance and supervise the performance
of other mobile team members.
Multi-drug resistant tuberculosis (MDR-TB)
A funding gap of $19 million in the national response to
MDR-TB was identified, and in March 2014 the 3MDG
Fund Board agreed to cover this gap. The Funds MDR-TB
grant has four major components:
1.
10000
8000
6000
30%
4000
30%
25%
2000
25%
0
All forms TB
Bacteriological
confirmed TB
The procurement of second line TB drugs for the 20

month course of treatment and also for the shorter
course treatment and operational research.
2. The renovation and construction of MDR-TB facilities
in Yangon and Mandalay.
3. The strengthening of data management in support of
patient case management and national coordination
of enrolment and treatment.
4. The provision of patient care and support and
directly observed treatment (DOT) to patients
for the completion of MDR-TB treatment without
interruption.
With this $19 million in funding support 3MDG partners
will be able to treat 2,200 new MDR-TB patients from 56
townships in Yangon and Mandalay regions, providing
services including nutrition and transportation support.
35
Context and policy environment

A joint monitoring mission of WHO external experts and
NTP and national technical experts was conducted in
December 2014 to assess current TB care and prevention
activities. The mission found that TB control in Myanmar
has good foundations and the strong NTP is highly
regarded nationally and internationally.
3MDG is fully aligned with these goals by expanding
NTP staffing, strengthening NTP-led case detection, and
adding resources to support the management and scale
up of MDR-TB patient enrolment, treatment and support.
PROGRESS
By effectively implementing active case finding through

mobile teams led by the NTP and other partners, 3MDG
support helped to detect hidden or undiagnosed TB
cases. The mobile teams operate in the evenings to reach
workers who cannot go to health centres during standard
operating hours. According to the last national TB
prevalence surveys conducted in 2009 and 2010, TB cases
are exceptionally high in urban slum areas compared to
rural areas.
Therefore, the NTP and partners prioritized identifying
more TB cases among the urban poor population in 100
townships, of which 53 are larger urban cities where most
urban slum populations live in crowded conditions which
favour the transmission of TB.
In 2014, the NTP conducted 43 mobile team activities and
detected and provided treatment to 969 confirmed TB
cases. A total of 20,167 suspected TB cases were screened
and approximately 24,000 people were reached by the
mobile teams.
In December 2014, the NTP also organized their first
mobile team outreach to mine workers in Namtu
Baw Twinn in Northern Shan State, another high risk
population in a remote workplace, where they screened
approximately 600 suspected TB cases and identified 28
cases.
Although the number of confirmed TB cases was not
high, it provided justification to reassess living conditions
provided for mine workers, which should also serve as
a guide to other mine sites. The NTP may need to restrategize mobile team approaches to mine sites and
plan to include smaller and medium sized mine sites
with substandard living conditions, and prioritize other
risk groups such as diabetes patients, elderly people and
chronic smokers.
CHALLENGES

PHOTO (top to bottom)- Health workers talk patients through their upcoming
treatment. Mobile teams provide prompt treatment; TB mobile team screening
prisoners in Lashio prison, Northern Shan State; Success of TB mobile team in
Northern Shan State (All images 3MDG).
36
TB active case finding issues related to new project

start up and the need to wait for procured equipment
and vehicles to arrive delayed full operation of the
mobile teams in 2014.
MDR-TB The National TB Programme developed
an MDR-TB scale up plan to provide diagnosis and
treatment to an additional 4,000 patients in 2015,
reaching 4,400 in 2016 with the additional funding
from 3MDG ($19 million) and the Global Fund ($18.6
million). The funds have agreed to complement each
other by sharing coverage, with 3MDG providing
support to MDR-TB patients in Yangon and Mandalay
regions, and through standardization of the incentive
scheme for the patient support providers and
volunteers. Harmonization of the rapid scale up
with two separate funders is a significant challenge
for NTP. This is also a big challenge for the 3MDG
fund management office to ensure and monitor
national targets during the implementation period
and requires close coordination with the Global Fund
principal recipients.
TABLE 11: TB MONITORING AND QUALITY ASSURANCE MEASURES
The 3MDG rapid service quality assessment and routine data quality assurance provide a framework to assess standard benchmarks of programme and data quality of implementing partners at the community level. The following is a summary of key findings and recommendations from 2014.
Recommendations
Findings

Opportunities to expand the availability of human

resources and infrastructure within the health
facilities.
Data recording and reporting system are not yet standardized

as the projects are newly established.
New health facilities should be built and some

existing ones refurbished.
3MDG should provide human resources support to
mobile active case finding services in remote areas.
Capacity of health care workers should be
strengthened to provide services through training
and mentorship.
Written guideline for reporting system and data management

system should be available for all levels.
Supportive supervision and regular monitoring need to
happen to strengthen the data management system across
all levels.
VOICES
Ma Lay Lay Khaing*, a 28-year-old textile worker living with her family in Dagon East township, Yangon Region, was
diagnosed with TB three years ago. After her first treatment failed she was confirmed to have MDR-TB. Following rigorous counselling and with the support from trained Basic Health Staff, she received the difficult retreatment regimen
on ambulatory basis near her house. During the first few months, she had to visit Aung San Hospital once a week. The
local midwife acted as DOT provider and motivated her to take the drugs twice a day. After four months of treatment,
bacilli could no longer be detected in her sputum. She has now completed more than one year of treatment. Although
she had to give up her work in the textile factory, she has regained much of her strength, allowing her to cook and do
the household work for her family. She says she really appreciated the support of her family as well as the kindness and
professionalism of the health care providers.
* Ma Lay Lay Khaing is a pseudonym
37
MOSQUITO NET DISTRIBUTION IN MANSI TOWNSHIP, KACHIN / COMMUNITY PARTNERS INTERNATIONAL
38
MALARIA
TABLE 12: MALARIA RESULTS AND TARGETS 2014
Number of people
tested for malaria
Number of people treated

for confirmed malaria
Number of confirmed malaria treated

within 24 hours of onset of fever
2014 achievements
469,714
29,530
15,729
Project to date
achievements (2013-2014
1,038,176
109,482
50,191
3MDG target (2013-2014)
NA
300,000
103,300
3MDGs malaria response went through a transition

period in 2014, with the phasing out of the previous
3DF-supported Myanmar Artemisinin Resistance
Containment (MARC) response, and the beginning of the
3MDG supported national MARC response. The focus
shifted towards the early diagnosis of malaria cases and
helping confirmed malaria cases to get effective and rapid
Artemisinin-based Combination Therapy (ACT) treatment.
This was done by expanding the areas served by the
trained volunteer network and health care providers at the
community level.
As the Global Fund had committed to increase its
long lasting insecticide-treated nets (LLIN) coverage
significantly in all high-risk areas, 3MDG significantly
reduced funding for the distribution of LLINs.
Approximately 133,000 LLINs were still distributed
to mobile migrant populations and marginalized
communities who live in conflict-affected areas, through
local community-based organizations.
A total of 2,899 volunteers were trained by partners who
equipped them with malaria Rapid Diagnostic Tests
(RDTs) and ACT kits.
Around 300 volunteers were trained to reach migrant
populations, including peer migrant workers who
volunteered their time to provide malaria diagnoses
and treatment services for their community. However,
recruiting volunteers among the mobile migrant
population was a challenge for implementing partners as
their mobility results in a high attrition rate.
3MDG partners provide a transportation subsidy to these
volunteers to effectively carry out their work. As a result,
partners achieved over 90% of their targets for testing
malaria with RDTs (a total of 469,714 tests were carried
out). However, malaria incidence is declining in the entire
country due to the collective effort of the National Malaria
Control Programme (NMCP) and partners.
FIGURE 13: MALARIA ACHIEVEMENT TREND

FOR 2013 AND 2014 (LLIN DISTRIBUTED)
900000
80%
LLIN Distributed
800000
RDT (Taken and read)
700000
600000
Pf + Pv treated
83%
97%
500000
400000
300000
200000
41%
100000
31%
28%
Achievement 2013
Achievement 2014
FIGURE 14: NUMBER OF MALARIA TESTS,

MALARIA CASE TREATED AND POSITIVITY
RATES IN THE 52 3MDG AND GLOBAL FUND
REGIONAL ARTEMISININ-RESISTANCE
INITIATIVE (GF RAI) SUPPORTED MARC
TOWNSHIPS IN 2014
469,714
500,000
Tested
Treated
400,000
325,369
300,000
200,000
Positivity
7%
Positivity (6%)
Positivity
6%
100,000
23,701
GF RAI 2014
29,530
3MDG 2014
Consequently the malaria test positivity rate among

tested cases was 6% in 2014, declining from 14% in 2013.
A similar trend was also observed in the Global Fund
achievements in 2014.
39
VOICES
Saw Kyaw Htoo Win is a carpenter who migrated to Kaw Kat Village,
Mon State. Two years ago, a World Concern field officer came and
explained the causes, signs, prevention and treatment of malaria,
he said. Thats why when I fell sick, I went to him and received
rapid blood tests. Saw Kyaw Htoo Win was diagnosed with cerebral
malaria and hospitalized for four days.
World Concern supported me not only with transport and hospital
charges but also provided moral support during my hospital stay. I
had no idea what to do when I suspected malaria before. It made a
huge difference for me to attend the health education session.
A SUN DOCTOR CONDUCTS A RAPID MALARIA TEST / POPULATION SERVICES INTERNATIONAL
40
KEY DEVELOPMENTS
In 2014, 3MDG agreed to collaborate with the U.S.

Presidents Malaria Initiative, which is being implemented
by USAID (USAID-PMI), to jointly fund the planned
nationwide malaria indicator survey to assess malaria
prevalence in Myanmar. This is an essential step to move
forward towards the pre-elimination of Plasmodium
falciparum and the containment of drug resistant malaria.
The Malaria Consortium was selected to conduct this
survey in collaboration with NMCP and the Department of
Medical Research. The first taskforce meeting was held in
December 2014. This survey will be conducted in mid-2015
before the start of the malaria season and the findings will
be available in early 2016.
PROGRAMMATIC FOCUS
In 2014, 3MDG supported complementary activities to

the national response to contain drug-resistant malaria in
priority Tier 1 and Tier 21 areas, located in the southeast of
Myanmar. The 3MDG Fund concentrated on areas where
the Global Fund had limited access (e.g. areas under
the management of non-state actors) by engaging with
informal healthcare providers and local religious networks.
CHALLENGES
Engagement with the private sector remained challenging.

There are many business types run by different sized
companies that employ thousands of migrant workers,
with only some companies providing basic health care
for their workers and malaria is major illness among the
migrant population.
PLANNED ACTIVITIES
There have been informal indications that MARC priority

Tier 2 areas might be significantly expanded beyond the
52 townships to most of the malaria endemic townships of
Myanmar to prevent the spread of drug resistant malaria.
If this occurs, re-programming will be a likely priority focus
of 3MDG in 2015, supported by the cost-effectiveness
research being carried out by Mahidol Oxford in the 52
MARC townships.
The 3MDG Fund worked closely with national bodies

and international partners to select new implementing
partners and then to conduct a highly consultative joint
planning process for upcoming work. Since the prioritized
Tier 1 area and Tier 2 area are small, with only 52
townships where many partners are working, the detailed
and coordinated planning was a significant achievement
to ensure harmonious delivery without overlap.
1
Tier 1 area: where there is strong evidence of suspected resistance; widespread ecological and social risk factors; intensive population movement; Tier 2 area:
where there is unclear evidence of suspected resistance; near suspected resistance
areas in Myanmar, Thailand and China
PHOTO LLIN distribution at a village covered by The Karen Department of Health and
Welfare (Source: Community Partners International)
TABLE 13: MALARIA, MONITORING AND QUALITY ASSURANCE MEASURES
The 3MDG rapid service quality assessment and routine data quality assurance provide a framework to assess standard benchmarks of programme and data quality of implementing partners at the community level. The following is a summary of key findings and recommendations from 2014.
Recommendations
Findings
There is need to strengthen partner supply chain

management and drug storage system.
Generally, diagnosis and treatment with ACT +PQ
are according to the guidelines with some exceptions
noted.
Township level coordination is a gap in some
new implementing partners and this led to area
overlapping in some townships.
Partners monitoring systems should be

strengthened to monitor the quality of service
provided by village workers.
Partners need to participate in state and region level
malaria coordination meetings.
Timely reporting, availability and accuracy of data remain

a challenge for community-based local partners and some
INGOs.
Data management system is still a gap between service
delivery level and central level by having lack of feedback
system and lack of written guidelines for service providers
Written guidelines for service providers outlining data
management and feedback between the service delivery
points and central level are needed.
Written guideline for reporting system and data management
system should be available for all levels.
Supportive supervision and regular monitoring need to
happen for strengthening the data management system
across all levels.
41
MIDWIFERY TASK ANALYSIS WORKSHOP FACILITATED BY JHPIEGO / 3MDG
42

KEY DEVELOPMENTS IN 2014

First Myanmar national supply chain baseline assessment completed

Supply chain strengthening agreement prepared for Magway, Bago, and Ayeyarwaddy regions
Analytical work on how to engage with the private health sector conducted
Seminars on health financing and universal health coverage conducted for the Ministry of Health,
Ministry of Finance, and development partners
$15 million agreement to strengthen health facility infrastructure across Myanmar signed
First Myanmar Health Systems in Transition (HiT) report produced and released
$20.7 million agreement to support the Joint UN Programme (WHO, UNICEF, UNFPA, UNAIDS) on
health systems strengthening
$10 million contract with Jhpiego signed and activities commenced to support midwifery schools
Financial support provided for Ministry of Health staff to pursue Master of Public Health degrees in
the Netherlands
The health sector in Myanmar continues to evolve rapidly.

The Government has committed to achieve universal
health coverage as part of its Vision 2030, defined as the
provision of optimal quality of health care to everyone
in the country that is accessible, efficient, equitably
distributed, adequately funded, fairly financed, and
appropriately used by an informed and empowered
public1.
Towards this goal, there has also been a sharp increase
in investments in health. General government health
expenditure as a portion of Gross Domestic Product (GDP)
was 0.2-0.3% between 2001 and 2011. Increased political
commitment for health resulted in an increase to 0.8% in
the fiscal year 2012-20132. Health expenditure per capita
was 1589 Kyats in 2011, and increased to 7237 Kyats by
20123.
Despite the increased health budget, structural challenges
persist and out-of-pocket payments remain the major
source of funding. External assistance will continue to
play a role, as new actors and new sources of funding
have proliferated recently. In 2014, the World Bank
pledged $200 million from the International Development
Association (IDA) to accelerate progress towards universal
health coverage, including approval of a $100 million
Essential Health Services Access Project. The 3MDG Fund
has a growing portfolio of health systems strengthening
grants, and other development partners are also active in
the area.
Much has changed since the 3MDG Fund was established,
and there are now increased opportunities for more
effective development cooperation and closer partnership
1
Ministry of Health, 2014. Strategic Directions for Universal Health Coverage: Myanmar.
2
Asia Pacific Observatory on Health Systems and Policies, 2015. The
Republic of the Union of Myanmar Health System Review.
3
Ministry of Health, Health Statistics 2014
with the Government of Myanmar. In 2013, the Nay Pyi

Taw Accord was endorsed, and Myanmar became a
signatory of the International Health Partnership and
related initiatives (IHP+) Global Compact a year later. An
expanded set of Technical Strategy Groups (TSGs) have
also been established to support the Myanmar Health
Sector Coordinating Committee (M-HSCC).
STRATEGIC DIRECTIONS FOR UNIVERSAL

HEALTH COVERAGE
In support of the Government of Myanmars commitment
to the goal of universal health coverage, the Ministry of
Health developed and presented its Strategic Directions
for Universal Health Coverage Myanmar. Whilst the
primary purpose is to outline the Ministry of Healths
strategic directions for the coming years, a secondary
purpose is to provide donors with clarity around Ministry
of Health priorities, which can then be supported through
external financing instruments such as the 3MDG Fund.
Figure 15 represents the Ministry of Healths priorities

and how these priorities contribute to improved health
outcomes, consumer satisfaction, and financial protection.
In 2014, significant effort went into planning how 3MDGs
resources can be most usefully aligned to support these
priorities.
PROGRESS
3MDG programmes under the health systems

strengthening component seek to advance governance
and stewardship, thereby strengthening the health system
and informing evidence-based policy to increase coverage
of quality health services, particularly among poor and
vulnerable populations. A strong health system is critical
for sustainable progress on health outcomes.
In 2014, through improved relationships with the Ministry
of Health, there was an agreement on broad areas of
focus for this work. Within these areas, programmes were
developed, prepared and established.
43
FIGURE 15: MINISTRY OF HEALTHS PRIORITIES FOR UNIVERSAL HEALTH COVERAGE

Improved
Health
Essential Health
Package
Health
Workforce
Consumer
Satisfaction
Essential Medicines
and Technologies
Financial
Protection
Public-Private
Partnerships
Community
Engagement
Health Financing and

Risk Pooling
Evidence Based
Information and HSS
Policies for
Health
Governance and
Stewardship
GOVERNANCE AND STEWARDSHIP
Ministry of Health stewardship

As part of the Joint UN Programme on Health Systems
Strengthening, 3MDG supported UNAIDS as the
Secretariat of the Myanmar Health Sector Coordinating
Committee (M-HSCC), the national coordinating body for
all public health sector issues. UNAIDS work under the
Joint UN Programme involves supporting the Ministry
in organizing annual health forums as well as helping
with the management and coordination of Technical and
Strategy Groups (TSGs)4 under the M-HSCC. In addition,
a communications strategy has been planned for the
M-HSCC and TSGs, which includes capacity strengthening
for the Ministry of Health to engage with the media. In
2014, UNAIDS supported a series of pre-planning and
preparatory activities including the first annual health
forum to take place in 2015.
Strengthening public financial management
Through a grant to the World Bank, 3MDG is supporting
the Ministry of Health to strengthen public financial
management in the health sector. This involves the
management of public funds throughout the budget cycle
and aims to improve fiscal discipline, strategic resource
allocation, and efficient use of resources for service
delivery. To date, the focus has been on documenting and
highlighting how existing financial rules and regulations
impede service delivery. The World Bank drafted a report
that describes how current rules and regulations on
budgetary authorization and travel reimbursement affect
service delivery at the township level. Stemming from
the assessment and ongoing dialogue with the ministry,
several areas of public financial management reform have
been identified. They include: resource allocation, capital
4
There are seven TSGs under M-HSCC: AIDS; TB; Malaria; MNCH and RH
including family planning; M&E and Research; Health Systems Strengthening; and
Public Health Emergency and Disaster Preparedness
44
and asset classification and management, budgetary

approval process and procurement rules. The World Bank
health team worked closely with the Ministry of Health
and Ministry of Finance to identify priorities and facilitated
inter-ministerial dialogue on issues related to planning,
budget allocation, budget executing and tracking.
Technical training courses
With 3MDG funding, the World Bank provided a series
of technical training courses on health financing to
share evidence from other countries and to promote a
common understanding of priorities for Myanmar to move
towards universal health coverage. These have included
seminars and learning sessions on health financing,
health insurance and universal health coverage with the
ministries of health, labour, social welfare and finance in
Nay Pyi Taw.
In 2014, the World Bank facilitated high level ministerial
participation in the Global Flagship Course in Washington,
D.C., and the participation of non-governmental
organizations in an Asia Regional Flagship course on
health systems strengthening and sustainable financing
for universal health coverage in Bangkok. The high level
delegation to Washington, D.C. included deputy ministers
of finance and health amongst other senior officials. At
the end of the course, the Myanmar delegation proposed
a road map to move towards universal health coverage.
In additional to technical training, these courses provided
a forum for interaction and knowledge sharing with peers
and experts.
To further strengthen existing capacity within the Ministry
of Health, 3MDG provided academic scholarships for
four Ministry of Health staff to participate in a Master
of Public Health at the Royal Tropical Institute in the
Netherlands for the 2014-15 academic year. This support
was formulated in close collaboration with the Ministry of

Health.
SUPPORTING EVIDENCE-BASED POLICY
To support the Ministry of Health in developing and

implementing policies, strategies and plans based on
sound and up-to-date evidence, 3MDG funded various
analyses of the health system.
Health financing policy for universal health coverage
The World Bank, with 3MDG support, is undertaking
analytical work and collating evidence from other
countries to inform the design of a health financing policy
for universal health coverage, with a particular focus on
expanding financial risk protection. This is an important
priority given the high out-of-pocket expenditure for
health care in the country. Based on the analysis, World
Bank experts produced a briefing for the Ministry of Health
on considerations for risk pooling.
Potential private sector engagement
With 3MDG funding, the University of California, San
Francisco conducted an early-stage scoping of the private
sector in Myanmar and made recommendations on
potential private sector engagement modalities. The work
is timely given emerging evidence that suggests a rapidly
expanding private sector.
and the midwifery education system in midwifery

schools
Strengthen the continuing professional education
system, including in-service training, which leads
to optimal performance by midwives and provides
support structures for midwives in facilities and
communities
Read about more of Jhpiegos work in the earlier chapter

on the first component of the funds work: maternal,
newborn and child health.
Training of auxiliary midwives
In collaboration with the Ministry of Health, 3MDG agreed
to support the training of over 5,000 auxiliary midwives by
the Department of Health across nearly 200 townships.
During November and December 2014, a total of 1,588
auxiliary midwives were enrolled in training programmes
covering 77 townships. Auxiliary midwives are trained to
provide antenatal and postnatal care, and to mobilize
mothers to seek essential health care for themselves and
their children. They are contracted to serve for at least
three years in their area of residence, and will be placed
under the guidance of local health officials. Building on
previous support provided, this amounts to a total of
5,500 new auxiliary midwives to be trained with 3MDG
support.
First Health Systems in Transition (HiT) report

The Asia Pacific Observatory on Health Systems and
Policies, released Myanmars first Health Systems in
Transition (HiT) report. The HiT is a systematic and
comprehensive review of the countrys health system,
assessing core components including organization and
governance, financing, physical and human resources,
service provision, and health reforms. Similar HiT reports
have been developed for the Philippines, Malaysia, Lao
PDR, and Cambodia. Over 1,400 copies of the Myanmar
HiT report have been disseminated to the Ministry of
Health and key stakeholders. In 2015, Ministry of Health
will host an official launch of the HiT report5.
SUPPLY CHAIN STRENGTHENING
A baseline report giving an overview of performance

and capability of the national supply chain, including
recommendations for improvement was produced.
STRENGTHENING THE HEALTH WORKFORCE
A finalized project charter was produced, including

objectives, scope, performance measures and
expected outcomes of a pilot implementation
phase in consultation with central, state/region,
and township stakeholders. This project design will
be implemented in Bago, Ayeyarwady and Magway
regions in 2015.
Well-trained health workers are essential to a functioning

health system. Recognizing this, 3MDG agreed with the
Ministry of Health to strengthen its health workforce. In
2014, 3MDG funded supporting activities for midwives and
auxiliary midwives as prioritized by the Government. The
Joint UN Programme, which was agreed in 2014, will also
address a range of human resource issues.
Supporting midwifery training nationwide
Jhpiego, through 3MDGs support, began to implement
their midwifery training programme in 2014. The
objectives of the programme are to:

Support the Ministry of Healths ongoing work to

improve the existing policy and regulatory framework
guiding high-quality pre-service education and inservice training
Support improvements in both midwifery education
5
The full report can be found at www.3mdg.org/library/item/517-apo-hitmyanmar-2014
Supply chains are essential in any health system to ensure

that the right medicine gets to the right person at the right
place and time in the right quantity and quality.
3MDG funded the Partnership for Supply Chain
Management (PFSCM) to conduct Myanmars first
national supply chain baseline assessment in 2014.
Following the assessment;
National cold chain system:

UNICEF, through 3MDG funding, is supporting the
Ministry of Health in nationwide cold chain strengthening
through the implementation of an effective vaccine
management improvement plan and a cold chain
expansion plan, as well as the capacity building of health
workers to improve skills in cold chain and effective
vaccine management. The timing is imperative as the
readiness of Myanmars cold chain will ensure the
successful introduction of new vaccines. This is part of the
Joint UN Programme (a consortium of UNAIDS, UNICEF,
UNFPA and WHO) which provides technical assistance to
the Ministry of Health on systems strengthening initiatives.
45
A SPEAKER AT THE 43RD MYANMAR HEALTH RESEARCH CONGRESS / 3MDG
46
COMMUNITY ENGAGEMENT
Community engagement creates opportunities for

learning from the ground up, and community views can be
used to inform health policies, programmes, services and
projects. Effective community engagement also enables
health providers to be more responsive to the needs of
people, which improves the quality of health services and
enhances satisfaction.
Developing capacity:
3MDG partners and other organizations need tools
and resources, awareness, skills and confidence to use
responsible, fair and inclusive practices in their everyday
work. In 2014, the 3MDG Fund committed to developing
the capacity and awareness of its implementing partners
to engage their target communities.
Partners were supported through a series of eight
training sessions throughout the year, and provided
with technical assistance to assess their organizational
policies and practices, including approaches to community
participation, information sharing and mechanisms
for community feedback. 3MDG established eight new
standards (see Figure 16) and an assessment tool to guide
partners in the application and measurement of their good
practices and areas for improvement.
Significantly, as part of the assessment process in 2014,
focus group discussions were convened between 3MDG
partners and a total of 921 community beneficiaries (458
women and 463 men) to hear their perspectives on 3MDGfunded services.
In line with 3MDGs objective to contribute to better
health for all in Myanmar through a responsible, fair and
inclusive health sector, 34 participants from 18 3MDG
partners attended gender awareness training in 2014,
facilitated by Thingaha Gender Organization, and gender
perspectives and indicators were integrated into capacity
development tools and guidelines. In 2014, implementing
partners reported that a total of 10,551 (or 44%) of
participants at village health committees or village tract
health committees were women, while only 64 (or 1%)
were women at Township Health Committee meetings,
demonstrating that there is room for improvement in
strengthening womens representation at health planning
and decision-making forums. In addition, 3MDG finalized
its strategy for operating in conflict-affected areas,
outlining essential principles for the Fund and its partners.
FIGURE 16: 3MDG ASSESSMENT TOOL ON

RESPONSIBILITY, FAIRNESS, INCLUSION
AND CONFLICT SENSITIVITY
STANDARD 1
Leadership on Responsibility,
Fairness and Inclusion
Organisations demonstrate their
commitments to program quality, which
includes accountability, equity and inclusion.
STANDARD 2
Staff Capacity and Support

Organisations support their staff to improve
programme quality.
STANDARD 3
Information Sharing
and Transparency
Organisations publicly communicate their
mandates, projects and what stakeholders
can expect from them.
STANDARD 4
Participation
Organisations involve beneficiaries and

communities in all phases of their projects.
STANDARD 5
Feedback and Response

Mechanisms
Organisations put formal feedback and

response mechanisms in place to gather and
act on feedback.
STANDARD 6
Monitoring, Evaluation
and Learning
Organisations learn from experience to

continually improve their performance.
STANDARD 7
Conflict Sensitivity
Organisations ensure that their activities do

not make conflicts worse and where possible
that they improve possibilities for peace.
STANDARD 8
Working with Partners

and Other Stakeholders
Organisations collaborate with partners and

other stakeholders to ensure coordinated
and efficient interventions.
47
TABLE 14: 3MDG CONTRIBUTION TO MINISTRY OF HEALTH PRIORITY AREAS FOR UNIVERSAL
HEALTH COVERAGE
Ministry of Health
priority area for
universal health
coverage
Description
3MDGs current contributions
3MDG planned contribution
Identify the
essential health
package
Ensuring access to comprehensive

quality health services for all.
Essential Health Package aims
to focus scarce resources on
interventions which provide the
best value for money for improved
efficiency, equity, political
empowerment, accountability and
more effective care.
3MDG is supporting the World Bank

to support the Ministry of Health in
the development and costing of an
essential package of services.
3MDG will support implementing

partners and the ministry to identify
and build consensus around the
essential health package.
Implementation
of the health
workforce strategic
plan
Enhance human resources

management through
implementation of the Health
Workforce Strategic Plan to
address the current challenges
hindering equitable access to
quality services.
3MDG is supporting the Ministry of

Health to strengthen the midwifery
profession by working in partnership
with Jhpiego as the technical advisory
organization.
3MDG will support the Ministry of

Health on developing a costed national
human resources for health strategy
and implementation plan.
3MDG is supporting the training

of additional auxiliary midwives in
collaboration with the Ministry of
Health.
3MDG is supporting the capacity
development of four Ministry of Health
staff through financing support to
study for a Masters in Public Health in
the Netherlands.
Availability of
quality, essential
medicines and
technologies
Ensuring the availability of quality,

efficacious and low cost essential
medicines and technologies
requires a variety of activities
including the strengthening of
supply chain management and
infrastructure at all levels.
3MDG is supporting the Ministry of

Health to strengthen the national
supply chain system through PFSCM.
A national baseline assessment and
the design phase for a pilot project in
three states and regions have been
conducted
3MDG will support strengthening the

Ministry of Healths cold chain system
for vaccines from the national to the
township level.
3MDG agreed to support the Ministry of

Health in the construction of up to 100
Rural Health Centres and sub-Rural
Health Centres to improve primary
health care services.
Enhance
effectiveness of
public-private
partnerships
Both public and private sectors

are growing and there are many
services and components where
public private partnerships can
play an important role.
Alternative
health financing
and risk pooling
mechanisms
Develop alternative health

financing methods and risk
pooling mechanisms in order to
alleviate the catastrophic health
expenditure of the community and
enhance financial protection.
48
To guide potential engagements with

the non-public health sector, 3MDG
supported the University of California
San Francisco to formulate an
analytical framework on potential nonpublic sector engagements, including
models of public-private partnerships.
3MDG will support on-going

discussions on developing a PublicPrivate platform.
The World Bank, through 3MDG

funding, will support the Ministry of
Health to develop a health financing
strategy through a variety of activities
including studies and analyses.
Ministry of Health
priority area for
universal health
coverage
Community
engagement in
health services
delivery and
promotion
Description
3MDGs current contributions
3MDG planned contribution
Strengthen community
engagement in health service
delivery and promotion, including
strategies, tools and resources to
support community engagement
approaches.
3MDG is supporting implementing

partners to conduct focus group
discussions with target communities at
least once a year (separately with men
and women), to listen to their views
about 3MDG-funded projects. This
includes guidelines, tools and technical
assistance to help partners to conduct
effective community engagement
sessions.
3MDG has offered support to the

Ministry of Health to strengthen
strategies focusing on consumer
satisfaction. Examples include
technical assistance for effective
strategies for community engagement
in health programmes; and gathering
and presenting international
evidence on health sector good
practice e.g. consumer satisfaction,
community feedback mechanisms and
participatory health planning.
3MDG is working in partnership

with six local Community Based
Organizations to improve the
understanding of the social factors
limiting access to health care, and to
support meaningful participation of
community members for better services
and consumer satisfaction.
Evidence-based
information and
comprehensive
management
information
systems
Strengthen development of an
evidence-based information
and comprehensive health
management information system.
3MDG supported WHO Asia Pacific

Observatory in the production of the
first Myanmar Health Systems in
Transition (HiT) report.

Health in strengthening the health
management information system
through grants to UN partners.
3MDG will support the Department of
Medical Research to host the upcoming
43rd Myanmar Health Research
Congress.
Policies for
Universal Health
Coverage and
evidence-based
information
Governance and
stewardship
Strengthen evidence-based
information and comprehensive
management information system
necessary for decision making.
The World Bank, through the 3MDG

Funds support, conducted seminars
on health financing and universal
health coverage with senior officials
and technical staff from the Ministry
of Health, Ministry of Finance, Social
Security Board under the Ministry of
Labour, Employment and Security, and
the Ministry of Social Welfare.
3MDG will support the Ministry

of Health in ensuring necessary
revisions in policies, legal frameworks,
training tools and quality assurance
mechanisms are in place.
Intensify the governance and

stewardship for attainment of
UHC.
The World Bank, through 3MDG Funds

support, conducted a flagship course in
Washington DC for senior officials from
the Ministry of Health and the Ministry
of Finance.

Health through the UN JPHSS to
strengthen the existing Myanmar
Health Sector Coordinating Committee
as well as technical and strategy
groups.
Critical for accountability and

responsiveness, and reaching the
right services to the consumer.
49
Supporting local organizations:

In an effort to generate better information for all
stakeholders on community health needs and to empower
local organizations to implement effective approaches
at the community level, in June 2014 the 3MDG Fund
issued a call for proposals for local Community Based
Organizations (CBOs). Six organizations were selected for
the Collective Voices: Understanding Community Health
Experiences funding stream and started their contracts in
2015:

Ar Yone Oo Social Development Association

Bright Future (La Yee Anar Gut)
Community Driven Development & Capacity Building
Enhancement Team
Charity Oriented Myanmar
Community Agency for Rural Development
Phan Tee Eain
Five of the organisations will focus on issues that are

gender specific or related to sexual and reproductive
health, including improving access to quality health
services for disadvantaged women; developing greater
understanding of the relationship between gender and
health-related knowledge, behaviours and attitudes;
and contributing to community awareness and accurate
utilization of family planning services.
Findings and experiences from the projects will be shared
nationally. Each lead organization is required to partner
with a minimum of three additional CBOs to develop the
capacity of smaller organizations. This means that in total
3MDG will reach 25 CBOs through this funding stream.
Smaller, local organizations often have less established
organizational management systems and procedures.
They require tailored capacity support to achieve their
objectives.
In 2014, 3MDG engaged Pact Myanmar to provide
organizational capacity development to local NGO/
CBO implementing partners to enhance ownership and
sustainability. This support will continue until the end
of 2016, enabling robust and comprehensive capacity
development for 3MDG local organizations.
PHOTO - Myanmar delegation attending the Global Flagship Course facilitated by the
World Bank in Washington D.C. in 2014 (Source: The World Bank)
50
CHALLENGES AND LESSONS LEARNED

Coordination with other development partners

remains a challenge. This has improved with
operationalization of the HSS TSG. It would be
helpful for sub-working groups to be established
under the HSS TSG to enable effective coordination,
harmonization and alignment on technical areas,
including health financing and human resources.
These could be chaired by the Ministry of Health and
should include representation from key stakeholders,
including other ministries as appropriate.
Alignment and communication with the Ministry of

Health has improved with the active HSS TSG and
working groups, as well as with the reconstitution
of the 3MDG Fund Board to include ministry
representation.
The need to leverage the HSS potential across the

work of the Fund through more integrated working
across maternal health and the three disease
components is a challenge since the strategy
for health systems strengthening is still under
development.
The organizational, behavioural, cultural,

attitudinal and social change required for effective
implementation of the principles of responsibility,
fairness, inclusion and do-no-harm takes time and
will be incremental and progressive in nature.
3MDG partners are keen to receive support and learn

how to strengthen their approaches to community
participation, inclusion, information sharing, and
responding to feedback. Having a structured tool and
assessment process has enabled 3MDG to more easily
understand the gaps and strengths of its partners,
and to monitor progress.
CBOs are keen to participate more substantially in

improving the health status of people in Myanmar,
particularly within their own communities, but often
lack the capacity, resourcing or experience to find
suitable points of entry to support the health system.
COMMUNITY HEALTH WORKERS PLAY A KEY ROLE IN HEALTH SYSTEMS / 3MDG
51
FUND STATUS
TABLE 15: DONOR CONTRIBUTION RATIO TO 3MDG (INCLUDING EARMARKED TOP-UPS)
3MDG donors
Overall
commitments
(million US$)
Overall
commitments
(%)
Disbursements
Received (million
US$, June 2012 December 2014)
Disbursements
Received
(%, June 2012 December 2014)
The United Kingdom (through the

Department for International Development - DFID)
143.7
45.20%
76.8
47.80%
Australia (through the Department

of Foreign Affairs and Trade - DFAT)
91.1
28.60%
48.2
30.10%
The European Union (EU)
32.1
10.10%
5.8
3.60%
Sweden
25.8
8.10%
10
6.30%
Denmark
9.2
2.90%
9.2
5.70%
Switzerland (through the Swiss

Agency for Development and Cooperation - SDC)
4.4
1.40%
2.2
1.30%
The United States (through the

Agency for International Development - USAID)
1.60%
3.10%
Roll over from 3DF
5.2
1.60%
3.3
2.10%
Roll over from JIMNCH
1.6
0.50%
tbd
TOTAL
318.1
100%
160.5
100%
Note: Donor commitments not yet disbursed to the 3MDG Fund are subject to exchange rate fluctuations, hence the total value of the Fund varies over time until all commitments
are met and disbursed.
DONORS
3MDG significantly accelerated the disbursement from

$568,348 during 2012; to $25,840,899 during 2013;
to $62,685,091 in 2014. This represents an annually
adjusted increase in programme delivery, as reflected in
expenditure, of 240% in 2014, as compared to 2013.
3MDG is a multi-donor trust fund that pools all

contributions received from donors into one central ledger
from which programme activities are funded. On top of
the commitments to the pooled fund, donors have also
pledged earmarked contributions to address specific
interventions for HIV, TB and malaria.
FIGURE 17: FUNDING BREAKDOWN

TB
laria
a
1
1%
M 10 %
H
HIV
4 I
4%
%
TB %
11
HS
8%S
a lt h
ild
%
63
d C hM a
h
t
Ch
ild
te rH e a l
d
n
n a l,
a
*Integrated TB, HIV and Malaria
N e w born
an
He
ew
rn
63%
Malar
*
3% 10% ia
l, N
bo
S
HS %
8
M atern a
ria
a
al
By December 2014, the 3MDG Fund Manager had

disbursed $89.1 million on behalf of the Fund Board.
Out of this total amount $78.7 million was disbursed for
programme activities, and $10.4 million was disbursed for
programme management, governance, evaluation, and
fund management office overhead costs.
52
d
an
EXPENDITURE
IV
,H
TB
The current Fund programming status (funds already

disbursed plus funds planned for disbursement, the
latter in part already legally committed as funds to
implementing partners) yields the following breakdown
per component, as shown in Figure 15.
d
te
ra
g
te
*In
FUNDING BREAKDOWN
3 *
The total volume of funds committed as of December

2014 stands at $318.1 million. Since inception of the Fund
the 3MDG Fund Manager has received $160.5 million in
disbursements from contributing donors.
GRANTS TO PARTNERS
ANNUAL AUDIT (FINANCIAL YEAR 2013)
In some particular cases, and upon authorization from the

Fund Board, 3MDG will commission a direct grant from a
particular partner if a number of specific criteria are met
and the situation demands it. Based on best practices
and lessons learned from previous funds, 3MDG has
established standardized, competitive Calls for Proposals
as the selection method, and a standard grant agreement
as the legal instrument for engaging the various
implementing partners.
In 2014, all partners and the Fund Manager were audited

for expenditure in the financial year 2013. This was the first
audit under the 3MDG Fund.
The selection of implementing partners follows a

competitive grant commissioning process where the Fund
Manager evaluates proposals through a constituted review
panel (usually with external representation, including the
Ministry of Health) in order to arrive at a recommendation
for funding decisions.
As a custodian of public funding, the 3MDG Fund adheres

to international best practices in transparency and
accountability. Next to robustly defined anti-fraud and
anti-corruption policies, monitoring missions and capacity
assessments, an annual audit is conducted by external
auditors.
Ninety-Four audit observations were raised from the

audits of 17 partners and 21 grants. Out of these, 1
observation was rated as high priority, 52 observations
were rated as medium priority and 41 as low priority. 38
audit observations could be closed before finalization
of the audit reports, translating into a preliminary audit
recommendations implementation rate of 40%.
Performance management is a shared responsibility

between the fund management office and the
implementing partners to ensure projects are completed
on time to an agreed standard. All work by partners
is actively supported and managed through regular
meetings and site visits to review performance and
develop risk mitigation measures.
The remaining open audit observations are now being

tracked and their implementation, where relevant,
monitored by the Fund Manager, to be reported in the
January June 2015 progress report.
For the Fund Manager, five audit observations are now
being tracked by the Fund Board and will be reported in
the January June 2015 progress report.
GRANTS AWARDED
By end of 2014 the 3MDG Fund had commissioned a total

of 66 grants to 41 partners. All of these grants combined
have a value of $178.9 million over the lifetime of the
fund. In 2014 alone, 3MDG significantly accelerated the
investment into public health services by commissioning
grants to partners to the value of $146.8 million, a fivefold
increase over 2013. These partners are the Ministry of
Health, UN organizations, international non-governmental
organizations, and local civil society organizations.
FIGURE 18: AUDIT OBSERVATIONS BY FUNCTIONAL AREA
26
36
General
administration 1
Procurement
Project
management
Finance
18 Human
resources
6
Asset
management
7
53
MONITORING AND EVALUATION

ROUTINE MONITORING IN 2014

35 programme monitoring visits were held in 2014

71 routine data quality assessments were completed
14 organizations underwent the data quality assessments
10 states and regions were covered by routine monitoring in 2014
The ultimate purpose of monitoring and evaluation (M&E)

is to support learning and the application of data to
continuously improve 3MDG-supported programmes.
Supporting the 3MDG Fund as a learning organization
requires the promotion of a culture of transparency,
mutual accountability and evidence-based learning, and
creating opportunities for sharing data and strengthening
knowledge management systems.
To achieve this, key M&E activities conducted by the
Fund include routine programme and data quality
assurance assessments, conducting value for money
analysis, on-going analysis of epidemiological trends and
mathematical modelling of the estimated results and
impacts of the programme.
A priority of the Fund is to work with 3MDG supported
partners to strengthen their M&E systems and skills. This
is done through joint monitoring visits, special seminars
and M&E working sessions, and by facilitating learning
sessions and joint M&E activities across partners.
The Fund supports the Independent Evaluation Group
to conduct robust evaluations and special studies for
programme improvement. In addition, the Fund supports
the Ministry of Health to lead the national Technical
Strategy Group (TSG) on M&E and Research by acting as
the co-secretariat.
EXTERNAL DATA QUALITY ASSURANCE
The Independent Evaluation Group conducted an annual

data quality assurance of the 3MDG M&E system and
evaluated the degree to which recommendations from the
2013 review were followed up. In addition, a new quality
assurance of data relating to health system strengthening
was conducted. The final results will be available in June
2015.
MONITORING AND EVALUATION AND

RESEARCH TECHNICAL STRATEGY GROUP
(TSG)
The first meeting of the Myanmar Technical Strategy

Group for Monitoring, Evaluation and Research was
held with the 3MDG Fund and the Global Fund Principal
acting as co-secretariat. The TSG is an inclusive, multistakeholder mechanism established under the Myanmar
Health Sector Coordinating Committee to coordinate
the implementation of national strategies related to
54
monitoring, evaluation and research. It provides technical

and strategic guidance to improve M&E coordination and
technical recommendations to improve national research
activities.
A work plan for the TSG, including discussions on
developing a national research agenda has been
scheduled for early 2015.
COMMODITY TRACKING REVIEW
Implementing partners receiving health commodities

need to ensure they have adequate supply chains in
place. On an annual basis the Fund Manager carries out a
commodity tracking systems review to verify whether the
supply chains operated by 3MDGs partners are sufficiently
robust. The review is outsourced to an inspection company
that follows a rigorous process including field visits, visits
to in-country headquarters and a desk review of supply
chain-related documents.
To evaluate supply chains from 2014, such a review was
conducted in January 2015 for all 17 partners receiving
health items from 3MDG. The overall result was good, as
all but one partner were evaluated as fully satisfactory.
The one partner who received a needs development
rating was because their supply chain was integrated with
the Township Health Departments.
Although the Fund Manager encourages this type of
integration as this is what the future should look like,
due to the integration the organization responsible was
no longer able to manage their supply line which is not
acceptable. The Fund Manager and the partner will be
looking at the best way to resolve this issue.
One reoccurring issue was the lack of registration
of distributions carried out to patients. In case
pharmaceuticals are recalled by the manufacturers,
partners should be able to trace the patients having
received these treatments.
Efforts are underway to correct this issue. The 10% no
score is related to specific activities that were not part of
the partners activities and therefore were not scored.
STRENGTHENING THE HEALTH

MANAGEMENT INFORMATION SYSTEM
Based on the routine data quality assessments it was

observed that there were several different approaches
for collecting village level data and information. In the
majority of townships volunteer midwives and health
workers have insufficient data recording practices and
tools. Standardized tools would be helpful for routine
data reporting, pregnancy and delivery care recording,
estimating medical supply reorders and far more, and
allow the volunteer to provide evidence of how much they
help their own village.
Following discussions with the Ministry of Health, the fund
management office worked with partners to establish a
standard volunteer recording system in 3MDG-supported
townships. The principles are to support the national
Health Management Information System (HMIS) capture
the minimum essential data set and provide volunteers
with a simple and user friendly tool. Volunteer data
collection requirements are based on national guidelines.
Key information to be captured includes:

maternal care
delivery
newborn care
referrals
health education activities
support to basic health staff
joint activities with basic health staff
case management
3MDG believe the information collected can be used for

evidence-based planning and projection for community
based interventions and capacity development, as well as
a source for routine monitoring at all levels.
REMODELLING COST-EFFECTIVENESS AND

LIVES SAVED ESTIMATES
A review of the cost-effectiveness assumptions and lives
saved estimations in the 3MDG Description of Action
(DOA) was undertaken in 2014.
The economic analysis that produced the estimated

results outlined in the original DOA were the result of
several limitations, including: calculation errors in the
original DOA, an overstatement of benefits related to
family planning, and an understatement of benefits
due to some interventions not being included in the
original model, such as benefits from HIV, TB and malaria
interventions.
Some benefits cannot be quantified as there are no existing models, such as improvements in health outcomes as
a result of health systems strengthening. The fund management office worked with technical specialists to revise
the original DOA figures as seen in Table 16.
TABLE 16: 3MDG DOA UPDATED EXPECTED

RESULTS AND ASSUMPTIONS FOR
COMPONENT 1
2013-2016 expected
results
Total lives saved
3,608
- averted maternal deaths
246 (7% of all lives saved

will be maternal)
- averted under 5 deaths
3,362 (93% of all lives

saved with be children
under 5)
Population reached by mother,

child and newborn interventions
4.3 million (agreement

with Ministry Of Health)
Cost per disability adjusted life

year averted
$577 [1]
GDP per capita $1126
(2012 UN data)
Additional skilled birth attendance
39,000
Additional antenatal care visits
32,000
Additional children immunized
18,000
Additional children breastfeed
Insufficient data to draw

adequate conclusions
Additional referrals
- Women
37,206
- Children
17,200
Contraceptive prevalence rate

- Cumulative increase %
13%
- Actual %
38-51%
Malaria treatment
- Cumulative increase %
34%
- Actual %
38-51%
- Number tested
1.3 million
- Number treated
380,000
MDR TB
2,000 (NEW)
Programme funding allocation

for component 1 (MNCH)
$112 Million
[1] 2014 analysis of actual expenditure indicates that referrals are highly costeffective in terms of total cost per DALY averted with a range from US$ 259 to US$
1,015.
Although the targets remain aggressive, it is important

to note that the locations supported by 3MDG are the
hardest to reach, with some of the most vulnerable
populations in the country. Programmes in these areas
will have to significantly scale up to meet the targets,
particularly for mother and child health.
55
ANNEXES
2014 Key Results vs. Targets

Maternal and child referrals (2014 data)
2014 Results Matrix
New grants signed Jan to Dec 2014
All grants signed since inception
Financial Status
56
57
59
60
68
70
75
3MDG Annual Report January to December 2014
Annex 1 - 2014 Key Results VS Targets

Maternal,
newborn
and child health
Ante-natal
care
(4 visits per
woman)
Births
attended by
skilled person
Post-natal and
newborn care
provided less
than 3 days
after birth
Referrals for
emergency
obstetric care
Children
immunized
against
measles
Diarrhoea
treated with
Oral
Rehydration
Therapy
2014 achievements
31,395
30,276
34,306
8,007
46,569
17,445
84%
98%
201%
107%
126%
176%
Project-to-date
achievements
(2013-2014)
51,668
47,703
52,119
13,754
80,154
23,446
Project-to-date targets
(2013-2014)
65,500
53,771
23,846
12,906
65,433
26,187
2014 progress towards

achieving the 3MDG
annual target
HIV

reached by prevention
programmes

distributed
People who inject drugs given

voluntary confidential counselling
and testing for HIV
2014 achievements
26,661
6,956,394
5,950
2014 progress towards achieving

the 3MDG annual target
106%
87%
112%
Project-to-date achievements
(2013-2014)
26,661
12,701,591
5,950
Cumulative annually
Project-to-date target (2013-2014)
25,000
15,800,000
5,306
Tuberculosis
People screened for TB

by 3MDG-funded
activities
Notified cases for TB

treatment
(all forms)
Number of MDR-TB
patients supported
Number of referrals to TB
Departments by
Community Health
Workers/Volunteers
50,294
4,262
372
9,912
13%
30%
71%
39%
383,848
14,147
524
2014 achievements
2014 progress
towards achieving
the 3MDG annual
Project-to-date
target
targets (2014)
Malaria
2014 achievements
2014 progress towards
achieving the 3MDG annual
target to date achievements
Project
(2013-2014)
3MDG target
(2013-2014)
25,187
Number of people tested for

malaria
Number of people treated for

confirmed malaria
Number of confirmed malaria

treated within 24 hours of
onset of fever
469,714
29,530
15,729
97%
28%
36%
1,038,176
109,482
50,191
NA (*)
300,000
103,300
(*) Malaria testing targets were added in 2015 due to the increased focus on malaria case finding.
54
Health systems strengthening
First Myanmar National Supply Chain baseline assessment completed

Supply chain strengthening agreement prepared for Magway, Bago, and Ayeyarwaddy regions
Analytical work on how to engage with the private health sector conducted
Seminars on health financing and universal health coverage conducted for Ministry of Health, Ministry of
Finance and development partners
$15 million agreement to strengthen health facility infrastructure across Myanmar signed
First Myanmar Health Systems in Transition (HiT) report produced and released
$20.7 million agreement signed to support the Joint UN Programme (WHO, UNICEF, UNFPA, UNAIDS) on
health systems strengthening
$10 million contract with Jhpiego signed and activities commenced to support midwifery schools
Financial support provided for Ministry of Health staff to pursue Master of Public Health degrees in the
Netherlands
55
Annex 2
Maternal and child referrals (2014 data)
Table: Outcomes and Interventions for all Maternal Emergency Referrals

State/Region
Total
Referrals
LSCS
Instrumental
Deliveries
Normal
Deliveries
Other
Maternal
Deaths
Foetal/Newborn
Deaths
Delta
6,982
2,989
779
2,651
563
120
43%
11%
38%
8%
0%
2%
158
34
232
126
20
29%
6%
42%
23%
0%
4%
195
22
183
59
42%
5%
40%
13%
0%
2%
44%
0%
38%
19%
0%
0%
3,350
835
3,073
751
148
41.8%
10.4%
38.4%
9.4%
0.04%
1.85%
% of all referrals
Chin
550
% of all referrals
Magway
459
% of all referrals
Shan
16
% of all referrals
Total
8,007
% of all referrals
Table: Under five emergency referrals disaggregated by sex and age and with outcomes
Number
2014
% of all
cases
Number
referred
Male
Female
0-28
days
28days
1 year
5,534
2932
2602
679
1913
2942
21
53%
47%
12%
35%
53%
0.38%
5 years
Deaths
56
Annex 3
2014 Result Matrix

Indicators
IMPACT
2013
Achievement
2014
Target
2014
Achievement
Cumulative
Achievement
Caveats/Notes
Improved maternal, newborn and child health and a reduction in communicable disease burden (HIV, TB, malaria) in areas and populations supported by the
3MDG Fund
Maternal mortality ratio per 100,000 live

births
200
190
Not available
Not applicable
World Health Statistics 2014 Report (WHO) and Trend in

MMR 1990-2013 Report (WHO) reported Myanmar
achievement as 200 per 100,000 Live births for 2013. Health
in Myanmar 2014 Report also presented MMR as 200 for
2013. No data available for 2014.
Under-five child mortality per 1,000 live births

(disaggregated by sex)
51
45
Not available
Not applicable
UN Inter-agency Group for Child Mortality Estimation Levels

and Trends in Child Mortality 2014 Report reported an annual
rate of reduction of 3.3% in Myanmar. No data available for
2014 result.
Neonatal mortality rate per 1,000 live births

(disaggregated by sex)
26
22
Not available
Not applicable
UN Inter-agency Group for Child Mortality Estimation Levels

and Trends in Child Mortality 2014 Report. No data available
for 2014.
HIV prevalence among people who inject

drugs (disaggregated by sex) in programme
areas
National TB (all forms) mortality per 100,000
population per year (disaggregated by sex and
age) in programme areas
Percentage of all deaths due to malaria (per
confirmed malaria diagnosis) in programme
areas
Not available
22%
Not available
Not applicable
49
55
Not available
Not applicable
Draft HSS 2014 data is with the National AIDS Programme

for finalisation. Preliminary data suggests higher prevalence
than previously reported.
2014 data is unavailable until December 2015.
Not available
6%
Not available
Not applicable
5
6
OUTCOME
1
NMCP 2013 Malaria Annual Report is not yet published and

2014 data is unavailable until December 2015
Increased access to and availability of (i) essential maternal and child health services for the poorest and most vulnerable in areas supported by the 3MDG
Fund and (ii) HIV, TB, and malaria interventions for populations and areas not readily covered by the Global Fund
Number and percentage of births attended by
skilled health personnel (doctor, nurse, lady
health visitor or midwife) in Component 1
townships
Number: 17,427
Number: 30,838
Number: 30,276
Denominator:
46,847
Coverage: 65%
Number: 47,703
Data completeness is an issue and further data quality

assurance should be conducted.
Coverage: 56%
Coverage:71%
Number and percentage of women attended

at least four times during pregnancy by skilled
health personnel for reasons related to the
pregnancy in Component 1 townships.
Number: 20,273
Number: 37,500
Number: 31,395
Denominator:
46,847
Number: 51,668
Coverage: 75%
Coverage: 67%
The indicator defines scheduled intervals for four ANC

services but the data collection forms do not have a clear
recording format for this information. Data quality assurance
should be conducted on service provision and reporting.
HMIS uses live and still births recorded not expected
pregnancies as the denominator. Achievements only include
data from the time periods of actual 3MDG programme
implementation e.g. Kayah was operational for 4 months in
2014 and only data from this 4 month period is reported.
Coverage: 65%

3
Number and percentage of mothers and

newborns who received postnatal care visit
within three days of childbirth
Number: 17,813
Number: 17,033
Number: 52,119
Coverage: 40%
Number: 34,306
Denominator:
45,945
Coverage: 75%
Data quality is an issue and further data quality assurance

must be conducted. Achievements only include data from
the time periods of actual 3MDG programme implementation
e.g. Kayah was operational for 4 months in 2014 and only
data from this 4 month period is reported.
Coverage: 58%
Number and percentage of newborns that

initiate immediate breastfeeding within one
hour after birth in Component 1 townships
(disaggregated by sex )
Not collected in
2013.
Not reported in
2014
Not reported in
2014
Not available
This is new indicator approved in late 2014. Achievement

data collection will start in 2015.
Contraceptive prevalence rate in Component 1

townships (disaggregated by age)
51%
47%
67% of married
couples
Not applicable
Age breakdown data can only be collected by survey. HMIS

only reports contraceptive prevalence rate for married
couples (eligible couples) using any method (both modern
and traditional methods) of contraception. HMIS reports the
denominator at end of each calendar year. Estimated
calculation of women of reproductive age (15-49) is 27%
(UNFPA 2007) of the 2014 census population for 3MDG
townships. Preliminary census report does not report women
of reproductive age.
Number:23,446
Only public health facility-based treatment figures are

reported for children under 5, this does not include
community based volunteer treated cases and private sector
figures. A system to collect community based information
will be implemented in 2015. Private sector distribution may
contribute to saving 34 lives and 3148 DALYs gained. Sex and
age groups, other than under 5 children, are not reported by
HMIS. Reported denominator is from HMIS. Targets are
calculated using 6.7% prevalence rate (MICS 2010) and not
episodes based on incidence. This leads to an underestimation of the target. Achievements only include data
from the time periods of actual 3MDG programme
implementation. Coverage data should be viewed with
caution. Data completeness and quality is an issue and
further data quality assurance should be conducted.
40% of women of
reproductive age
(estimated)
Number and percentage of diarrhoea cases

treated with ORT (disaggregated by sex and
age) in Component 1 townships
Number:
Number and percentage of children under five

with pneumonia treated correctly with
antibiotics (disaggregated by sex and age) in
Component 1 townships
6,001
Number: 9,905
Number:
17,445
Denominator: 19,115
Coverage: 99%
Coverage: 74%
Coverage: 91%
Not collected in
2013.
Number: 2,706
Number:
14,150
Denominator: 13,710
Coverage: 52%
Coverage: 103%
Number:
Denominator:
14,150
13,710
Only public health facility-based treatment figures are

reported for children under 5. Sex and age groups, other than
under 5 children, are not reported by HMIS. Private sector
distribution may contribute to saving 42 lives and 3594
DALYs gained. Targets are calculated using pneumonia
prevalence rate (MICS 2010) and not episodes based on
incidence. This leads to an under-estimation of the target.
Achievements only include data from the time periods of
actual 3MDG programme implementation that may affect the
coverage calculations. Coverage data should be viewed with
caution. Data completeness and quality is an issue and
further data quality assurance should be conducted.
58

8
Number and percentage of children under one

immunized with (i) DPT3/Penta3 and (ii)
Measles (disaggregated by sex) in Component
1 townships
Number and percentage of people who inject

drugs (PWID) reached by HIV prevention
programmes in programme areas
(i) Number:
27,647
(i) Number:
38,110
(i) Number: 47,305

Denominator:
48565
(i) Number: 74,952
Achievements only include data from the time periods of

actual 3MDG programme implementation that may affect the
coverage calculations. Sex breakdown data is not reported by
HMIS.
Coverage: 83%
Coverage: 94%
Coverage: 97%
(ii) Number:
33,585
(ii)Number:
36,894
(ii) Number: 46,569
Coverage: 101%
Coverage: 91%
Coverage: 96%
Number: 18,934
Number:
25,000 PWID in
programme area
Number:
26,661
Number:
26,661
Coverage: 82.3%
Coverage: 65%
of 38,000 PWID
Coverage:
70%
Coverage:
70%
(ii) Number: 80154
Denominator:
48,565
10
Case notification rate of all forms of TB per

100,000 population
(bacteriologically
confirmed
plus
clinically
diagnosed)
(disaggregated by sex and age)
297
319
Not available
11
Not reported in
2013
Not reported in
2014
Not reported
2014
Number:
Number: 44,300
14
Percentage of confirmed MDR TB cases

successfully treated (disaggregated by sex and
age)
Number and percentage of confirmed malaria
cases treated in accordance with national
malaria treatment guidelines within 24 hours
of onset of symptoms (fever) in 3MDG
supported townships
Perception of progress in strengthening aid
effectiveness
Proportion of community members reporting
OUTPUT 1
Delivery of essential services, with a focus on maternal and child health, strengthened in target townships
Total number of Couple Years of Protection

(CYPs) delivered through public sector services
and private sector channels in Component 1
townships
Number and percentage of appropriate EmOC
referrals supported in Component 1 townships
12
13
34,462
Not available
2013 data is reported in National TB Programme (2013)

Annual report. 2014 data is unavailable until December 2015.
in
Not available
MDT TB target set for 2015 and 2016 to align with

implementation.
Number:
Denominator:
3MDG Strategic Review

Conducted
Not available
Coverage: 36%
Coverage: 45%
Number:
15,729
Denominator:
33,924
Coverage: 46%
Not reported in
2013
Not available
Qualitative
analysis
>70%
3MDG
Strategic
Review Conducted
Not available
28,263
Number:
5,747
Coverage:
958/township
Minimal double counting in some implementation areas

exists.
Data quality assurance has documented the
limitations and recommended actions are being
implemented.
50,191
128,437
Coverage: 39%
Increased community awareness on malaria service

contributed this achievement although malaria case
decreased compared to 2013.
Feedback systems are currently being developed to collect

this information.
86,997
27,490
55,753
3MDG
commodities
were
delayed
leading
to
underachievement. Achievement includes both public and
private sector contributions.
Number: 7,500
Number:
8,007
Denominator:
53,758
Number: 13,754
Coverage: 15%
of expected
pregnancies
Coverage: 15%
Among total referrals, 210 are from Hard to Reach (HtR)

villages which is around 6% of expected pregnancies in HtR
areas. 16 referrals from Shan 3 townships which started in
December 2014.
59

OUTPUT 2
Strengthened systems for delivery of essential MNCH services
Number and percentage of doctors, nurses

and midwives trained in MNCH including
delivery and emergency obstetric care in
Component 1 townships
Number:
353
Coverage: 39%
Number:
2,720Coverage:
85%
Number:
1,371Denominator:
2,712Coverage: 51%
Not available
Number and percentage of auxiliary midwives

and community health workers receiving
quarterly supervision and monitoring
Not available
Number: 2,500
Number:
3,289
Denominator: 5,190
Number:
Denominator:
Coverage: 50%
Coverage: 63%
Coverage: 63%
Number and percentage of functioning AMWs

and CHWs who report no stock-outs of
essential medicines and supplies
Number of midwifery graduates per annum
from
Ministry of Health educational
institutions using the revised curriculum
Number and proportion of health facilities
built and renovated per annum with 3MDG
support
Not collected in
2013
Not reported in
2014
Not reported
2014
in
Not applicable
Not collected in
2013
Not reported in
2014
Not reported
2014
in
Not applicable
Not collected in
2013
Not reported in
2014
Not reported
2014
in
Not applicable
3
4
5
Data quality is an issue due to limitations with the

comprehensive human resource management information
system. Coverage percentage is calculated annually by using
the total number of BHS reported by HMIS at the end of each
calendar year. Reported coverage % includes only those that
were trained during this reporting period. Staff transfers lead
to difficulties in calculating those already trained. Double
counting may exist and inadequate documentation may lead
to over/under-reporting.
3,289
5,190
Achievements should be viewed with caution. Coverage is

overachieved due to data inconsistencies. Challenges exist
due to limitations with the human resource management
information system. Some townships cannot provide
person/head count figures. Indicator guideline revisions and
systems strengthening in 2015 is needed in order to collect
this indicator.
Data collection will possible at 2015 onward using the
community based HMIS.
OUTPUT 3
Prioritised HIV, TB and malaria interventions not readily covered by the Global Fund provided to targeted populations or areas
Number of sterile injecting equipment

distributed to people who inject drugs
5,745,197
8,000,000
6,956,394
Number of bacteriologically confirmed DR TB

cases who began second line treatment.
Not collected in
2013
Not reported in
2014
Not reported
2014
Rate of new smear positive/bacteriological

confirmed TB patients notified to national TB
programme during the year (per 100,000
pop.) (disaggregated by sex and age)
89
119/100,000
(Male)
59/100,000
(Female)
101
Not available
Number of RDTs taken and read
568,462
483,300
469,714
12,701,591
in
Average of over 250 needles per IDU was distributed.
Not applicable
Not applicable
2014 data is unavailable until December 2015.
1,038,176
60

5
Number of people with confirmed malaria

(disaggregated by sex and age) treated as per
the national treatment guidelines.
Total
(3MDG+MARC
Top-up)= 79,952
3MDG 43,051
Male: 28,929
Female: 14,122
<1 yr: 149
1-4 yrs: 1,730
5-9 yrs: 4,178
10-14 yrs: 4,403
>15 yrs: 32,591
3MDG 57,000
MARC Top-Up
Funds 48,000
3MDG 16,031
Male: 10,358
Female:5,673
<1 yr: 17
1-4 yrs: 543
5-9 yrs: 2,063
10-14 yrs: 1,946
>15 yrs: 11,461
109,482
Male: 19,080
Female: 10,450
<1 yr: 32
1-4 yrs: 1,001
5-9 yrs: 3,800
10-14 yrs: 3,585
>15 yrs: 21,112
Top Up Funds
13,499
Male: 8,722
Female: 4,777
<1 yr: 15
1-4 yrs: 458
5-9 yrs: 1,737
10-14 yrs: 1,639
>15 yrs: 9,651
Top Up 36,901
Male: 24,797
Female: 12,104
<1 yr: 128 1-4 yrs:
1,482
5-9 yrs: 3,581
10-14 yrs: 3,774
>15 yrs: 27,936
Total 4,394 cases are not included in the reported figure as

they were not treated according to the national treatment
guidelines.
Approximately 40% out of 4,394 cases are report from
NMCP.
OUTPUT 4
Prioritised components of the health system are strengthened for greater sustainability
Contribution to the existence of up to date

National Health Plan and selected policies,
strategies and plans linked to health needs
and priorities
Not reported in
2013
Not reported in
2014
Not reported in
2014
Not applicable
Contribution to the national Essential Package

of Health Services
defined, costed and
adopted.
Percentage of townships with functional cold
chain equipment and adequate storage space
Not reported in
2013
Not reported in
2014
Not reported in
2014
Not applicable
Not reported in
2013
Not reported in
2014
Not reported in
2014
Not applicable
Percentage of health facilities experiencing a

stock-out
in
3
PFSCM
supported
states/regions.
Not reported in
2013
Not reported in
2014
Not reported in
2014
Not applicable
Number of staff from Ministry of Health (MoH),

Implementing Partners (IPs), local NonGovernmental Organizations (NGOs) and
Community-Based Organizations (CBOs) (at
central, regional and township level), trained
in Accountability, Equity, Inclusion and
Conflict Sensitivity (AEI & CS)
3
4
OUTPUT 5
1
2014 Total (3MDG+Top up)= 29,530
Enhanced health services accountability and responsiveness through capacity development of target communities, civil society organizations and the public
sector
25
196
Male: 114
Female: 82
196
Male: 114
Female: 82
61

2
Numbers and percentage of community

members i) aware of ii) use mechanism(s) to
provide feedback in 3MDG-supported areas
(disaggregated by sex and age)
Not reported in
2013
i) Coverage:
45%
i) Number: 141
Male: 89
Female: 52
Denominator: 932
i) Number: 141
Male: 89
Female: 52
Denominator: 932
Coverage: 15%
Coverage: 15%
ii) Not reported

in 2014
ii) Not reported
ii) Not reported
Number and percentage of implementing

partners with improvement in their
Accountability, Equity and Inclusion (AEI) and
Conflict Sensitivity (CS) systems and practices
Not reported in
2013
i) 45%
68%
68%
Number and proportion of women

representatives
attending
the
annual
Comprehensive Township Health Plan (CTHP)
review workshop
Proportion of women representatives on (i)
township health committee (ii) village tract
health committees/ village health committees
Not reported in
2013
Baseline
collected
Baseline collected
Not applicable
i) Number: 31
Coverage: 27%
i) 20%
ii) 30%
i) Number: 64
Denominator: 337
i) Number: 64
Denominator: 337
Coverage:19%
Coverage:19%
ii) Number: 10,570

Denominator:
24,363
ii) Number: 10,570

Denominator: 24,363
Coverage: 43%
Coverage: 43%
ii) Number: 3,479

Coverage: 44%
OUTPUT 6
Delivery of essential services, with a focus on maternal and child health, strengthened in target townships
Fund Manager performance: (i) Percentage of

Fund Manager annual work plan milestones
achieved (ii) number FM monitoring visits
conducted as planned
Documented analysis of cost-efficiency and
value for money based on 3MDG Fund Value
for Money Framework
i) 71%
ii) 88%
(i) and (ii) >90%
i) 61%
ii) 85%
Not applicable
Qualitative and
Quantitative
Assessment
Conducted
Qualitative and
Quantitative
Assessment
Qualitative and
Quantitative
Assessment
Conducted
Not applicable
A comprehensive baseline assessment was collected in 2014.

The first key element is human resources/recruitment. 13 out
of 19 organizations recruited staff/focal points to implement
AEI and CS systems and practices. 2015 results matrix will
document the level of improvement of the system and
practices.
37% attending the annual CTHP review workshop were
women: 68 women of 185 participants
62

3
Number of operational research studies and

case studies produced and disseminated
10
13
Number of policy dialogue and technical and

strategic forums where 3MDG Fund results are
presented and discussed
14
At least 3 per
year
18
32
2014 studies include one MNCH, three malaria and three

health system strengthening studies.
* Barriers to exclusive breastfeeding in Ayeyarwady Region in
Myanmar: Qualitative finding from Mothers, Grandmothers
and Husbands
* Improving maternal, neonatal and child health in Myanmaroptimizing the role of the AMW cadre. Lessons to support a
national scale-up (reported in 2013 but published in 2014)
* Situational analysis on drug use, HIV and the response in
Myanmar
*Situational analysis on HIV among female sex workers and
their clients in Myanmar
* National HIV Legal Review
* Entomological Study (vector bionomics) and insecticide
susceptibility in 3 new areas
* Day 3 parasitaemia
* Behavioural study of population at risk in Tier 1 and 2 areas
* Strategic framework for engagement of the non-public
sector in Myanmar
* National supply chain baseline in Myanmar
* Health in Transition series (HiTs)
Forums include: SCGs, TSGs/TWGs, official workshops,
conferences, central/state/region meetings and partner
forums. Incomplete and delayed reporting leads to an
underestimated achievement.
Note:
a) Target figures are as of 3MDG LF Version 3 approved by Fund Board at December 2014.
b) Denominator are based on 2014 annual HMIS data. Adjustment done for those townships with an implementation period <12 months during 2014.
c) Coverage % is based on the specific denominator figures (HMIS or Model based calculation)
63
Annex 4 - New grants signed Jan to Dec 2014

COMPONENT 1 - MATERNAL, NEWBORN AND CHILD HEALTH
Sector
Implementing partner (IP)
Project Title
Start date
Total
Amount
(US$)
End Date
Scale up services in conflict affected areas

MNCH
IRC International Rescue Committee
Supporting implementing Maternal Newborn and Child

Health services (MNCH) in Kayah State
01/07/2014
31/12/2016
891,740
MNCH
RI

Health services (MNCH) in Southern Shan State
01/12/2014
31/12/2016
1,742,116
MSI private sector MNCH project
01/01/2014
31/12/2016
7,277,005
Relief International
Support to health care in Special Regions

-
Strengthening service delivery both public and private

MNCH
MSI
MNCH
MNCH
PSI Population Services International

PSI private sector MNCH project

Myanmar MNCH Project in Chin State
01/01/2014
01/02/2014
31/12/2016
31/12/2016
8,368,884
5,939,327
MNCH
MSI
Marie Stopes International (MSI) Maternal, Newborn, Child

Health (MNCH) Project in Magway Region
01/02/2014
31/12/2016
5,516,726
MNCH
SC Save the Children
The Save the Children Fund Magway Region MNCH Project
01/02/2014
31/12/2016
4,121,689
MNCH
PSI Contraceptive Procurement Project
18/03/2014
31/12/2015
1,620,100
Improved Midwifery for Maternal, Newborn and Child Health

Services
01/07/2014
31/12/2016
10,000,000
3MDG contribution to the Family Planning Best Practice

Conference
12/06/2014
31/07/2014
32,225
Support to the Ministry of Health Human Resource for Health Strategy

MNCH
JHPIEGO - Johns Hopkins Program for

International Education in Gynaecology
and Obstetrics

MNCH
MPCL - Myanmar Partners Co. LTD
Evidence base for national MNCH Strategies

-
COMPONENT 2 - HIV, TB and Malaria

Sector
Project Title
Start date
Total
Amount
(US$)
End Date
Support to the National Strategic Plan on HIV/AIDS (Harm Reduction)

HIV
BI-MM
Burnet Institute Myanmar
Enhancing education and health services to reduce harms related to drug

use
01/04/2014
31/12/2016
1,002,106
HIV
MANA - Myanmar Anti-Narcotics Association
Comprehensive HIV prevention and care among drug users with effective
harm reduction intervention
01/04/2014
31/12/2016
4,398,398
HIV
SARA - Substance Abuse Research Association
Consolidating the momentum to develop the capacities of communities to

deliver HIV and drug abuse prevention and support activities in high-risk
townships of Kachin Region
01/04/2014
31/03/2015
566,039
Support to the National TB Strategy (ACF and MDR-TB)

TB
MAM - Medical Action Myanmar
TB ACF in Hard to Reach areas
01/04/2014
31/12/2016
1,846,452
TB
MHAA - Myanmar Health Assistant Association
MHAA TB ACF Project
01/04/2014
31/12/2016
2,026,866
TB
MMA - Myanmar Medical Association
MMA ACF TB PROJECT
01/04/2014
31/12/2016
2,132,299
TB
NTP National TB Program
Scaling up of active case finding activities
01/04/2014
31/12/2016
3,827,245
TB
PSI
Accelerated TB active case finding among urban slum dwellers and clients
of MNCH services
01/04/2014
31/12/2016
4,090,659
TB
UNION
Program to Increase Catchment of Tuberculosis Suspects (PICTS) 2
01/05/2014
31/12/2016
1,371,041
TB
WHO - World Health Organisation
Technical support for TB Care and prevention activities
15/09/2014
31/12/2016
586,962
TB
NTP - National TB Program
Implementation of a Grant in Myanmar provided by the Three Millennium

Development Goal Fund
01/10/2014
31/12/2016
11,445,870
Malaria services for most hard to reach populations
01/04/2014
31/12/2016
1,760,520
Population Services International
Support to the National Malaria Strategy

Malaria
Malaria
Malaria
BI-MM
Malaria MARC project
01/04/2014
31/12/2016
5,805,767
MHAA - Myanmar Health Assistant Association
Community-based malaria prevention, control and MARC project
01/04/2014
31/12/2016
976,776
Malaria
PSI - Population Services International
Containment of Artemisinin Resistance in Eastern Myanmar
01/04/2014
31/12/2016
2,714,800
Malaria
WC World Concern
Strengthening of Prison Healthcare
MARC project
01/04/2014
31/12/2016
1,860,463
65

Integrated HIV/AIDS, TB, Malaria
Integrated
AHRN - Asian Harm Reduction Network
Harm Reduction and HIV/TB Health Promotion Services for PWID/PWUD

and their partners & household members
01/04/2014
31/12/2016
8,493,786
COMPONENT 3 - Health Systems Strengthening

Sector
Project Title
Start date
Total
Amount
(US$)
End Date
Governance and Stewardship

UN joint assistance to strengthen health systems in
Myanmar
07/11/2014
31/12/2016
1,335,592
Human Resources for Health
MNCH
Implementation of a Grant in Myanmar provided by the

01/11/2014
31/12/2015
1,947,655
National Supply Chain Baseline
19/03/2014
15/11/2014
249,397
HSS
UNAIDS - United Nations Programme on

HIV/AIDS
Support to evidence base strategy and policy
MOH
Ministry of Health
Systems Support
HSS
PFSCM - Partnership for Supply Chain

Management
Community Engagement
HSS
HAP International
Provision of HAP Technical Support for Implementation of

the 3MDG Accountability, Equity and Inclusion (AEI)
Framework in Myanmar
24/03/2014
31/12/2016
1,980,276
HSS
PACT Institute
Organizational capacity development for 3MDG local

NGO/CBO Implementing Partners
20/10/2014
31/03/2015
126,964
66
Annex 5 - All grants signed since inception

COMPONENT 1 - MATERNAL, NEWBORN AND CHILD HEALTH
Sector
Scale up services in conflict affected areas

MNCH
MNCH
RI
Support to health care in Special Regions

-
Project Title
Start date
End Date

Health services (MNCH) in Kayah State
01/07/2014
31/12/2016
891,740

Health services (MNCH) in Southern Shan State
01/12/2014
31/12/2016
1,742,116
01/01/2013
31/12/2016
7,963,685
Medecins Du Monde MNCH Project in the Ayeyarwady

Region
01/01/2013
31/12/2016
5,455,954
Strengthening service delivery both public and private

IOM International Organisation for
International Organization for Migration MNCH Project in
MNCH
Migration
the Ayeyarwady Region
Medecins du Monde
Total
Amount
(US$)
MNCH
MdM
MNCH
Merlin - Medical Emergency Relief

International
Medical Emergency Relief International MNCH Project in

the Ayeyarwady Region
01/01/2013
31/12/2015
6,332,803
MNCH
RI
Relief International MNCH Project in the Ayeyarwady

Region
01/01/2013
31/12/2016
6,514,319
MNCH
SC - Save the Children
The Save the Children Fund MNCH Project in the

Ayeyarwady Region
01/01/2013
30/06/2016
3,805,357
MNCH
DRC
Development of Township Health Plan in Mindat and

Madupi Townships in Chin State
01/09/2013
31/12/2016
5,355,171
MNCH
Merlin - Medical Emergency Relief

International
Development of Township Health Plan in Falam and Tedim

Townships in Chin State
01/09/2013
31/12/2016
13,222,074
MNCH
MSI
MSI private sector MNCH project
01/01/2014
31/12/2016
7,277,005
MNCH
PSI private sector MNCH project
01/01/2014
31/12/2016
8,368,884
MNCH
Myanmar MNCH Project in Chin State
01/02/2014
31/12/2016
5,939,327
MNCH
MSI
Marie Stopes International (MSI) Maternal, Newborn, Child

Health (MNCH) Project in Magway Region
01/02/2014
31/12/2016
5,516,726
Danish Red Cross
67
MNCH
SC Save the Children
The Save the Children Fund Magway Region MNCH Project

01/02/2014
31/12/2016
4,121,689
MNCH
PSI Contraceptive Procurement Project
18/03/2014
31/12/2015
1,620,100
01/07/2014
31/12/2016
10,000,000
12/06/2014
31/07/2014
32,225
Support to the Ministry of Health Human Resource for Health Strategy

JHPIEGO - Johns Hopkins Program for
Improved Midwifery for Maternal, Newborn and Child
MNCH
International Education in Gynecology and Health Services
Obstetrics
MNCH
MPCL - Myanmar Partners Co. LTD
Evidence base for national MNCH Strategies
-
3MDG contribution to the Family Planning Best Practice

Conference
-
COMPONENT 2 - HIV, TB and Malaria

Sector
Project Title
Support to the National Strategic Plan on HIV/AIDS (Harm Reduction)

HIV
ASG - AIDS Support Group
HIV Spread Free Zone
Total
Amount
(US$)
Start date
End Date
01/01/2013
30/06/2013
39,916
01/01/2013
31/12/2013
130,540
01/01/2013
31/12/2014
707,763
HIV
BS - Black Sheep Peer Support Group
HIV
Malteser International
Harm Reduction Care and Support for (Injecting) Drug

Users
Prevention and Treatment of Sexually Transmitted
Infections and HIV/AIDS in Wa Special Region II and Shan
Special Region IV Shan State Myanmar
HIV
MANA - Myanmar Anti-Narcotics

Association
Comprehensive HIV prevention and care among drug users

with effective harm reduction intervention
01/01/2013
31/03/2014
640,060
HIV
MHT - Mahaythi Women's Development

Cooperative
HIV/AIDS Prevention, Treatment,Care & Support for Poor

and Marginalised Female Youth
01/01/2013
30/06/2013
45,247
HIV
RMO - Ratana Metta Organization
Treatment, Care and Support for People Living With

HIV/AIDS (PLHIV)
01/01/2013
30/06/2013
70,000
HIV
SARA - Substance Abuse Research

Association
Scaling-up the capacities of communities to deliver HIV and

drug abuse prevention and support activities in high-risk
townships of Kachin and neighbouring regions
01/01/2013
31/03/2014
631,663
68

15/07/2013 30/06/2016
1,865,757
HIV
UNAIDS United Nations Programme on

HIV/AIDS
Addressing policy, legal and social barriers in order to

expand and improve HIV prevention for people who inject
drugs, people engaged in sex work and men who have sex
with men and transgenders in Myanmar.
HIV
UNODC United Nations Office on Drugs

and Crime
Expanding access to HIV prevention services among people

who inject drugs
01/09/2013
31/07/2015
912,700
HIV
BI-MM
Enhancing education and health services to reduce harms

related to drug use
01/04/2014
31/12/2016
1,002,106
HIV
MANA - Myanmar Anti-Narcotics

Association
Comprehensive HIV prevention and care among drug users

with effective harm reduction intervention
01/04/2014
31/12/2016
4,398,398
HIV
SARA - Substance Abuse Research

Association
Consolidating the momentum to develop the capacities of

communities to deliver HIV and drug abuse prevention and
support activities in high-risk townships of Kachin Region
01/04/2014
31/03/2015
566,039
01/07/2013
30/06/2014
261,574
Support to the National TB Strategy (ACF and MDR-TB)

TB
WHO World Health Organisation
Sustaining MDR-TB management in Myanmar
TB
TB ACF in Hard to Reach areas
01/04/2014
31/12/2016
1,846,452
TB
MHAA TB ACF Project
01/04/2014
31/12/2016
2,026,866
TB
MHAA - Myanmar Health Assistant

Association
MMA ACF TB PROJECT
01/04/2014
31/12/2016
2,132,299
TB
NTP National TB Program
Scaling up of active case finding activities
01/04/2014
31/12/2016
3,827,245
TB
Accelerated TB active case finding among urban slum

dwellers and clients of MNCH services
01/04/2014
31/12/2016
4,090,659
TB
UNION
Program to Increase Catchment of Tuberculosis Suspects

(PICTS) 2
01/05/2014
31/12/2016
1,371,041
TB
Technical support for TB Care and prevention activities
15/09/2014
31/12/2016
586,962
TB
NTP - National TB Program

01/10/2014
31/12/2016
11,445,870
MARC Support to Participatory Prevention of Malaria

Among Vulnerable Communities Project
01/01/2013
31/03/2014
270,853
Community-based Artemisinin Resistance Containment for

Mobility-impacted Communities in Mon state
01/01/2013
31/03/2014
1,021,005
Support to the National Malaria Strategy

CDA - Community Development
Malaria
Association
Malaria
IOM International Organisation for

Migration
69

01/01/2013
31/03/2014
519,642
Malaria

Association
Community-based malaria prevention, control and MARC

Project
Malaria
Quality Diagnosis and Standard Treatment of Malaria
01/01/2013
31/03/2014
426,541
Malaria
01/01/2013
31/03/2014
2,175,310
Malaria
WC
Myanmar Artemisinin Resistant Containment (MARC)
01/01/2013
31/03/2014
184,001
Malaria
National Malaria Control Programme including Artemisinin

Resistance Containment
01/01/2013
30/06/2014
5,872,110
Malaria
3MDG Fund Flow Mechanism
01/06/2013
31/08/2014
423,399
Malaria
University of Oxford
01/09/2013
31/08/2015
697,419
Malaria
CPI - Community Partners International
Economic-epidemiological modeling to support the

containment of artemisinin resistance in the MARC regions
of Myanmar (MARCMOD)
16/09/2013
30/09/2015
3,000,164
Malaria
MHDC - Myanmar Health & Development

Consortium
Development of private public partnership (PPP) research

products
25/09/2013
31/01/2014
30,000
Malaria
Optimising operational use of artemether-lumefantrine
05/11/2013
31/07/2015
163,236
Malaria
BI-MM
Malaria services for most hard to reach populations
01/04/2014
31/12/2016
1,760,520
Malaria
Malaria MARC project
01/04/2014
31/12/2016
5,805,767
Malaria

Association
Community-based malaria prevention, control and MARC

project
01/04/2014
31/12/2016
976,776
Malaria
01/04/2014
31/12/2016
2,714,800
Malaria
WC
01/04/2014
31/12/2016
1,860,463
World Concern
World Concern
MARC project
Strengthening of Prison Healthcare

-
Integrated HIV/AIDS, TB, Malaria

Integrated AHRN - Asian Harm Reduction Network
Integrated
PDO - Phaung Daw

Education Affiliation
Oo
Monastic
Harm Reduction and HIV/TB Health Promotion Services to

(Injecting) Drug Users
Paung Daw Oo Jivaka Integrated HIV/AIDS, Malaria, TB
01/01/2013
01/01/2013
31/03/2014
1,653,902
31/06/2013
63,954
70

Integrated
AHRN - Asian Harm Reduction Network
Harm Reduction and HIV/TB Health Promotion Services for

PWID/PWUD and their partners & household members
01/04/2014
31/12/2016
8,493,786
Start date
End Date
Reimbursable Advisory Services Agreement
29/05/2013
28/05/2016
2,228,000
UN joint assistance to strengthen health systems in

Myanmar
07/11/2014
31/12/2016
1,335,592
Technical support to the Government of Myanmar efforts to

develop and implement evidence based health sector
policies in support of Universal Health Coverage
01/04/2013
30/06/2015
97,846
Framework for Private Health Sector Engagement in

Myanmar
31/10/2013
30/04/2014
105,662

01/11/2014
31/12/2015
1,947,655
National Supply Chain Baseline
19/03/2014
15/11/2014
249,397
Provision of HAP Technical Support for Implementation of

the 3MDG Accountability, Equity and Inclusion (AEI)
Framework in Myanmar
Organizational capacity development for 3MDG local
NGO/CBO Implementing Partners
24/03/2014
31/12/2016
1,980,276
20/10/2014
31/03/2015
126,964
COMPONENT 3 - Health Systems Strengthening

Sector
Project Title
Governance and Stewardship

HSS
WB
World Bank
HSS
UNAIDS - United Nations Programme on

HIV/AIDS
Support to evidence base strategy and policy

HSS
HSS
UCSF - The Regents of the University of

California
Human Resources for Health

MNCH
MOH Ministry of Health
Systems Support
PFSCM - Partnership for Supply Chain
HSS
Management
Community Engagement
HSS
HAP International
HSS
PACT Institute
Total
Amount
(US$)
71
Annex 5 - Financial status
The Three Millennium Development Goal Fund

Fund Management Office - UNOPS
No. 12(O), Pyithu Lane, 7 Mile
Mayangone Township, Yangon, Myanmar
T +95 1 657 278, 657 280-7, 657 703-4
3mdg.org
@3MDGfund

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2014

January to December 2014

3MDG Annual Report - January to December 2014

All costs are in United States Dollars ($) unless

3MDG Annual Report - January to December 2014

HEALTH OUTREACH ACTIVITIES IN AYEYARWADY REGION / INTERNATIONAL ORGANIZATION FOR MIGRATION

3MDG Annual Report - January to December 2014

During 2014 3MDG also initiated a strategic review

3MDG Fund Board Chair

3MDG Annual Report - January to December 2014

3MDG RESULTS AT A GLANCE

Maternal, Newborn and Child Health

PEOPLE WHO INJECT

PEOPLE WHO INJECT DRUGS

NEEDLES AND SYRINGES

PEOPLE SCREENED FOR

* Programme behind targets due to delay in start up in October 2014

PEOPLE TESTED FOR

** Cases of malaria falling faster than predicted.

NOTIFIED CASES FOR TB

PEOPLE TREATED FOR

3MDG Annual Report - January to December 2014

HEALTH SERVICE COVERAGE

In addition to this map 3MDG funds nationwide

Maternal, Newborn and Child Health

Tuberculosis (ACF, MDR-TB)

3MDG Annual Report - January to December 2014

2014 PROGRESS AND ACHIEVEMENTS

As of the end of 2014, 3MDG has achieved significant

Key maternal, newborn and child health targets set by

3MDG Annual Report - January to December 2014

Multi-Drug Resistant Tuberculosis (MDR-TB): MDR-TB is a

Whilst containment programmes remain vital as part of

Malaria: During 2014, almost 500,000 people suspected

FIGURE 1: 3MDG KEY PROGRAMMATIC AREAS

Scale up of services in conflict

Support to the National Strategic

Governance and stewardship

MNCH quality improved

3MDG Annual Report - January to December 2014

FIGURE 2: 2014 KEY RESULTS AGAINST TARGETS

Post-natal and newborn care

Referrals for emergency

FIGURE 3: 2014 KEY RESULTS AGAINST TARGETS

Needles and syringes

People who inject drugs given

Nbr of referrals to TB clinics

Number of confirmed malaria

COVERED BY MOBILE OUTREACH

3MDG Annual Report - January to December 2014

HEALTH SYSTEMS STRENGTHENING

Contributions to health systems strengthening are

WORKING TOGETHER TOWARDS UNIVERSAL

The 3MDG Fund Board has accepted the reviews

maternal, newborn and child health as well as health

2014 FINANCIAL STATUS

In light of the Strategic Review the 3MDG Fund Board

3MDG Annual Report - January to December 2014

AN AUXILIARY MIDWIFE CONDUCTS A HEALTH CHECK ON A CHILD IN AYEYARWADY REGION / 3MDG

3MDG Annual Report - January to December 2014

ABOUT THE 3MDG FUND

Design work on the 3MDG Fund commenced in 2010 with

the implementation of their health workforce strategy;

3MDG FUND APPROACH AND PRINCIPLES