Improving primary healthcare in Myanmar

'I cannot pick which one is my favourite, as I think all these activities are really important to the community.' Ma Nilar Soe, a 37-year old auxiliary midwife, talks about her work as a Village Health Committee (VHC) member. Because of her high school education, her work and her passion to improve health in the community, she was nominated to become a member of the VHC.

As a VHC volunteer she has many tasks. She provides health education sessions to cover topics related to hygiene, nutrition or specific diseases. To ensure people attend the sessions, she uses her networking skills, sometimes involving the village leader. She also organises group discussions, or provides individual counselling on reproductive health for young men and women, for example advising a woman who survived rape to take emergency contraception at the health facility.

As a trained auxiliary midwife she attends about 5 deliveries per year, assisted by a traditional birth attendant. With her knowledge she is able to correct some of the customary practices, such as applying pressure to the abdomen during delivery, or using unclean threads to tie the umbilical cord. She fondly remembers when she referred a woman in labour to the clinic but she and her colleague had to deliver the babies on the way there. The woman gave birth to twins and seeing her and her babies alive and well was 'a very delightful moment for me'.

The VHC manages an emergency referral system and a community fund to support people financially. This helps them to overcome one of the most important obstacles in emergencies: transportation costs. After patients are discharged from the health centre, they pay back into the community fund. Soe particularly remembers the case where she referred a patient with gastrointestinal perforation, because 'the doctor said he would have died if he had come 2 hours later'.

In 2018 the VHC managed to keep the village free of dengue fever, a major improvement on the year before when they saw many cases. Ma Nilar Soe  took preventative measures, chlorinating water containers and other sources which raised community awareness, so people started to request this. Another highlight of her work is assisting the midwife in immunisation. Every month, she organises people to come, even those who live far away on the edge of the forest. She is proud that the people trust the VHC more and they get their children immunised. 'Nowadays, every child in our village is immunised', she said.

Through the programme Ma Nilar Soe received refresher training on many topics, such as delivery care, nutrition, health education practices. 'I never really knew that pregnant women with diabetes mellitus should be referred to the health centre, but I learnt this in our refresher training'. Regular meetings with the rural health centre also help to keep her knowledge up-to-date. But mostly she feels that her training and participation in the VHC have helped her personal development. 'I am now more confident to provide health care services. And I’ve become more empowered to talk in public. I have gained more knowledge on health and I am able to share my knowledge with the villagers'.