FORMAT FOR REPORTING - World Health Organization



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World Health Organization

Progress Report to the Department of International Development (DFID) on the WHO Project

Health Coordination at Myanmar-Thailand Border

June 2002

BASIC DATA SHEET

Name of the Agency

The World Health Organization

Project Name

Health Coordination at Myanmar-Thailand Border

Duration of Project

Ongoing

Date of Pledge -- 28 November 2000

Date Contribution Received – 23 January 2001 (#04009308)

Project Cost

$384,780 contributed by DFID

Purpose and Key Outputs

To improve the health of the population in the border areas of Myanmar and Thailand with special focus on the health and humanitarian aspects of the migrant population.

Outputs of the Project are:

• Facilitated interactions between government and international workers who address the needs of the migrant population from Myanmar, temporarily living in Thailand.

• Made 17 field visits and participated in more than 200 meetings.

• Provided technical support to partners; distributed more than 600 WHO publications free of charge to border health workers.

• Sponsored SPHERE best-practices training for border workers

• Working with MOPH and international organizations, strengthened border health surveillance system and data collection and sharing within camps.

• Working with MOPH and international organizations, began plans to better assess the health of the migrant population outside the camps.

• Developed inventories of border health assessments and began creation of searchable data base

• Participated in cross-border meetings

Meetings of the Thailand and Myanmar Minister of Health at Tachilek/Mae Sai

Meetings of the Thailand and Myanmar Ministers of Health at Ranong/Kawthoung

• Facilitated preparation of joint Thailand/Myanmar Global Fund proposal

• Coordinated with IOM and MOPH in submission of proposal for provision of primary health care, reproductive health services and health information system for migrants

• Developed inventories of international organizations working in the border area and began creation of searchable data base

• Held border-wide coordination meeting for MOPH, other government agencies, NGOs and other international organizations working in the border area

Status of Report - Interim Progress Report

Flagged Issues

A large area within Myanmar, bordering Thailand, is not easily accessible to the Myanmar government or internationals and is nominally under control of several armed insurgent groups. Only a very few NGOs are able to operate in this border area of Myanmar.

In addition, continuing conflict between the Myanmar and Thailand governments, as well as between several large well-armed armies of ethnic-identity political action groups, makes cross-border activities challenging. All official Thai/Myanmar border crossings have been closed since May 23, 2002.

A large proportion of the migrant population who have come into the Thailand border area from Myanmar do not have legal status. Because of this, in addition to financial, cultural and geographic barriers, they are often reluctant to utilize public health services for fear of being deported. The lack of immunization and other potential public health risks are a serious concern.

Given the political situation, continued coordination among the Thai government and international agencies is needed to try to address the public health risks posed by the migrant population to themselves, as well as to Thai citizens.

Narrative Report

Pushed by internal conflict and drawn by economic opportunity, an increasing number of citizens from Myanmar have crossed the border into Thailand. Numbers have increased during the last two decades. The total number of migrants in Thailand is currently estimated at more than 1 million. The majority live in the ten provinces bordering Myanmar. Currently, the ten border provinces are the homes for about 110,000 officially displaced persons living in nine border camps, 163,000 registered workers with work permits and legal rights to remain in Thailand, and an estimated 300,000 to 500,000 unregistered migrants.

The Thai Government has pursued a positive humanitarian policy towards the growing migrant population, and support has also come from agencies working in the border area. While the health needs of the camp residents are addressed by NGOs and while the registered workers have access to government health services, the large number of unregistered migrants experience financial, security, cultural, language and geographic barriers in obtaining health services. NGOs have limited access to work outside the camps, and security concerns prevent many migrants from seeking care within the Thai government system. The mobility of the population, combined with access barriers, is producing increased morbidity and mortality. Addressing these public health challenges is difficult.

In July 7-9 of 2000, the Health Ministers of Myanmar and Thailand, along with other public health leaders of both countries, held a meeting in Chiang Mai, Thailand, to discuss border health issues between the two countries and identify strategies for disease control. A “Joint Action Plan for the Myanmar-Thailand Health Collaboration at the Border” was produced, and WHO funded several interventions implemented by the Thailand Ministry of Public Health. These programs target malaria, tuberculosis and HIV/AIDS in four border provinces in Thailand and are due to be completed in July of 2002.

In 2001 DFID funds were used to establish the Border Health Program, a complementary activity to the Joint Action Plan. This program, under the technical supervision of WHO’s Division of Emergency and Humanitarian Action, has the following objectives:

1. Achieving a better understanding of the health situation of the migrant population and determinants for disease patterns.

2. Disseminating health information and analysis on the health situation.

3. Strengthening the coordination of health initiatives to address the specific health problems in the border areas with specific attention to malaria, control of tuberculosis and HIV/AIDS & sexually transmitted diseases.

4. Assuring public health best practices adoption, that humanitarian assistance provision is in line with recommended health policies of the national health authorities and WHO.

5. Advocating and negotiating for secure humanitarian access as integral parts of public health promotion.

Activities of the Border Health Program during the project’s inception to June 2002 can be categorized as follows:

1. Assessing the health status of the border area.

Field Visits – Seventeen field visits were made to the border provinces, visiting provincial health offices, vector-borne disease units, government clinics and hospitals, NGOs, factories, detention centers, camps for displaced persons, and migrant communities, gathering information and assessing the situation. Because of security issues, field visits to Myanmar were limited to Yangon and the border towns of Tachilek, Myawaddy, and Kawthoung. In Yangon meetings were held with international organizations working on the Thailand border of Myanmar, as well as with UN agencies, WHO Myanmar and the Myanmar MOPH.

Reports – Following each field visit reports, with findings, were produced. Needs were identified during these visits, and attempts were made to address needs.

Situational Analysis - Consultant (Steven Lanjouw) produced a situational analysis of border provinces. This report is under review by the Thailand MOPH. If approved, it will be distributed.

Health Statistical Report of Camp Population - WHO supported CCSDPT in the production of an annual health statistical report, containing demographic data and vital statistics, from all border camps in Thailand.

2. Strengthening the mechanism for health assessment and surveillance of the displaced population in the border area.

Inventory of Assessments - An inventory of assessments and studies conducted in the border area by international organizations and the Thai government has been collected and compiled. This will be expanded, and a searchable data base will soon be available.

Standardization of data collection system in camps. WHO supported the MOPH and NGOs in the creation of a standardized health data collection form, process and case definitions for organizations working in the border provinces. The system has been agreed upon and adopted by both the MOPH and NGOs. As they are standardized, the health statistics of the camps can now be compared.

Standardization of data collection outside camps. WHO has supported several meetings to address the need for a standardized data collection system of the migrant population outside the camps. Currently, the Thailand MOPH is reviewing survey tools used by an NGO to survey the migrant population outside the camps. The MOPH plans to make a recommendation for a common survey tool(s). A coordination meeting with all relevant players will be held on this issue in Bangkok in September. The meeting, hosted by WHO, will also be an opportunity for information sharing.

3. Strengthening the mechanism for border health coordination

Facilitated interactions between MOPH and international organizations. WHO facilitated greater interaction between the Ministry of Public Health and international organizations working on the border by arranging the MOPH’s participation in NGO coordination meetings, helping to arrange the participation of international organizations in MOPH meetings, sharing information, and serving as a contact point for health issues. The MOPH and international organizations have worked together effectively on a number of issues. For example, a meeting was held with NGOs and the MOPH regarding the typhoid/dengue outbreak in TamHin Camp.

Meetings with MOPH and international organizations -- BHPO participated in more than 200 meetings related to border health issues.

Border-wide Meeting – About 100 people attended a 2-day collaborative meeting on March 11-12, 2002. The objective of the meeting was; 1)to share information on the border situation and on activities of organizations working in the Thailand/Myanamar border area; 2)to distribute technical information particularly on malaria, HIV/AIDS and tuberculosis; and 3)to identify issues for potential cross-border activities and cooperation in the future.

The meeting was attended by representatives from all ten provincial health offices, the Ministry of Public Health in Bangkok, the Ministry of Interior, Ministry of Labor and Social Welfare, UN agencies, NGOs and other organizations working on the border areas of Thailand and Myanmar. The next meeting is tentatively scheduled for October in another border province.

Group identification of needs and potential activities -- At the Border Health meeting in March, participants self-selected and joined one of three groups: HIV/AIDS/tuberculosis, malaria or polio/immunization. For five hours government representatives, UN agencies and NGOs discussed obstacles and possible solutions in reducing mortality and morbidity. Results were recorded on three Power Point presentations.

Inventory of Border Organizations – A list of organizations working in the border area has been created. This list describes the activities and objectives of organizations, as well as identifying their targeted populations. The list is being expanded, and a searchable data base is scheduled to be available in August.

4. Providing technical support to border health workers.

Distribution of WHO technical materials. Approximately 600 WHO technical publications were distributed to organizations working in the border area. In addition, WHO responded to numerous technical questions regarding immunization, nutrition, reproductive health, dengue, rabies, etc.

Sphere Training – WHO sponsored SPHERE training in minimal humanitarian standards for organizations working in the border area. Participants in the workshop included NGOs, UN agencies and the MOPH. An evaluation of the workshop is attached.

Border Health Publications - Along with MSF, SMRU and other organizations working on the border, WHO serves in an advisory capacity for Health Messenger, a quarterly publication for health workers in the border area. WHO routinely contributes technical material for use by the editor.

EHA Presentations – WHO gave four presentations on the topic of Emergency Humanitarian Action. Presentations were given at the MOPH Field Epidemiology Training Program (Emergency Surveillance), the Asian Disaster Preparedness Center (Emergency Surveillance and Emergency Reproductive Health) and SEARO’s Intercountry Workshop on Management of Anthrax.

5. Supporting initiatives for addressing identified needs in the border.

Primary Health Care – WHO provided support to IOM and the MOPH in the development of a project providing primary health care services to the migrant population in the border areas.

Global Fund Joint Proposal - WHO supported and helped facilitate the preparation of a Thai/Myanmar Global Fund proposal for border area activities. Thailand MOPH representatives traveled to Yangoon, Myanmar, for three days in Febraury. With WHO, the two Ministries of Health jointly worked on a proposal. Additional work was done during the Ranong/Kawthoung retreat. The time from start to completion of the proposal was 17 days. Though funding was not received, preparation of a Global Fund proposal offered an opportunity in a non-threatening way for the two countries to come together to discuss border health issues and build relationships. A number of border health issues were discussed while the two countries worked on the Global Fund proposal.

Plans were made to resubmit the proposal addressing the lack of specific cross-border activities. Another joint meeting was planned, but because of the political situation it may not be possible at this time. Continued efforts will be made when it becomes feasible.

Situation re-assessment

• As a result of this project, more information on the health situation in the border area is available. Assessment reports and situational analyses following field visits have been disseminated within WHO and the MOPH.

• Progress has been made and cooperation continues to build in the collection, compilation and sharing of information on border activities.

• As a result of this project, there have been improvements in the standardized process of data collection and information sharing on the migrant population, with a coordinated approach by the MOPH and international organizations. Progress continues towards a systematic, standardized and coordinated approach to data collection on the migrant population outside the camps.

• There have been coordinated activities related to border health between the government and international organizations. A structure for coordinating information and activities in the border area has been established through the beginning of regular border-wide health meetings, attended by all relevant players.

• Due to the distribution of WHO technical information to all Provincial Health Offices and all international health-related organizations working in the border provinces and Sphere training, border health workers have more technical information for doing an effective job.

• There has been positive and useful interaction with the Myanmar Ministry of Health and limited cross-border trips. Structured discussions continue towards the eventual implementation of cross-border activities.

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