Health service readiness, availability, and utilization of primary health care facilities for non-communicable diseases in Shan State, Myanmar

Abstract

The main purpose of this study was to determine the health service readiness, availability, and utilization of primary health care (PHC) facilities for non-communicable diseases (NCDs) in Shan state, Myanmar. A cross-sectional survey was employed among 242 PHC facilities (48 rural health care centers; RHCs and 194 sub-rural health care centers; S-RHCs) of three districts (Taunggyi, Loilem, Linkhae) in southern Shan state, Myanmar. A questionnaire was an instrument based on the world health organization (WHO) package of essential non-communicable diseases intervention (PEN) assessment tool and framework of WHO six-building blocks of the health system for data collection. Validity of instrument by index of item-objective congruence value was 0.67-1 and reliability by Kuder–Richardson formula 21 value was 0.5-0.75.

The results shown that, in NCDs capacity readiness, about 80% of RHCs were readiness for health workforces except public health supervisor grade (I) 27.1% and about 75% of S-RHCs were readiness for workforces. 88.4% of health facilities were readiness for health information system, 87.6% were readiness for medicines, 97.9% were readiness for equipment and 83% were readiness for governance. But just 2.5% of health facilities were readiness for finance. When comparing the NCDs capacity readiness by Chi-square or Fisher’s exact test, the results found that readiness of health workforces in S-RHCs, readiness of health information system, readiness of essential medicines and equipment, and readiness of governance, were significantly (P value < 0.05) different among three districts. NCDs service availability was compared among three districts by Chi-square was significantly (P value = 0.046) different among districts. 77.3% of health facilities were available for health services. NCDs service utilization consisted of screening rate, referral rate, and new patient rate, was compared among three districts by Kruskal-Wallis test. Screening rate and new patient rate, were significantly (P value = 0.04 and P value = 0.041 respectively) different among districts. Multiple comparisons for utilization rates were compared between three pairs of districts (Taunggyi and Loilem, Loilem and Linkhae, Taunggyi and Linkhae) by Mann-Whitney test. Between Taunggyi and Linkhae, new patient rate was significantly (P value = 0.006) higher in Linkhae district. Between Taunggyi and Loilem, screening rate and referral rate were nearly significant (P value = 0.045 and P value = 0.017) higher in Loilem. Between Linkhae and Loilem, screening rate was nearly significant (P value = 0.044) lower in Linkhae.

In conclusion, health workforces were readiness in 80% of RHCs and more than 90% of available health workforces from RHCs had already got training. Midwife was readiness in almost all S-RHCs but public health supervisor grade (II) was readiness in about 90% of S-RHCs from Taunggyi districts and only 60% of S-RHCs from Loilem and Linkhae districts. Training of available health workforces from S-RHCs was less percentage than RHCs. Health information system was readiness in about 87.6% of health facilities. For essential medicines, medicines for hypertension and diabetes were more readiness than other medicines. Essential equipment was readiness in more than 97% of health facilities. According to compare the health service readiness, availability, and utilization of PHC facilities for NCDs, NCDs capacity readiness and NCDs service availability were higher in Taunggyi district and NCDs service utilization was higher in Loilem and Linkhae districts.

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