This document summarizes the implementation of a package tour by midwives to provide health services in remote villages in Myanmar. The midwife describes traveling long distances by public bus, cycle taxi, and walking for 7 hours to reach Bawgahta subcenter. Health services like antenatal care, immunizations, weighing children, and health education are provided through group activities. Strengths include providing multiple services in one visit and reaching unserved villages. Constraints include the time needed to gather communities, lack of cooperation from village authorities, difficult travel during rainy season, inadequate supplies, and missed deliveries while traveling between villages.

1. Implementation of package tour
Experience sharing by Midwife
Daw Khin Myo Win
Midwife
Bawgahta Subcenter
Boe Ma RHC

2. Background
• Boema RHC is 60 miles away from Pyinmanar Township.
• There are 4 sub-centers and 25 villages under Boema RHC.
• All the villages are hard to reach and situated on the hills.
• Population residing are mostly Kayan and Kayin races.
• Social barrier and financial barrier are also present .

3. Bawgahta sub-center is 20 miles away from Boema RHC
To reach Bawgahta subcenter from Pyinmanar--•First travel by public bus to
Yeni from Yedarshe
township,
• from there by cycle taxi to
Yepu subcenter of Boema
RHC for night stop
•and then walk for 7 hours
in the next morning to reach
Bawgahta SC.

4. Package of Services
• Started in January to April 2012 according to CTHP .
• Service package cannot be conducted in rainy season.
• Two groups of BHS - (4) in each group
HA + 1 MW +1 PHSII + 1 AMW in one group
LHV + 2 PHSII + 1 AMW in other group
• Also plan to deliver package of service in November and
December, 2012

5. Package of Services

6. Preparation of Package Tour
• Prepare for HE session (IEC materials)
• Prepare for reports/returns (register book)
• Prepare some drugs/equipment (bathroom scale, salter
scale, BP cuff, Stethoscope, MAC tape, Test strips)
• Prepare to carry vaccines in vaccine carrier
• Information about package tour is sent to village
authorities one week before actual implementation

7. Implementation of Service Packages
• First, HE session is given using IEC materials as soon as
community is organized.
• Health talks and focus group talks are conducted according
to planned topics. (4 cleans, nutrition, danger signs of
pregnancy)
• Hand washing - practical exercise by community.
• Then group of health staff conduct each activity separately
- one performing quality ANC,
- another performing immunization,
- another performing weighing of under five

8. • General examination of people for their illnesses and
treatment are given accordingly for ARI, hypertension
and minor ailments.
• After that inspection of latrines in the village is done by
group of health staff.
• VHWs (AMW & CHW) assist the activities by
- calling and gathering pregnant mothers for ANC
- weighing under five children
- assist in recording activities
- translate to the community

9. Strengths
• Many services (EPI, MCH, Nutrition, EH & HE) can be given
during one visit.
• The unreached villages can be reached and provide
services.
• Quality ANC and PNC can be done due to group activity .
PMCT also conducted.
• Under five children can be weighed and screening can be
done for malnutrition and referral.
• Iodized salt contents can be examined randomly in some
households

10. Strengths
• Focus group talks to target population used to be
conducted as follows:
–
–
–
–
–
Pregnant mothers for ANC, danger signs of pregnancy
Adolescents in separate groups for RH
Elderly for nutrition
Mothers of under 5 children on EPI and ARI, breast feeding
Men group on risks of HIV/AIDS and STDs
• Hand-washing demonstration is being appreciated by the
people

11. Constraints
• Time consuming for collecting the community if the
villagers are working in the fields.
• Village authority are not cooperative sometimes .
• More difficult to travel during rainy season.
• When hired/owned cycles are broken down during
package tour, it is difficult to compensate or could not
repair for high cost .
• Slip and fall due to thick mud and dust while climbing up
the hills

12. Constraints
• Inadequate medicines for giving general treatment to
people who come for illnesses.
• No bathroom scale for weighing AN mother.
• Missed delivery cases while travelling for group tour to
other villages.
• Sometimes health posts -not convenient for conducting
activities.
• Difficult to construct sanitary latrine and repair after
latrine inspection in the village.

13. Thank
You