Notes from Myanmar - an ENN and Nutrition International joint visit

By Charulatha Banerjee on 13 April 2017

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I began April with a weeklong visit to Myanmar, not my first visit but the first in my role as KM Specialist with ENN. Myanmar and its “first citizen” of sorts, Nobel Peace Prize Winner Aung San Syu Kyi were in the news in the same week on contentious issues. However, I returned home encouraged that this country, with its year-old government, is taking all the right first steps to improving the nutrition status of its population. For this visit I accompanied Manpreet Kaur Chadha the Nutrition International (formerly the Micronutrient Initiative) Asia Regional Manager for the TAN programme on her mission to identify nutrition technical assistance needs in the country. The TAN programme is the DFID funded package of support under which ENN provides knowledge management and NI technical assistance support to SUN countries.

Myanmar is one of the 7 countries in the Asia region on which NI and ENN are focussed. The main purpose of this trip was for NI to identify through a consultative process with the various SUN networks the technical assistance needs to support improved nutrition status in the country. From ENN’s perspective this was an opportunity to observe the process of technical assistance needs identification and to pick up opportunities for KM to be followed up later. With the TAN programme aligned to the second phase of the SUN Movement (2016-2020) the relationship and support provided by ENN and NI to Myanmar will be ongoing over the coming years.

Myanmar is a country of 54 million people with stunting prevalence of 29% in children under 5, one of the highest stunting levels in South East Asia with overlapping problem of high levels of anaemia in women of reproductive age across wealth quintiles (47%). The cause of Nutrition was given a huge fillip by ‘The Lady’ Aung San Syu Kyi in January 2017 in a small town called Pakoku in central Myanmar where she chaired the first ever National Coordination Meeting on Nutrition bringing together 5 ministries thus recognising and emphasising the need for a multisectoral approach to address undernutrition. In her position as State Counsellor she is the first and the last word on everything of significance in this country.

Data necessary for planning has been scarce in this country which has had limited external support and resources due to long term sanctions. The release of preliminary results of the Demographic Health Survey (DHS) conducted in 2015 has filled a critical data gap. This has been the starting point for a larger exercise –  the Nutrition Stocktaking Exercise led by UN REACH which has included both Government departments, Civil Society actors and bilateral donors and includes situation analysis, detailed reviews of legal frameworks and existing policies and stakeholder mapping. This year long exercise which is in its final stages has challenged the Government systems considerably mainly because of the newness of the multisectoral approach to nutrition. This is not unique to this country but is considerably magnified here as the architecture for nutrition governance to be yet clearly laid out.

So far, the Government has formed a body called the Development Assistance Coordination Unit (DACU) to improve the coordination and effectiveness of development assistance to Myanmar. It is heartening to see that Coordination between sectors is emphasised in early documents and nutrition finds a place as one of the ten sector coordination groups.

The SUN architecture presently consists of a Government Focal Point within the Ministry of Health with the National Nutrition Centre (NNC) being the coordinating body.  The Multi stakeholder platform has representation from Government, Civil Society, UN agencies and donors and has been active and in the forefront of the Nutrition Stocktaking exercise. A priority list of 20 core nutrition actions across 7 sectors within 5 ministries have also been identified and outlined by the platform.

The Civil Society network has over 100 members,  the majority being local NGOs with wide reach across all states and regions. The business and academia networks are yet to be established but the importance of this is well understood. 

While there is a lot of good news and clear signs of progress, what are the challenges still facing this country?  

1. The DHS results are encouraging but also point out the wide disparities between regions and states - it is likely that further disaggregation will throw up even intra-regional variation. Addressing this will require some level of decentralised planning and implementation- in a country in the early years of democratic governance, power and decision-making is still quite centralised and top down.
2. There is an urgent need for technical and managerial capacity building - what is needed also is to instil confidence in the workforce in their own abilities. Many years of isolation followed by a sudden influx of well-intentioned external experts has left qualified, able and committed local professionals questioning their own roles and capacities despite many years of experience. We heard in many conversations that “everything is happening too fast” - what is needed to move forward is an approach that ensures the transfer of capacity and ownership to local actors.
3. The country has a long list of urgent needs which needed to be addressed “yesterday”. Despite this, nutrition has seen important momentum and has mobilised activities with the Ministry of Health & Sports (this is a unique and appropriate combination I have not seen anywhere else) in the lead. It will be critical to sustain this momentum lest it get lost amongst other competing needs. In this, the UN agencies and the Civil society organisations have a clear role to play.

So, what were the pressing needs identified to be addressed? The country needs an implementation and a monitoring plan which will ensure that the Core Nutrition Actions (CNAs) are rolled out, in SUN language a Common Results Framework (CRF). It is not really starting from scratch. There have been earlier efforts such as the Myanmar National Action Plan for Food and Nutrition Security (MNAPFNS) – a response to the Zero Hunger Challenge - and an earlier National Plan of Action for Food and Nutrition (NPAFN) and SUN Plan. The recently identified CNAs need to be repackaged, costed and adapted to arrive at a ready-to-use and easy document which can be used across sectors for programming and financial tracking. Finally, there was  a long-term need identified to build the capacity of the NNC and relevant sectors to operationalise the costed CRF at different levels.

I left Myanmar with the country getting ready for  the upcoming Water Festival and the Burmese New Year. I will be sure to return later in the year to participate in the High-Level dissemination of the results of National Nutrition Stocktaking exercise.