"The World Health Organization (WHO) Country Cooperation Strategy (CCS) 2014–2018 for Myanmar provides a coherent medium-term vision of WHO’s technical cooperation, and defines its strategic framework for working in and with the country. It aligns closely with the priorities of the National Health Policy, Strategies and Plans and is harmonized with efforts of the United Nations (UN) system for country development. The present CCS is built on the experience and achievements of the previous CCS 2008–2011 and takes into consideration the emerging country situation. It also follows the guidance of Twelfth General Programme of Work (GPW), which provides a six-year (2014–2019) vision for the Organization. GPWs set a global health agenda for all stakeholders and establish a strategic, results-based and accountable framework for WHO. The Twelfth GPW comprises five, as opposed to a previous 13, programmatic categories and one administrative category. Myanmar emerges from decades of isolation with much hope and support from the global and regional communities. The country has a high potential for rapid growth and development given its natural resources and youth representing nearly 40% of the population. Despite this, and consistent efforts for further development, Myanmar faces multiple constraints and risks that may limit its progress. For example, important disparities are apparent in access to benefits between rural areas, where about 70% of the population resides, and urban areas. In the health sector, constraints to improve the health status of the people include: access to basic health services; inequities and service availability; disparities in availability and affordability of essential medicines; adequate infrastructure and public expenditures; and trained health personnel. Myanmar has made progress towards the Millennium Development Goals (MDGs): its infant mortality rate (IMR), under five morality rate (U5MR) and maternal mortality ratio (MMR) declined between 1988 and 2007. The U5MR declined steadily since then and if this trend continues, the country will achieve the MDG4 (reduce child mortality) target of 43.3 by 2015. However, the rate in rural areas is almost twice that of urban areas, and this will also need to be addressed. IMR is also in declining trend, but challenges remain to meet the MDG target of 28.3 by 2015. Meanwhile, immunization data are encouraging; Myanmar is free from wild poliovirus transmission and measles immunization coverage increased from 82% in 2008 to 88.0% in 2011. In November 2012, Myanmar introduced Haemophilus influenza type b (Hib) as a pentavalent vaccine (DPT+HepB+Hib) in the immunization programme. Based on these trends, the 2015 target of 90% coverage for DTP 3/ Penta3, free from wild poliovirus transmission is expected to be fulfilled. Reducing maternal morality under MDG5 represents a major challenge and will require significant efforts to meet the goal. About 88% of deliveries take place at home with maternal deaths overwhelmingly predominant in rural areas. On the positive side, the proportion of births attended by skilled health personnel increased from 51% in 2001 to 70.6% in 2010. MDG6 – combating HIV/AIDS, malaria and other diseases – has a major potential to be achieved by 2015. Myanmar already has achieved the goal of a 50% reduction in malaria morbidity and mortality since 2007, with use of insecticide-treated nets (ITN) more than doubling between 2004 and 2008. At the same time the tuberculosis (TB) death rate target has been achieved and the TB incidence target is on track. However, additional efforts are needed to meet the MDG target of halving the TB prevalence rate by 2015 as compared to 1990. The main challenges include finding the many undetected/unreached TB cases, scaling up multidrug-resistant (MDR) TB management and reducing the dual burden of TB and HIV/AIDS. With regard to HIV/AIDS, the epidemic is considered to have stabilized nationally since 2000, with hot spots of high HIV transmission identified at several locations. Continued focus is needed on mostatrisk groups to maintain initial positive achievements. Major challenges also exist to scale up HIV treatment, which now covers only about 1 in 3 of those in need. The strong Government commitment to comprehensive development, including the health sector, is seen in the Framework for Economic and Social Reform (FESR), which outlines key parameters of the reform process. FESR is an essential tool to realize both the short- and long-term policy agenda of the Government over the three-year period starting in 2013, i.e. focusing on both immediate actions as well as on issues that require in-depth analysis and/or consensus-building. In the health sector, the Government will focus on a number of innovative measures in health financing. Particular attention will be paid to allocating more resources to rural primary health care (PHC), infectious disease control and maternal and child health, in view of the acute need to improve health indicators in all these areas. At the ministerial level, ‘Myanmar Health Vision 2030’ was drawn up in 2000 to meet future health challenges. Supporting this ambitious, long-term health development plan, the Ministry of Health has formulated the National Health Plan (NHP) 2011–2016, which is aligned with the latest five-year National Development Plan, the Rural Health Development Plan, the Project for Upgrading Hospitals, and the National Plan for Promoting National Education. As such, the NHP is an integral part of the national economic and development blueprint. It takes account of the prevailing health problems in the country, the need to realize the health-related goals of the MDG, the significance of strengthening the health system and the growing importance of social, economic and environmental determinants of health. WHO has closely collaborated with all health stakeholders in Myanmar in the successive phases of the NHPs – its strategies and plans, resource mobilization, implementation and monitoring processes – and in providing technical advice for the development of the health sector in Myanmar. Poverty is the principal constraint to improving health status, compounded by factors affecting vulnerability, difficult-to-reach areas and conflict among ethnic groups. The Government has undertaken remarkable efforts to build understanding among these ethnic groups in order to establish a peaceful environment that fosters development. To address poverty, the United Nations Development Programme (UNDP) introduced the Human Development Index (HDI) in 1994, and provided a significant impact in building community capacity for self-reliance. In moving forward the socioeconomic growth of the country, official development assistance (ODA) plays a significant role in health sector programmes. The total ODA provided to Myanmar was US$ 109.5 million (US$22.6 million, 20.7% for health) in 2002, increasing in 2009 to US$ 390.7 million (US$ 61.2 million, 15.7% for health). The aid environment is expanding and reaching all development sectors. UN Country Team is also engaging in a common framework – UN Strategic Framework – to assist Myanmar. Now in its second cycle, the present UN Strategic Framework 2012–2016 addresses four priority issues: encourage inclusive growth, increase equitable access to quality social services, reduce vulnerability and promote good governance. WHO is the lead agency in health sector of the country, in which it actively collaborates in all development processes and capacity building of the health system. The CCS follows the guidance of the Twelfth General Programme of Work and regional orientations and priorities. During its elaboration, the social developments emerging from the national reform process and key health challenges confronting the country were carefully synthesized to feed into the strategic agendas and priorities. Close consideration was given to the contributions by other external partners in identifying challenges and gaps in health sector cooperation, as well as to lessons learnt from a review of WHO’s cooperation over the last CCS cycle. Special consideration was also given to accelerating achievement of the health-related MDG targets by 2015. The strategic priorities of the CCS 2014–2018 are: (1) Strengthening the health system. (2) Enhancing the achievement of communicable disease control targets. (3) Controlling the growth of the noncommunicable disease burden. (4) Promoting health throughout the life course. (5) Strengthening capacity for emergency risk management and surveillance systems for various health threats. The priority areas will be addressed through a coordinated programme of work that will seek to harness the potential strengths of stakeholders The first priority area is to enhance national capacity to strengthen the health system, including equity in health, increased access to services, and an adequate and sustainable health-care financing mechanism. The second priority area is to enhance the achievement of the communicable disease control targets and MDGs; the third priority area comprises controlling the growth of noncommunicable disease burden and minimizing the major risk factors prevalent in the environment. The fourth area aims to strengthen health system to improve the health conditions of women, children and adolescents and ensure accountability through reporting on progress towards reproductive and sexual health as part of achieving the MDGs. The fifth priority area is to prevent disease outbreaks through improved rapid response. For each of the strategic priorities, a set of main areas of focus and strategic approaches have been formulated. In addition to the five priority areas, WHO will continue its core functions as directed by its governing bodies and will actively cooperate with Myanmar on any other public health challenges. The impact of changes in budgets and staffing with required skills and competency in the WHO Country Office are expected to be moderate. The CCS will be implemented in close alignment and in harmonization with the national strategic agenda and the UN Strategic Framework. WHO will focus its efforts on achieving the targets identified by the health sector of the country..."