Key Implementation Steps
At a workshop in Myanmar (July 2014), a team comprising experts from Australia, the Ministries of Industry & Health planned the following strategies (first 2 operating at a national level; the 3rd at regional level).
1. Improving Antivenom Production
Improving the quantity and quality of antivenom is a key to this Project. Current production is inadequate to meet the need. The Project will:
1.1 Reduce the high mortality rate amongst horses used for antivenom production from ~60% per year towards the standard benchmark of <1%.
1.2 Develop sustainable availability of venom used in immunisation of horses.
1.3 Establish quality control of production processes.
1.4 Determine the mix of venom used for immunisation.
1.5 Improve animal welfare (snakes & horses).
2. Increase the Availability of Antivenom
2.1 The lack of electricity mandates a change from liquid to lyophilised (freeze dried powder) form of antivenom to avoid cold chain requirement. We will assist in establishing lyophilisation capacity in Myanmar.
2.2 Currently there is suboptimal distribution of antivenom. We will develop a trackable distribution system to reduce waste, to maximise availability of antivenom when and where needed, and to redress the supply-need mismatch.
3. Optimise the Mangement of Snakebite Patients
3.1 We will undertake clinical and epidemiologic surveys to establish the health system capacity to respond to snakebites, using selected Project townships.
3.2 Strategies will be implemented to improve responsiveness in terms of timely and appropriate management at community health centres to reduce morbidity and complications from snakebites.
3.3 Training programs will be developed using international experience, and implemented in Project townships to train front-line community health workers for timely and appropriate management of snakebites.
3.4 First-aid options will be examined, selected, and tested to ensure applicability in rural settings.
3.5 Strategies to strengthen primary prevention will be implemented in the Project townships.
The project will commence in late 2014 and is scheduled to complete the initial funded phase in mid 2017. It is likely that some project activities will continue past this time. The benefits produced through this project should be sustainable in the long term in Myanmar and the underlying aim of the project is to empower the people of Myanmar to sustain good outcomes for snakebite patients into the future.