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The health system in Republic of the Union of Myanmar has historically evolved through many distinct periods of political and administrative regimes (WHO, 2014). After gaining independence in 1948, the country’s health sector was reorganized in 1953 with assistance from WHO. The government of Myanmar has been the key financial source for healthcare, providing nearly free services to its citizens until formulation of user-charges as an alternative expenditure in 1993. Subsequently, household out-of-pocket payment (OOP) has become a crucial monetary source for the health sector (O’Donnell et al., 2008). The Ministry of Health and Sports of Myanmar (“Moh.gov.mm” 2016) remains a significant core provider of comprehensive healthcare across the country (“Moh.gov.mm” 2016). Further, several public and private institutions finance and provide organizational and delivery services. Also, traditional medicine is an integral part of the health system in Myanmar (Awale et al., 2006).
This report introduces the roles of the government and non-government organizations (NGOs) in Myanmar’s health system. Further, it presents a detailed analysis of the government health policies and initiatives followed by a discussion on performance assessment of its health system. Finally, past and future health reforms in Myanmar are illustrated.
The Ministry of Health and Sports of the Myanmar government (previously called Ministry of Health) is the key organization which provides comprehensive health services to its citizens (“Moh.gov.mm” 2016). The total yearly spending of MOHS was around 583 million USD in the fiscal year 2014-2015 showcasing a yearly increase of about 10%. All healthcare sector services are based upon relevant policies and guidelines formulated in the Constitution of the Republic of the Union of Myanmar in 2008 (“Myanmar Health and Development,” 2015) and include preventive, therapeutic and rehabilitative procedures throughout the country. In addition, the Ministry of Industry runs and controls Myanmar’s pharmaceutical factories for producing medicines to meet domestic requirements. Alongside, private non-profit sector provides ambulances and outreach services. The MOHS also finances and provides traditional medical services through its Department of Traditional Medicine (“Moh.gov.mm” 2016). MOHS is actively responsible for formulation, finance, regulation and administration within the health system. Myanmar government facilitates efficient, well-organized and resourceful health services to its citizens throughout the country (Thien and Nyo, 1999; James, 2009).
In accordance with the constitutional guidelines, various local and overseas NGOs (“Devex” 2015; Wikiversity, 2016) contribute in extending collaborative health services to the grassroots. The NGOs are of tremendous importance for the future of Myanmar’s health system since they assist to promote partnerships among local organizations and communities to design and implement health projects that capitalize on local ownership and also leverage the established governmental networks.
MOHS’s long-term visionary health plan titled “Myanmar Health Vision 2030” (“Myanmar Health and Development,” 2016) is aimed at developing and implementing a health system in accordance with varying political, demographic, social, cultural, technological, environmental and economic trends in Myanmar.
The key objectives of the “Myanmar Health Vision 2030” are:
Overall improvement of the health status of the citizens while ensuring uniform coverage of healthcare services across the country through an association of hospitals and other primary healthcare centers that provide preventive and therapeutic services.
Elimination and reduction of major health problems including communicable diseases like Malaria.
Design of control strategies for prevention of emerging diseases and/or health problems.
Ensuring availability both in terms of quality and quantity of allopathic and traditional medicine within the country.
Development of medical research, resources and training of human health workers to meet global benchmarks.
Modernization of Myanmar’s traditional medicine practices to encourage broader reach and usage.
In the last half century, health outcomes in Myanmar have failed to keep pace with its other South-east Asians neighbors. WHO has ranked the overall performance of Myanmar’s health system the lowest in comparison to 190 countries (Chan and Taylor 2012). Myanmar spends only roughly about 2% of its GDP on healthcare, lower than impoverished Loas and Cambodia (Chan and Taylor 2012). Since the spending by its government has been low, Myanmar is struggling with basic health problems related to communicable diseases especially Malaria which is the principal cause of morbidity and mortality in Myanmar especially in rural areas. Majority of deaths due to Malaria and TB are caused by drug-resistance and Myanmar accounts for nearly 50% of all Malaria deaths in South-Asia region (Beyrer and Lee 2008).
Burden of household health expenditure: One fourth of Myanmar’s population is below the poverty line and roughly 70% of the country lives in rural areas. Due to the implementation of out-of-pocket (OOP) policy, of the 10% public expenditure on health, 82% to 85% was OOP (WHO, 2016) since social security does not exist in Myanmar. This high OOP expenditure is a financial burden on low-income, poor and vulnerable households.
Encouragement of health expenditure: Health expenditures in Myanmar are largely driven by citizen’s private income and it has been reported that nearly 93% spending at the end of 2012 was out-of-pocket (WHO, 2016). Thus, a substantial increase in personal incomes as well as disposable spending is seen to be critical for the growth of the health sector in Myanmar (Chongsuvivatwong et al., 2011).
Adequate education and training: Myanmar’s lack of administrative capability which is required to undertake spending and prioritizing decisions is an impediment to the growth of its health sector. Already, the country’s emergency and trauma care facilities are extremely inadequate and it also lacks sufficient number of specialists and super-specialists like oncologists and cardiologists. Myanmar has only 6.1 doctors for 10,000 people recorded which is lowest for any Asian country (“Moh.gov.mm” 2016). MOSH needs to prioritize growth of healthcare infrastructure along with at least 1500 medical graduates every year who are well-educated, well-trained and also well-paid.
Better investment opportunities: healthcare businesses and investors are unable to ascertain interests and intentions of Myanmar towards new products or services mainly due to ineffective policy and administrative capabilities. Since Myanmar is now under the global radar for funding and offshore investments, MOHS should formulate appropriate strategies to attract interests.
Performance evaluation of Myanmar’s health system
Myanmar’s health system is currently in transition and requires consistent and clear measurement of performance to ensure its efficacy, improve decision-making by the policy makers. Data collection, analytical methodologies and performance indicators for primary and hospital care, mental health, financial protection can evaluate health system responsiveness.
The important aspects for assessment of performance of health system in Myanmar are:
WHO has routinely placed Myanmar’s health system among the least responsive. Patients and their families show total decision dependency on doctors regarding their treatment and care. Also high OOP household expenditure leads to varied and sometimes biased perception among the public and medical professionals. Now with free and accessible media in Myanmar, the disparities in user experiences within the health system are transparent to the public. Enhanced user experiences can be achieved with better communication skills and higher ethical standards of medical professionals.\
Evidence indicated that huge disparities exist within Myanmar in terms of access and utilization of health services in rural and urban areas (Zaw et al., 2015). These disparities are further widened by geographical, social, economic and educational barriers (Chan and Taylor 2012). Regular equity monitoring is the key to bridging these gaps. Survey has shown that infant and under-five mortality rates per thousand live births were 60 and 78, respectively, and maternal mortality ratio was 255 per 100 000 live births (WHO, 2014). These disparities in infant and child mortality are affected by gender, maternal education and economic status.
Overall, the life expectancy for both females and males has increased between 1980 and 2011 (WHO, 2014). However, around 40% of total deaths in the country are due to the burden of non-communicable diseases and Myanmar accounts for nearly half of all Malaria deaths in South-Asia region (Bayrer and Lee 2008). Also, dietary risks/contaminations, tobacco and air pollution contribute to the disease burden in Myanmar already complicated by social, cultural and economic challenges.
MOHS health investments have been majorly towards hospitals and tertiary care and have considerably increased since 2008 (Bishai et al., 2013). This move has seen a three-fold increase in the number of patients from 2008 till 2014. Though the numbers of medical doctors and nurses increased by 3572 and 7457 respectively, tangential workers like pharmacists have seen comparatively lower growth between 1988 and 2007 (“Moh.gov.mm” 2016; WHO, 2014). Further, number of hospitals has increased from 897 in 2010-11 to 1029 in 2015, though annual data show that about 60% of the hospitals were underperforming in terms of bed occupancy and the standard turnover of patients per bed. This low performance is attributed to inadequate staffing, insufficient medicines and equipment and inability of the poor to overcome financial barriers.
The design and implementation of health policies has always been a bureaucratic procedure in Myanmar. Also, no transparency or accountability has existed to enlighten the public about allocation of health resources etc. In such a scenario, persistence of health professionals, their loyalty to their profession, their moral and ethical values and free and accessible media are sustaining the health system in Myanmar.
The health system in Myanmar has been historically contoured by the various periods of administrative and political systems (Grundy et al., 2014). It is reemphasized that Ministry of Health and Sports is the key player in facilitating healthcare in the country. Since 1978 onwards, four yearly health plans and other short-term plans have been designed and subsequently implemented by the MOHS including the most recent National Health Development Plans 2000-2016. The National Health Committee constituted in 1989 is a high-level health policy-making body which transcends various government ministries and plays a crucial role in facilitating the collaboration and coordination between government, public and private sectors. As discussed above, MOHS’s “Myanmar Health Vision 2030” aims to provide universal and uniform health cover to all citizens by 2030. The Constitution of the Republic of the Union of Myanmar has incorporated policy and guidelines for health service provision in the country through different articles (“Myanmar Heath and Development,” 2016). After the 2010 national election, significant societal understanding and settlement in Myanmar’s political and administrative scenario has provided higher expectations for significant upgrading and advancement in the health system (Saw et al., 2013).
Since it was reported that nearly 93% of healthcare expenditure was out-of-pocket income by the end of 2012, the government is developing an initiative to introduce social protection to all citizens by 2030 through the Social Protection System (“World Bank” 2015). The overall government health expenditure which is around $30 per capita is expected to increase to $2000 in the coming decade (Shobert, 2015). The government funding to Myanmar’s pharmaceutical industry is also expected to increase by 10-15 percent a year. Further, in the past couple of decades Myanmar is becoming of substantial interest to overseas firms to own up to 70% of hospitals and health clinics. Myanmar’s economic reforms shall be beneficial through increased personal income and per-capita disposable spending by the citizens and this will lead to higher willed expenditure in the health sector.
Despite its complex history, Myanmar’s political and administrative system is evolving and promoting healthcare as more public-centric with higher accountability and transparency in the recent decade. The Ministry of Health and Sports of the Myanmar government is integral to planning, design and execution of reforms and action plans in the health sector. The most ambitious plan of the government titled “Myanmar Health Vision 2030’ shall provide uniform and universal health cover for all citizens through improved infrastructure, competent healthcare workforce and broader outreach. Addressing health inequities is the most significant challenge for Myanmar. It needs effective, timely and transparent reforms which will facilitate efficient functioning of community health systems and ensure healthcare services to poor and vulnerable groups, minorities and people in conflicted and far areas of the country. Other issues that require focus are adequate funding, dealing with socioeconomic burdens like poverty, reduction/abolishment of out-of-pocket household burden, good quality education and training of health workers and higher investment opportunities in the health sector for local and/or overseas businesses. Further, systematic reporting and documentation, monitoring of medicines and continuous education/training of medical professionals is required. For higher efficacy of a collaborative health system, it is imperative to recognize the growing importance of all major relevant sectors at different administrative levels so as to mobilize the community more effectively facilitating an efficient, fair and sustainable health system in Myanmar.
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