Till very recently, tourists and expatriates coming to Myanmar, were warned, ‘just pray that you don’t fall sick. Make sure emergency evacuation is covered in your insurance package’. This evoked an element of fear in the minds of all those entering Myanmar, but as most of us who have spent a few years here, know that this is a gross exaggeration. Healthcare may not be comparable to other countries in the ASEAN region, and yes, remote rural areas do not have hospitals etc., but cities like Yangon and Mandalay are slowly catching up, with private hospitals, qualified doctors and nurses, and a few do have state-of-the-art facilities. Treatments and drug availability is not as elusive as it was a decade ago, and emergency evacuation is more out of the fear psychosis than a dire medical need.
The health care industry is in its nascent stages, having coped with minimal budgetary allocations, shortage of doctors and qualified medical personnel, seeing an exodus of trained professionals over the years, and foreign trained Myanmar professionals not inclined to return. All that is changing, with senior doctors, many in the 50-plus age group, returning to serve in reputed private hospitals in Yangon. For the first time, the newly appointed Health minister Dr Myint Htwe, will have access to over 757 billion Kyats to transform this neglected sector that can radically improve the quality of life of millions of Myanmar people. Healthcare is also one promising opportunity for business besides the social good.
The present healthcare scenario Even as improvements are witnessed and the two big cities are seeing new hospitals, some of the latest diagnostic equipment gets installed, more English speaking doctors join international clinics and emergency services become available 24×7, the ground reality about Myanmar’s healthcare remains dismal. The World Health Organization has ranked Myanmar at 190th position out of a total of 191 countries in terms of ‘overall health system performance’. This is because there is just one doctor for every 2772 people, only one psychiatric hospital in the country, and there are vast expanses of rural terrains where no medical aid is available. Besides medical aid being extremely expensive, Myanmar has the highest individual out of pocket expenses, and also has the lowest level of government health expenditure.
In terms of public health and disease, an Asian Development Bank report reveals that diseases like malaria, tuberculosis and HIV have raised morbidity and mortality rates. The incidence of malaria in Myanmar is six times more and prevalence of tuberculosis is 1.3 times more than the average of seven out of ten ASEAN nations. Lack of hygiene and high probability of contamination leads to stomach disorders and severe gastrointestinal problems. The number of deaths caused by non-communicable diseases is constantly increasing, to add to the woes of the health authorities. Infant mortality rates are higher than other countries, and over 80% of deliveries take place at home, though 70% of them are now supervised by skilled medical personnel.
The current healthcare system is such that it entails out of pocket expenses with no external insurance agencies or even the government pitching in. out of pocket expenses 78% ( down from 82-85% just five years ago) of total medical spending on diagnostic, private clinic visits and also self prescribed medicines. The small amount left is spent by the government and a few NGOs supporting primary healthcare in rural areas. Fifteen UN agencies operating in Myanmar support specific areas; for example, UNICEF provides vaccines and equipment among other things, and UNFPA provides assistance in areas of reproductive health and prevention of HIV/AIDS.
The principal healthcare provider is the Ministry of Health that runs the 2,000 plus government hospitals with over 55,000 beds, as stated in the Oxford Business Group’s Myanmar Report 2016. Sixteen of these hospitals offer alternative healing with traditional medicine, which is resorted to, by the rural masses at most times. dietary and lifestyle changes, biomedicines and herbal remedies are often the first line of treatment. The ministry has seven departments- one each for Health, Planning, Medical sciences, three for medical research and one for traditional medicine.
Data collected to gauge the state of health in the country shows vast regional disparities in access, availability and quality of health services and the worst affected are ethnic minorities and people in remote areas. Myanmar’s healthcare industry
The country’s healthcare industry is growing rapidly and is likely to cross the $ 2 billion mark. This can be attributed to the increased focus of the government on this relatively neglected sector and also an increasing awareness among the locals to solicit better healthcare facilities than what they have been accustomed to, for decades.
This rise in demand has led to private participation and new private hospitals and clinics mushrooming in big cities after the government opened its doors and initiated the liberalization process. International players have also appeared on the scene to set up diagnostic and testing laboratories. The healthcare industry involves players from the public sector which includes the Ministry of health, the private sector that runs hospitals and clinics, international NGOs, donor agencies and the military. Primary and specialist hospitals are located in the two main cities of Yangon and Mandalay which cater to the needs of the people from surrounding areas as well. Beyond these cities the facilities are quite basic and not equipped to handle emergencies and critical illnesses.
The human component
Healthcare necessitates concerted efforts to build human capital in the form of doctors, nurses and trained technicians for diagnostic testing. Efforts are on to undo past damage and in the coming year 5,600 medical professionals are being trained and will be ready to join the healthcare work force.
Most of the students of medicine, training to be doctors, come from affluent families. There is an acute shortage of medical professionals and human capital totally deficient. Besides, doctors the number of nurses is far too less, with one nurse for every.
10,000 people. The gap left is often filled by the 20,000 midwives who provide care not just to pregnant women and perform deliveries, but also provide primary care at village level. The salaries of all medical staff are low and they are expected to work with minimal resources and equipment. Rural areas feel the pinch much more with their healthcare centers seldom well staffed or well equipped.
Patients need to visit hospitals in Yangon and Mandalay each time there is a serious health concern, only to find overcrowded clinics and overworked staff. Those who can afford it, or live in border areas, seek medical treatment in neighboring countries with the maximum number of Myanmar citizens traveling to Bangkok, Thailand.
The healthcare challenge
Putting a systematic healthcare system in place is not an easy task for any government. It is a process that evolves over time, based on the needs of the populace. Myanmar’s 51 million have till recently, had access to basic treatments, having had to travel to Yangon and Mandalay for serious problems, resort to traditional medicine, seek advice of midwives in the absence of doctors, or if affordable, travel to neighboring Thailand, Singapore, Malaysia or India for treatment. Medical tourism of these countries has been advocated in Myanmar much more, due to its own deficient and cash strapped system.
with governments spending 1-2.7% of GDP on healthcare, far below Vietnam’s 6%, Indonesia’s 3.1% and Malaysia’s 4%. Per capita spending on healthcare is as low as $ 35 which is less than half of the amount spent by Indonesia ($ 107), Vietnam spending $ 111 while Malaysia spends $ 423.
The allocated spending on healthcare according to the Oxford Business Group Report for 2015-16 has been $ 533.5 million, which indicated an over 10% increase from the previous year. This is being spent on upgrading hospitals and health centers, improve drug availability and being invested in human resources.
Health insurance which was missing all these years has been introduced for the first time in July 2015, with a one year trial period to start with. Eleven private domestic insurance companies besides the state owned Myanma Insurance have offered similar policies with identical benefits and coverage with customers being able to buy 1-5 units of coverage. One unit provides basic cover and costs 50,000 kyat for individuals between 6 – 65 years, and the appointed agents would get 10% commission on the premium. This has become the first step towards reducing patients’ out of pocket expenses
The healthcare challenge is huge and poverty the biggest impediment to improved health status. Inadequate hygiene and sanitation, malnutrition, remote areas with poor connectivity, are other contributing factors.
Myanmar Health Vision 2030
A series of measures have been initiated by the government and budget allocations are being consistently increased by approximately 6% per annum till 2020. The government has formulated a plan to improve the quality of healthcare available to its people by setting short term and long term goals. The need is for Myanmar to have a health care system that keeps pace with its rapidly changing political, social and economic environment and with changing technology. Hence, Vision 2030 delineates the targets and goals to be achieved. These include:
Uplifting the health status of the people
- Communicable diseases must not be public health problems, and target complete elimination or eradication while reducing the severity of other health problems.
- Put systems in place to foresee potential health problems and emerging diseases, and ensure their timely control.
- Provide for universal health coverage for the whole nation
- Provide facilities for training and education of all categories of human health resources within the country and bring them up to international standards. • Modernize the traditional medicine sector
- Put systems in place to provide sufficient quantities of quality medicines and traditional medicines
In the last three years, there is reason for optimism with improved child immunization rates, a skeletal health care system being put in place in remote areas, increased budgetary allocation and increased support by two top international health donors, namely, The Global Fund and The 3MDG Fund. The only path open now, seems to be pointing upwards.
