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One – to – One with Deputy Minister of Health Dr Thein Thien Htay

Name – Dr Thein Thien Htay

Position – Deputy Union Minster – Ministry of Health

Brief Bio: – As a Deputy Minister for Health, Dr Thein’s main responsibilities are for the medical education and health services delivery. Dr. Thein is also an adjunct faculty member as well as an honorary Professor in the University of Public Health in Myanmar. She obtained her Master of Health Science in population development and reproductive health from the John Hopkins Bloomberg University of Public Health in 2000. She earned a range of certificates on Maternal and Child Health/Family Planning including those from University of California, Los Angeles (UCLA) and Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN), Indonesia in early ’90s. Prior to that, she received her Master of Public Health from the University of Medicine (1), Yangon in 1987 and also holds a medical degree from the University of Medicine (2), Yangon since 1977. Her career focus originally on maternal and child health, and then extends to reproductive health since 1996. Dr. Thein was one of the founding members of family planning program in Myanmar. In this capacity, she leads the public health division of the Department of Health throughout her career, with main thrust on meeting Millennium Development Goals 4 and 5. She is also volunteering as a technical consultant to one of key national NGOs, Myanmar Maternal and Child Welfare Association since 2003. She has been a research consultant to many United Nations funded Rural Health projects She also served as a member of Gender Advisory Panel at World Health Organization. Headquarters from 1999 to 2004, and as a regional steering committee member for the Lancet series of South East Asia Region’s health issues. Currently, she is a member of International Steering Committee of 8th Asia Pacific Conference on Sexual & Reproductive Health and Rights. She is keen in integrating Human Immunodeficiency (HIV) and Family Planning services since decades ago and have participated in every effort to make it happened at country level. Her keen interest and vast experience in medical education has been instrumental in advocating decision makers for the reform towards new paradigm of medical education system in Myanmar. Currently, she is leading the country’s initiatives towards Universal Health Coverage and malaria elimination, both to be fulfilled by 2030.

MI : How did you start your career as a civil servant and how did you end up in this position as the deputy minister?

I grew up in a family of civil servants. My father was a government officer. He is an honest and well-disciplined man. I admire him a lot and he is my role model. When I was young, I wanted to be like him and contribute to the country. That is the reason why I joined government civil service.

When I graduated from University of Medicine (2), to become a civil servant, we had to take an entrance exam. I passed the entrance and became a medical officer (MO) at North Okkalapa hospital, situated at peri-urban area. It is a good opportunity as well as turning point for me. First and foremost, being as a doctor, my desire is to make sick people feel better. Something more was introduced in my life. When I worked for pediatric ward, I discovered the vicious cycle of patients being discharged and coming back again after three or four months with same problem. I have no idea of the meaning of “Public Health” at that time. I thought something must have been wrong. Later I understood the meaning of “Public Health”. I have worked for six and half year there and I obtained Master of Public Health. Since then, I devoted myself to Public Health sector.

First I joined as a Medical Officer at Public Health Division, Health Department under Ministry of Health. This is rare because I worked in same department from being a Medical Officer to Assistance Director for almost 25 years. Normally, after two or three years, people have to move around to other divisions.

For me, I had to sacrifice. Whenever I got a chance to be promoted, if it is not the Public Health division, I would never take. In 2012, I was asked to be a Director General, very first woman Director General of Health department.

MI : As the Deputy Minister, what are your primary responsibilities?

First and foremost, we have to be an accountable and a reliable person for the Minister. One of my admirable senior colleague told me that Deputy Minister is just like second in command. They are instrumental people between commanding officer and junior staffs. They must check whether the junior people are operating systematically and functionally within the given time frame according to government’s objectives. At the same time, we have to provide feedback to our senior ministers what policies are the best for ministry and people. The information we provide must be evidence based.

As a deputy minister, I have to perform both technically and administratively.

MI : Do you think the government reform process so far is meeting the expectation of local and foreign government enterprises, citizens, government agencies and NGO?

Whenever we are talking about reform, we have to realise it just happened. Our administrative cycle is just 5 years. It has limited time frame and just enough time to complete laying the foundation systematically. One administrative cycle cannot meet all expectations. But we are on the right tract. One day we will meet the expectations of the each citizen of the country, government agencies and NGOs.

MI : Can you explain to our readers the current reforms being carried out at the ministry?

There are two reforms; structural reform and functional reform. Structural reform is very significant. Our healthcare needs are changing everyday. For instance, Food Safety Department was previously only one small division under the Public Health. Until a few years back, we did not have to worry much for food safety. In recent years, we have to think if it is organic or free from pesticides, etc. Now we have food and drug administration (FDA) as a separate department.

Previously, we have three departments of medical research (DMR); Upper Myanmar, Central Myanmar and Lower Myanmar. Now there is only one department of medical research. This is one example of structural reform.

The crucial change took place at the department of Health, the department where I come from. This is a service provision department which is operating in the whole country. We now officially divide it into two departments; treatment and public health. We faced a lot of challenges. Public Health is operating more of technical and community based while patients’ services department is operating hospital based.

Another major change is not only for the Ministry of Health but also for our country. We now have permanent secretary office for the Ministry for the first time in Myanmar. The objective is to have a smooth transition from current government to the new one. We have structure in place but not the man power yet.

MI : What are the main policies that your ministry has changed or adapted to accommodate Myanmar’s new trend of opening up the country?

Firstly, let me tell you that I am so positive toward country’s opening up. Regarding policies, information sharing was very limited previously. We constantly received complaints from our international counterparts on credibility of our information. Now, to some extent, we can share information openly. This is a significant change. Now we can better inform the international community on what we have done and what we are doing for uplifting our country health standards. Because of such sharing, we know what other people are doing and learn from the mistakes they have made in other parts of the world. We get golden opportunity to take the best from the rest.

How we see the world and how world see us has profound impact on our health policies. For instance, we have already achieved our target for malaria elimination. But when we compare with our neighboring countries, our malaria affected 200,000 persons per year here, while there are around four thousand per year in neighbor countries. Another difference is that malaria can be easily found in Myanmar yet it is curable while disease-resistant kind can be found at neighboring countries.

MI : What are ministry’s plans for PPP (Private Public Partnerships) in the healthcare sector?

Since 2011, government has been urging foreign investors to invest 100 percent or as joint venture in the medical sector. We tried hard to get interested parties to come and discuss with us. We are still exploring what would be the best approach for PPP. In the past, there were few roles for private sectors because of the close system. We are on the way toward democracy and an open economic system and private sector can play a vital role. Foreign investors can invest more easily than past but still thinking about some issues like land investment.

One of my senior colleague within ministry, used to say that when building a hospital or buying high end or super-expensive medical instrument, do not use the money of Ministry of Health; we have to think about “service procurement”. It means bringing in the services providers and paying for the service by the Ministry of Health. It is much cheaper than building a new hospital. Now we are discussing within the ministry to follow this path.

MI : Do you have a specific solution to improve healthcare sector in Myanmar?

It is related to my previous answer. In regional comparisons with other neighbor countries, health spending as a percentage of total government expenditure, we are still the lowest. Government trying to provide what we need. At the same time, we have to open our eyes. Government’s financial capacity is limited and government expenditure has to be shared with other ministries. We need the innovative financial strategieson how can we better spend with limited budget to achieve goal we need. We have to learn about those subjects and train people in health economics. To run the health system as a viable operation, we need lots of health economists.

MI : Among the many things that could be done to improve the healthcare of Myanmar citizens, what, in you opinion, is the priority #1?

As I already mentioned, coverage, health budget and collaboration with other helping hands are all important.

There is a vulnerable group (children, pregnant women, elderly persons who needed most of health care. I want to try to reach our healthcare assistance to vulnerable group as much as we can. That is not expensive but priority number one. We only need to help with very strategic planning and activities. There must be balance between prevention side and cure side. Instead of waiting the money that might arrive, we try to use wisely the budget that already given as. This is the best solution.

MI : What do you think is the solution to ensure that healthcare costs remain affordable to the country and the public, in the long term?

Like Myanmar, Singapore got independence from UK but its independence was quite later than us. We inherited the British Health system but they did not. Even for the developed country like Britain, they facing lots of issues regarding health care cost. What I really meant to say no country can afford free medical care all time regardless how rich they are.

In Myanmar, in the very first round of patient administrative cycle, we decide to give public free healthcare. One thing for Myanmar health care system is our staff (lowest rank to highest rank) dedication is really good. Last year, we received the highest allocation of health expenditure in the history of the ministry. There is free medical care first time for every citizen. We can witness lots of significant changes.

MI : What are the biggest challenges the Ministry is currently facing?

One challenge is how to effectively allocate or spend with limited budget. On the other hand, one biggest challenge remains the human capital. Right now, Government has given us permission to expend our human resources.

MI : Can you briefly explain to our readers about allocation of the ministry budget to various departments and projects?

For 2015-2016 budget, Public Health gets 25 %, Medical Care Services Department gets 67 %, Health Professional Development and Management Department gets 4.5 %, Department of Food and Drug Administration (FDA) gets 0.2 %, Department of Medical Research gets 0.6% and Department of Traditional Medicine gets 1.9 %.

We need financial analysis to allocate effectively. We are uplifting and innovating our hospitals to have a pleasant atmosphere. We bought super-expensive and ultra-modern medical instruments as much as we can to keep pace with modern technology. But there are lots of gaps between expectation and fulfilling them. We have tried so hard to meet people needs and expectations.

MI: For the appointment of retired military personnel into the administrative ranks within the Ministry, do you think it is optimal?

Let me start from rationally thinking. We do not need administrative people from the military. Assuming if there is no one have capacity to manage or administer from within the ministry, we will need someone from outside the system. But we have to make sure whether the people from Ministry of Health have the capacity to manage or not. When it comes to recruiting new person, we can not judge just by seeing his or her cover. We can not take granted and can not decide generally. We do have limited human capacity within our ministry.

MI: Do you think free for all health care can be sustained in Myanmar in the long run?

If not, what are the alternatives? In the long term, health care cannot be free; even developed countries do not provide free healthcare. As health technology becomes more complex, health costs grew higher too.

People also expect higher standards of care. Currently, we do not have health insurance but what we are trying is to link between health care costs and individual responsibilities. For coming few left months, government trying as “Myanmar Provident Fund” program, money saved aside for health care. Regardless of your salary, you will save a certain amount of money monthly and then use it when there is need for health care.

MI: What are the best and worst parts about being a deputy minister, esp., in the Ministry of Health?

Good part is I have tried step by step to become a deputy minister. I came from the very basic step. Success Planning is my forte. I can coach next generation to replace my position to contribute towards the country. For community health service, I can do better or cover a wider range of scope. Based on my experiences, I can also collaborate with International Organizations to get best result.

The worst part is sometime I cannot fulfill all the needs. I can focus on one thing at a time to get best result.

MI: Are you competing in the elections in November?

What are your future plans? No, I will not be compete in the elections. There are a couple of reasons. Throughout my life, as a workaholic, I never get any opportunity to look at another sector apart from health. Most of the time, I do not have weekends and public holidays. Now I need a kind of balanced life between family and work. Additionally, as a devoted buddhist, I want to do religious work for the next life. In my heart, I always want to use my capacity to the fullest extent for our country health care system.

MI: If you could make one major change to any government policy, what would it be?

If I could make one major change to government policy, I would change the one which related to public health and can benefit immediately and effectively for poorest people from rural side and prevention side of health care.

MI: If you could recall some of the bigger achievements of the Ministry for the past five years, which are the ones you are most proud of?

The one most I proud of achievements is government budget line for rural health facilities grants. In past, there were lots of weak points in system. For instance, we have to report to central through step by step even for small issues and took lots of time to proceed with the procedures. Now, grants would be provided to Township Medical Officers (TMOs), for onward disbursement to Station Hospitals (SHs), Rural Health Centers (RHC), SubCenters (SC) and MCH Clinics, based on Standard Operating Procedures (SOPs). Additionally, we can now provide high end medical equipment for patients in public hospitals.

MI: What are your personal hobbies apart from the governmental responsibilities?

I am interested in doing pro bono activities. We have a pro bono network on LinkedIn social website. Additionally, I enjoy reading and writing in my spare time.