Myanmar has undergone sweeping economic and political reforms since it transitioned to a civilian government in 2011, and then opened up to foreign investment two years later. But the health care system is still reeling from over 50 years of neglect.
While neighboring countries have made huge progress in combating communicable diseases, in Myanmar malaria and tuberculosis continue to be the leading causes of morbidity and mortality.
But the opening of the country’s economy has created new opportunities for both the public and private health sectors to provide better services to the population as it moves toward the goal of universal health coverage — one of the key targets of the Sustainable Development Goals.
Health care system challenges
Dr. Phone Myint Win, Myanmar country representative for the Burnet Institute, a nongovernmental organization that works to improve the health of poor communities through research and public health, said there were myriad challenges for the health care system moving forward. These include the coordination and integration of subsystems, such as the ministry of defense and industry, workforce capacity and leadership challenges.
In addition, there are deep-rooted inequities including huge out-of-pocket spending and access to care in rural areas where over 65 percent of the population live, according to the World Bank.
“The previous government used health as an instrument for political purposes rather than health as a basic end, Win told Devex. “There are very positive expectations for changes.”
He said the government was “very serious” about alternative health care financing to make UHC a reality through increased taxation, but no specifics have been confirmed.
Private sector opportunity
As state spending on health continues to increase — the 2015-16 fiscal year alone it increased by 7 percent — demand for private and specialist services are also expected to increase as the middle-class grows.
With this comes an opportunity for the private sector to work with the public sector, NGOs and the government to improve the situation across the country.
Dr. Gershu Paul, executive chairman at Siloam Hospitals Group, which provides health care to 2 million people in Indonesia through a network of private hospitals which are continuing to grow. In partnership with Lippo Group, a real estate company in Indonesia, and Serge Pun & Associates, a hospital developer, their network has now expanded to Myanmar where it runs a 175-bed hospital in Yangon.
“We saw the opportunity in Myanmar and knew that people were looking out for trusted health care where they get good quality and value for what they seek,” he said. “Recognizing that, we put in place a strategy.”
That strategy — similar to the model deployed in Indonesia — is to open 10 new hospitals in the next seven years and provide affordable health care based on tiered pricing; the next one will open in March in Mandalay, a city in the north.
“The government knows there’s an opportunity and it understands it can’t do it alone. It’s learning from mistakes from other emerging economies that it’s best to invest money in prevention and education,” Paul said, adding that building synergy between the private and public sectors and the community was critical to the success of health care in Myanmar.
“I really hope and pray that all these verticals work in a convergent way, rather than working in silos.”
The World Health Organization also recognizes that the work of private health care providers needs to be streamlined and aligned to national health policies and objectives.
“The economic results that drive private sector engagement shall need to be contextualized with regards to the social values and results that underline the objective of achieving UHC in Myanmar,” a spokesperson for the WHO told Devex.
But again, Paul’s model of private health care is not without major challenges, primarily the health workforce capacity and its ability.
“We’re coming out of a very dark period where there’s minimal exposure of rank and file of physiotherapists, radiographers, pharmacists, middle management and executives,” he said. “These people have never been exposed to international best practice and standards — that is one of the biggest burdens.”
However, the tide appears to be shifting as thousands of highly skilled Burmese who had previously emigrated to countries such as Singapore and Australia return, Paul added.
There’s still a massive health force shortage, particularly in rural parts of the country. While the doctor population ratio and the health worker ratio has improved since 2011, those gains have been largely felt in urban areas.
But this is also where the private sector can play a part — by opening nursing and allied health care schools, which helped boost Indonesia’s workforce while simultaneously boosting university places.
However, Win said that if the private sector’s full potential was to be realized and the trend of the middle and upper class seeking health care in Thailand and India reversed, trust had to be improved.
“Trust level is still low for in-country private hospitals,” he said, adding there were cost and accountability issues with regards to privacy and respect.
In addition, he said there were many unregistered private facilities operating without checking the quality of the doctors or whether they had passed the Myanmar Medical Council exam.
Despite this, the Burnet Institute’s Win predicts that as the private sector expands, so will its demand.
“More middle-class people will go [to private hospitals] whether they like it or not.” he said. “But people are now more aware of their patient and consumer rights and, as a result, the check and balance sector is increasing.”
Seeking care abroad
In the same vein, Paul used the example of Indonesia where Siloam Hospitals had been accredited by the Australian Council on Healthcare Standards, which had helped to instill trust among the community and reduce the desire to seek care overseas.
He explained that the number of Indonesians seeking care predominantly in Singapore and Malaysia over the last decade had dropped but the trend was still continuing, largely because of cost and proximity.
“I believe there will be a significant change once private infrastructure grows in the country — there will be a significant reversal of the trend of people leaving for care. The key is to create a level of trust. How do we create trust? I say I’m good but anyone can say that.”
With Yangon’s Pun Hlaing Siloam Hospital due to receive international recognition next year, this could give a cue to the community to stay local, said Paul.
“If a world organization can accredit a hospital as safe, then why go to Bangkok and pay double the price?”
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Sophie Cousins is a health writer based in India. She was previously based between Lebanon and Iraq focusing on refugee health and conflict. She is particularly interested in infectious diseases and rural health in South Asia. She writes for international medical journals, including The Lancet, and for international news websites such as Al-Jazeera English.
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