In 2018, Myanmar ranked 190th in the World Health Organization’s ranking of the world’s health due to the country's low expenditure in the healthcare sector. Even though in 2017, healthcare expenditures have been reduced from 85% to 62% from 2014 to 2015, patients still have to pay the majority of healthcare costs by themselves.
For every US$ 10 spent on health in Myanmar, $7 is paid by people and less than $3 comes from the government. Actually, medical charges are high for most of Myanmar citizens compared to their minimum wage, 4,800 Myanmar Kyats (roughly $3.6) per day. Thus, underprivileged patients in Myanmar have to rely on support from their communities, charities and non-profit organizations. In fact, government health providers are supposed to provide medication free of charge to underprivileged people but this is not always the case due to the limited budgets that public hospitals get.
“My husband has been paralyzed for six years and is hospitalized very often. I work as a vendor and sell vegetables. The family’s income doesn’t cover his medical charges. We rent the land we are staying at the price of 10000 MMK per month,” said Daw Hla Hla Aye who lives in East Dagon. (Thingangyun San Pya hospital).
“We are from Mawlamyine but due to the mental illness of my daughter, we moved to Yangon. My husband, me, and my daughter worked at polices. Since we are low-paid and the three of us have health problems, we entered into monasticism,” said the nun Daw Waibaryi. (Thingangyun San Pya hospital)
“I need a 24-hour oxygen supply due to my lung disease. I have no family and I am surviving with the support of this (Insein) hospital,” said a 60-year-old pick-up patient, U Myo Than. (Insein Hospital)
60-year-old patient U Myo Than needs his oxygen to survive.
Photo by Gandamar Kyaw
Not only do patients in Myanmar need better healthcare but also doctors in government hospitals need to be provided with more equipment and facilities.
“To upgrade the healthcare system of Myanmar, we basically need four Ms - men, money, methods, and materials. The main cause that brought health problems to the underprivileged people is their poor education. As they have poor education and healthcare knowledge, they come to suffer from many diseases of which the major cause is their unhealthy lifestyles. To upgrade the standard of public health, we need to provide good education and health knowledge to our citizens,” said Dr. Ne Lin Tun, lecturer and consultant physician at Thingangyun San Pya Hospital.
Lack of well-trained health staff creates barriers for people to access proper healthcare, especially in rural regions. Medical staffs typically receive low wages which created a lack of motivation to deliver a high-quality service. For example, in some of the villages of Bilin Township of Mon State, there is a shortage of midwives and visits often take place more than two weeks apart.
According to Yoshihiro Kimata, a professor at the Okayama University Graduate School of Medicine, there are only about 30 doctors per 100,000 people, one-seventh that of Japan. Only four universities in Myanmar have medical schools, and the shortage of doctors has become a chronic problem.
“The relationship between the community and public health system had acted as a barrier to health in the communities we engaged within Mon State,” said Bright Future, a local organization that undertook community consultations in Mon State to generate information and improve understanding of the social factors limiting access to healthcare.
A midwife reported that community members do not follow her instructions about antenatal care and child delivery. Underprivileged people in rural areas are reluctant to trust government healthcare providers over the informal healthcare provider who had a close relationship with them for years. Sometimes, community members feel frustrated with medical staff, whom they say, rarely discuss in detail about their health concerns and answer their questions. Also, traditional beliefs and superstitions about health create difficulties for medical staff who have to deal with underprivileged patients in rural areas.
In order to enhance the healthcare services in Myanmar, Ministry of Health and Sports has set the National Health Plan which focuses on human resources, infrastructure, service delivery, and health financing. The first step of the plan, covering 2017 to 2021, will be implemented in 78 townships and it will deliver the primary healthcare services.
“The ministry can’t afford to cover all townships, so the cooperation of general practitioners, Civil Society Organizations, Non-Governmental Organizations, and ethnic health organizations is much needed,” said Dr. Thant Sin Htoo, assistant secretary of Ministry of Health and Sports in an interview at Myanmar Times.
“The 78 townships were selected according to their level of infrastructure,” explained Dr. Khin Thu Htet, a member of the National Health Plan Implementation Monitoring Unit (NIMU).
The National Health Plan aims to provide better healthcare service and lower private spending.
From my personal point of view, most of the citizens in Myanmar are poor and underpaid. As a result, people cannot get proper healthcare services because of their low income. Besides, foods in the market are not healthy which largely affects public health. And most of the health problems in Myanmar are brought by unhealthy food, unhealthy lifestyles and limited knowledge about healthcare. What the government can do to tackle this issue is to increase healthcare expenditures and modify the policies of public health.