By Thein Thein Htay
When I was a child growing up in Myanmar, we had a family doctor system for those of middle class and affluent status. In most cases, we didn’t need to go to a clinic, dispensary or hospital. Our family doctor was very personalized and the whole family was satisfied with the health care system at the time, as we had very safe and effective medicines, and our doctor used to advise us on ways to stay healthy and prevent illness.
However, that was not the case for my fellow citizens in the rural areas, and when I grew up I sadly learned that we had had a very high maternal mortality ratio (MMR) in the early 1950s. with 890 per 100,000 live births.
Still, in spite of the very low investment in health over the decades plus insignificant ODA compared to the neighboring countries in the region, Myanmar has succeeded in bringing down its MMR to 580 in 1990 and 200 in 2011.
Despite that, the rate of annual decline has been notably low, which calls for more investment in healthcare. With a remarkable increase in investment in the health sector since the outset of the new administration in 2011, the Ministry of Health has provided an ample supply of essential medicines to both urban hospitals and rural health facilities. The health care budget increased under the new administration with an increase of 7 Billion Kyats to over 700 Billion Kyats per year, and the Ministry of Health began to more focus on improving the healthcare infrastructure in rural areas.
Nevertheless, because of chronically low investment before 2011, the system needs to be strengthened, and we cannot look at this drastic jump alone and consider it sufficient. In order to establish a sound, working health care system for the entire country, the budget still needs to be increased two or three fold.
The system also needs to be strengthened in its all round development, using the most appropriate, evidence-based best practices including World Health Organization’s building blocks, among others. Along with its rapid transition in the political, economic and social framework, Myanmar has now opened up the page towards Universal Health Coverage.
All political, social and ethnic fractions in Myanmar may have different views on a lot of things but they share a common belief in that Myanmar’s health care system needs to change for the better. This consensus, given its neutral and apolitical nature, could serve as a model for initiating other key changes – such as peace talks and arms proliferation.
Before, the idea of reaching the healthcare millennial goals was merely on paper but there were no actual funds to implement. But now, the increase in finances makes it an achievable possibility.
Before, the health care system in Myanmar was run by a top-to-bottom approach, where top Department of Health officials alone decided how much funding was allocated to various regions. Now, the new model being implemented takes a bottom-up approach, where health sector representatives from rural areas are included in major decision-making processes so they can reflect on what particular regions, districts and villages really need. This prevents waste in areas of excess and provides the right materials to areas of need.
Nevertheless, the government also keeps trying to raise its own health budget to reach a minimum of at least 5 percent of GDP as soon as possible.
Increased funding does not necessarily mean better health services or outcomes. Planning and proper management are necessary. Also, the provision of a certain level of autonomy to particular regions is essential to the success of a working health system.
We have our dreams. How can we bring it?
— The government side has to hold its end of the bargain and needs to provide accurate, understandable and clear healthcare education, but the people also need to put in effort by being conscientious on healthcare education, follow their doctors’ instructions and do what’s best for their own health.
— No individual from any demographic should be denied the right to health care and quality service. They should also be provided the necessary environment to be well informed on health education.
— It is crucial to ensure that country is in the driving seat by respecting national ownership.
— Increasing population and growing national and international expectations should be taken into consideration when looking at Myanmar’s health care system. A good example is the issue of accountability. Before, doctors didn’t have to worry much about the consequences that associate their actions but now, the possibility of legal actions associating accountability measures become a distant possibility.
Finally and most importantly, Myanmar has had a problem in the past where assignments to particular health departments don’t necessarily reflect the individuals’ credentials. A lot of this occurs as part of the political patronage problem which stems from decades-long corruption and lack of oversight in the country.
So, it is crucially essential to put the right people in the right positions to have our dreams come true.
Dr. Thein Thein Htay is the Deputy Minister of Health for the Republic of the Union of Myanmar.
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Jack Myint contributed some translation services for this Op-Ed.
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