Myanmar has one of the most poorly developed health infrastructure among the South East Asian countries. Although the majority of Burma’s population lives in rural areas, most health services continue to be concentrated in larger towns and cities and most villages lack basic healthcare services. The chief challenges facing the healthcare system in Myanmar are:
Inadequate infrastructure: In 2000, the World Health Organization (WHO) ranked Myanmar among the lowest of 190 countries for their health systems. The government spent 1.9 percent of its gross domestic product (GDP) on health in 2007, the lowest rate among countries for which WHO had collected data. Nationwide, there are 1,504 rural health centers covering more than 65,000 villages, according to a 2010 Health Ministry report. Myanmar had an estimated 13 doctors and nurses/midwives per 10,000 residents, according to a WHO 2010 calculation.
There are 14 public (but no private universities) offering medical courses in Myanmar. Those doctors already in practice are badly under-compensated. The country’s trauma care and cardiovascular diagnostic capabilities are extremely inadequate.
The HIV problem: An estimated 38 million people are living with HIV globally. Half a million of those are in Thailand and a further 200,000 in Burma. Burma’s growing drug trade coupled with the decimated healthcare system could quickly spread HIV. With ongoing increases in narcotics production in Burma, an issue directly linked to ongoing failures in ethnic reconciliation and widespread official corruption, the combination remains a dangerous one for the unchecked spread of HIV and its consequences in Burma. HIV is largely concentrated in high-risk behavior groups and settings and prevalence varies greatly by geographic locations and by population subgroups. A high prevalence of HIV is observed in the border areas, large cities, the northern and eastern states of the country where there is a large cross-border mobile population, and mining areas where there is a highly mobile migrant worker population and compounded with easy money, sex work and drug use is common.
Communicable diseases: Because of the pitiful amount of money the government has historically spent on healthcare, Myanmar continues to struggle with basic problems related to communicable diseases. Malaria is the leading cause of morbidity and mortality in the country. Many of these deaths occur from a drug-resistant form of the disease common along the country’s border with Thailand. TB rates in Myanmar are estimated to be three times the global rate, and the majority of cases are drug-resistant. Burma also has more than 50% of all malaria-related deaths in Southeast Asia. This is in part due to poor diagnosis and treatment, but also to the widespread prevalence of counterfeit anti-malarial medication.
Ineffective Governance: Although Burmese government increased spending on health care in 2013, Burma faces a long list of challenges when it comes to improving health care in the country. One key challenge will be ensuring designated funds reach intended recipients. Widespread corruption can mean that the government’s increased spending on the healthcare system may disappear before it reaches its intended target. According to the World Bank, Burma ranks in the lowest percentile when it comes to government effectiveness, regulatory quality, and control of corruption—all key factors when it comes to ensuring that the government’s increased spending on health care reaches intended targets.
Corruption: At the other end of the spectrum, patients are frequently expected to make under-the-table payments as a means to ensure they receive quality care. Burmese patients seeking care report that bribery is a common and a widely accepted aspect of getting health care in Burma. In addition to the up-front costs of doctor visits, medication, and supplies, patients report having to pay for everything from extra blankets to using the toilet. Many of the health centers lack basic supplies, medication, and equipment. Patients with complex medical conditions frequently travel great distances within Burma, often to a larger city like Rangoon, in the hope of finding treatment which is often cost-prohibitive.
Lack of reliable health indicators: In previous years, constraints on health activities in Burma made data collection difficult and presented challenges for accurately assessing and responding to the most challenging health issues in the country. The lack of reliable data is likely to change as more health and humanitarian organizations start working within the country. However, it is important that the government also plays a role in contributing to reliable, consistent, and long-term data collection and analysis that can help inform the country’s priorities in healthcare delivery and investment. Aside from concerns over graft, Myanmar lacks any sort of substantial administrative public health capacity. Questions over how new money will get spent, and who makes decisions about what to prioritize spending on, remain unanswered. Given the sheer size and scope of the problems within Myanmar’s health infrastructure, no one at the Ministry of Health has a clear hierarchy of priorities on where money should get directed towards first.
Ethnic conflicts: The country’s long history of conflict and unrest adds another layer of complexity to the challenges Burma will face on the road to health care reform. According to Karen News, before the KNU and the Burmese government reached a cease-fire last year, Karen health workers were at risk of arrest and detention. In government designated ‘black zones’ ‘shoot on sight’ orders were in place, and health workers risked death for providing health service to Karen communities. Conflict also adds another layer of complexity for aid organizations interested in working in Burma, where aid groups need permission from local armed groups to enter territories under their control.
In 2010, WHO published 16 recommendations to boost the odds of rural residents accessing lifesaving care, including recruiting medical students from rural areas, compulsory rural health service, improving living conditions and offering financial incentives to rural health workers. However, the focal point is that against the backdrop of these many different and pressing needs, a clear set of priorities on how to spend limited government resources will be necessary to deal with the healthcare situation in Myanmar.