Myanmar’s Vice President Dr Sai Mauk Kham recently visited Singapore to discuss “health and education,” with the country’s political leaders in hopes of assisting his governments future reforms.
Despite sweeping policy changes since President U Thein Sein came to power in 2011 improving national prosperity, Myanmar still faces a long list of challenges hindering the country’s development process.
When Australia announced a $24-million aid package to support the government’s national efforts earlier in July, Foreign Minister Julie Bishop stressed education, economic development and equality for women as the package’s key targets.
But left less publicised has been Myanmar’s debilitating healthcare system, which despite recent funding increases continues to have medical infrastructure and supply shortages throughout the country.
One can only hope Vice President Kham’s observation of Singapore’s Khon Teck Puat hospital during his trip to the country is a sign of the government’s continual commitment to improving its national health care provisions.
Over the past three years, Myanmar has tripled its healthcare expenditures as authorities try to support an underdeveloped medical system left starved by the country’s previous military government.
In his meeting with Singaporean President Tony Tan, Vice President Dr Sai Mauk Kham said Myanmar has a “keen interest” in their Southeast Asian partner’s medical system.
President U Thein Sein signed a memorandum of understanding with Singapore for the country to share development and training expertise with Myanmar in January 2012.
Vice President Sai Mauk Kham met with President Tony Tan to affirm the bilateral relations between the two countries and express Myanmar’s appreciation of Singapore’s assistance in their development efforts.
But Myanmar’s government must ensure their discussions with Singaporean political leaders are taken as an opportunity to improve the country’s own health care system.
Bloomberg ranks Singapore as the 2nd most efficient healthcare system in the world through its non-modified universal provision’s capacity to offer high quality services on a modest 4 percent of its total GDP output.
The country health care system has one of the lowest infant mortality rates and among the highest life expectancies in the world, according to the World Health Organisation (WHO).
In comparison, Myanmar’s lack of government investment over decades,along with foreign sanctions barring support from non-governmental organisations, left the country’s healthcare system ill equipped to deal with the nations medical needs.
Myanmar was ranked as the second worst overall health system when surveyed in a WHO report of 191 countries around the globe in 2000.
The nation ranked in the bottom third in doctor accessibility with just 0.36 physicians to every 1,000 people, according to a 2004 report by research centre National Master.
Myanmar’s government needs to continue its healthcare reform efforts if the country is serious about overcoming its medical deficiencies.
In 2013, Myanmar’s government increased healthcare spending to around $450 million (K450 billion) to help support the country’s medical infrastructure struggles.
The reforms were a 2 percent government funding increase from the 1.9 percent budgetary assistance provided by authorities in 2012.
Myanmar’s new quasi-civilian government’s increased commitment to supporting the healthcare system has seen wide spread improvements throughout the country
Recent healthcare funding improvements show an increase from the $7,688 contributed by authorities over 2000-01.
Singapore’s high-quality public health system of universal coverage shows where Myanmar needs to aim in order to improve its own national healthcare capacity.
By creating an affordable and accessible public health care system, 70 percent of Singaporeans now choose to obtain medical services through the country’s state-run hospital sector.
This is in stark contrast to Myanmar where the country’s underdeveloped system has led to health-care provisions being dominated by under the counter payments in direct transactions between patients and medical professionals.
Most of Myanmar’s population cannot afford private health services, instead choosing polyclinics or monasteries where they pay a small fee for medical services since public health systems are already overtaxed by the nation’s medical demands.
In the fiscal year ending in March 2010, Myanmar’s general public payed the 81 percent of healthcare costs – the highest amount in Asia, according to the World Bank.
Medisave, Singapore’s national medical savings account and a national government restructuring of hospital ownership in the 1990s, have enabled Singapore’s universal health coverage.
National savings strategy
Poverty is the major constraint hindering the development of the country’s health care system, according to the World Health Organisation’s 2014-18 Cooperative Strategy with Myanmar.
Singapore’s Medisave encourages citizens to use government health services by subsidising the costs of bills through having employees contribute 6.5 to 9 percent of their monthly salaries into personalised savings accounts.
But for Myanmar implementing a national saving’s scheme is unrealistic given the nation’s local financial constrains.
The country remains one of the poorest in Asia, with an average only 25 percent above the poverty line and a per capita GDP of just $868.
Myanmar’s Ministry of Health revealed rural health centres have increased from 1,337 to just 1,565 since 1998 in their 2012 report.
Inadequate funding
Myanmar’s government has so far been unwilling to divert the large percentage of funds that would be required to revolutionise the country’s healthcare system.
The government’s healthcare spending represents one of the lowest in the Association of Southeast Asian Nation’s region (ASEAN).
Medical investment makes up just two percent of the country’s total GDP output contributing only 12 percent to the sector’s total revenue.
As such, health deficiencies, including access to basic health services, inadequate infrastructure and skilled health professional shortages remain prominent.
Hospital restructure
Where Myanmar could learn from the Singapore health system development model is it’s 1990 state-owned restructuring to improve medical infrastructure.
Myanmar’s medical professionals have called for government healthcare investment to increase to 6 percent over 2014 to expand service accessibility, according to the Burma Children Medical Fund.
But given the government’s recent budgetary increase to the health sector last year, any further short-term funding to improve the country’s healthcare accessibility may be overly optimistic.
Alternative reforms
If not through state-owned restructuring, the government must find another means of improving medical infrastructure and health supplies to increase service accessibility throughout the country.
The country’s future healthcare advancements will most likely stem from the private sector, following Myanmar’s continual economic expansion.
Already the government’s increased spending on healthcare is expected to increase Myanmar’s pharmaceutical industry by 10-15 percent a year.
The rise is thanks to increased foreign investment interests in the country’s expanding pharmaceutical market with 90 percent of the industries medicine coming from overseas.
Private investment
Myanmar’s government is looking towards foreign investment to support the country’s healthcare system overhaul.
Last month France held its first Health Forum in Myanmar in20 years to discuss investment opportunities in the country’s healthcare system.
The French Agency for International Business Development event saw six French companies tour local hospitals in Yangon, according to The Irrawaddy.
In June, Singapore Asia Medic Ltd announcedit signed a joint venture with Myanmar’s Five Oceans Service Co Ltd to invest $3 million in two hospitals in Mandalay.
Government reforms
The future government healthcare reforms needs to target cooperation between the country’s government and private health to improve healthcare accessibility.
In 2000, the Ministry of Health drew up its “Myanmar Health Vision 2030,” a document that outlined the country’s aim to provide universal health coverage by 2030.
Myanmar faces a long road ahead before achieving this goal.
The government needs to ensure increased foreign investment in the country’s pharmaceutical markets and private hospital systems are filtered through to the country’s public system.
To increase healthcare accessibility, Myanmar’s government needs to inject more funds into the country’s public sector to ensure effective private-public cooperation can take place.
Based on current trends, if Myanmar’s economic progress continues to increase, it is likely the country’s health system will progress in the future.
But the country will only reach its target of universal health coverage by 2030 if medical infrastructure remains at the forefront of government reforms and are not lost as an afterthought in the nation’s financial progress.
