National Health Plan MyanmarMyanmar National Health Plan
Investment in health is vital not only to improve health results but also to support the economy. Investment in health pays off. The right investment in health is stimulating the economy, as shown by the world' s knowledge. From 2000 to 2011, health improvement represented about 11 per cent of the economy's increase in low and middle-income group.
The health system is a powerful and consistent system that provides the basis for good health for young people, family and community, and contributes to a prolific work force and a people that can take full benefit of the chances of growing the economy. The system also helps protect the family from livelihoods caused by the cost of health services.
In 2017-2021, the National Health Plan (NHP) is aimed at strengthening Myanmar's health system and improving fair and equal universal accessibility to good basic health care for all.
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Improvement, but the disparity is still great - Teacircle
Brennan investigates Myanmar's healthcare system, its achievements and health care issues. At the end of July, there was a wave of anxiety in Yangon and parts of Myanmar when word of an "outbreak" of the Hitler Youth 1N1 broke out in the public eye. It was followed by a briefing at which Myanmar's Ministry of Health reported that two individuals had been killed by influenza 1H1, generally known as that.
Others have been discovered in isolated areas of Myanmar, such as 10 cases in Matupi, Chin State, and others in the Bago area, Ayeyarwady and Naypyidaw area. Myanmar's recent cases of HIV/AIDS (H1N1) have shown how far it has come in health communications and work.
In fact, Myanmar's healthcare system has come a long way since the beginning of democracy in 2011. Eliminating disparities in health care provision across the whole territory must be a key area. Especially the bridge of performance gap between municipal and countryside municipalities and for ethnical minorities.
It will be worthwhile for the goverment to improve these facilities. Overall, greater trust in the administration will have a beneficial effect on the continuation of cease-fire talks and policy dialogues with the people of the area. Indeed, these matters must be addressed both cooperatively and to some extent from a centralised point of view, which calls for cooperation between minority groups and the NLD administration.
This means investment in a more robust environment for global donor support for improving the health system in one of the world's most disaster-prone nations, located between the two most populated states. The purpose of this article is to provide a guide to some of the most urgent issues in the overall health system of Myanmar today.
Whilst the global sustainability targets for 2030 leave Myanmar lagging behind in all elements of the WHO health system. To meet the objectives of UHC and other WHO health system requirements, Myanmar needs to be significantly improved across all elements, particularly in relation to three key elements - health care service, health personnel and health information.
The prerequisite for this is that further modules of management, control and funding of the health system will be reached if capacities within the system are further expanded. Previously, the quasi-military coalition increased health expenditure from 0.2% of GNP in 2009 to over 1% in 2014.
Acknowledgement of the importance of public health and health investments continues to grow. The National League for Democracy (NLD) has made Universal Health Care and accessing a Basic Essential Package of Health Services (EPHS) the core political goals of the administration since it came to office in 2016, placing health policies in the foreground during the first 12 month of its term of office.
In fact, significant improvement in the funding of the health system must be made. In Myanmar, payouts are well above the worldwide 32% mean of a country's overall health spending.
The latest NLD health care policies have aimed to reduce out-of-pocket spending to 25% of total health care outlays. With capacities within the MoHS and the health care sectors in Myanmar still low, there are many NGOs that support capability development programmes. An important one is the World Bank's essential health care access projects, a $100 million program that runs from 2014 to 2019 and is aimed at improving basic health care with a strong emphasis on the health of mothers, newborns and children.
Like in most industrialised and industrialised nations, there are differences in the provision of health care between the city and the countryside. About 70% of the Myanmar community lives in the countryside and is mainly active in sub-sistence economy. Much of Myanmar's indigenous people still follow culture and take conventional medicines.
The search for astrologists, sorcerers and health workers to manage health services is widespread. This health-promoting behavior can lead to a complication in today's healthcare system, where less efficient treatment or mystique replaces today's medical science. Whilst eight ethnically militarized groups in October 2015 sign a cease-fire with the Tatmadaw, Myanmar's army, a number of other groups are still in various levels of conflicts.
Subnational government bodies, among them subnational health care providers, have been established by the profound and decades-long abuses between minority communities and the Tatmadaw. In the absence of a federation that can integrate these infrastructures, there is a wide disparity in the provision of service throughout the state. Myanmar's health system challenges have led to a mix of successes in meeting the health-related Millennium Development Goals (MDGs).
One of the key issues mentioned was a poor health system. But as was demonstrated in 2016 by a fatal eruption in the Naga areas of isolated northwest Myanmar, differences still exist in terms of ethnicity. Naypyidaw's greatest challenge, as the MDGs fail ures show, remains the establishment of a health system in areas of communities of national minorities where there has been profound distrust in the face of a decade of conflict with the federal state.
There is little opportunity for the Myanmar administration in a dozen of Myanmar communities and the struggles between ethnically based groups and the Tatmadaw continue. Collaboration with community-based ethical health organizations (EHOs) and NGOs will be critical in these areas if the MoHS is to meet its SDG commitment to providing all Myanmar's citizens with access to health care.
Further societal factors affecting health provision in Myanmar include extreme levels of extreme poverty, continuing conflicts, indigenous and ethnic disparities, fragile and inadequate government, bad infrastructures, peak seasons of global warming, and inadequate health provision. Myanmar's health system will have three key elements to address these issues, as outlined in the following review:
healthcare, health personnel and health information system. Others, such as devices and technologies, will continue to be critical, but should be improved as the three above mentioned elements move forward. According to MoHS, in 2014 it was operating 988 clinics and 1,684 health centers in the countryside. There were 348 health centers for mothers and children.
It quoted 13,000 physicians, 30,000 registered medical staff, 22,000 middlemen and 11,000 health personnel across the state. Number of health professions was well below the WHO goal per 1,000 population. Health volunteers remain central to the provision of services, particularly in minorities and countryside, and they often have to provide services beyond their initial education.
The World Bank reports that some health system performance figures suggest that performance has deteriorated during the course of war. Even during the period of reigning the army, half of the health workforce worked in city areas, although the great majority of the people live in the countryside. During the former regime of the former regime, people in minorities in the countryside and among minorities largely depended on conventional health practice, basic health provision locally, or the efforts of multinational health experts working with NGOs.
For a long time there has been a wish to make better use of health personnel. In 2000, this was expressly declared by the army in a strategy pamphlet titled Myanmar Health Vision 2030. It also underlined the need for the provision of all-purpose health services. From the beginning of the 2011 period of democratisation, the effort to strengthen the health system, which includes the improvement of health personnel, has been reaffirmed.
NLD has expressed a wish for decentralisation of the previously strongly centralized health care systems. Today the 330 Myanmar Townships are looked after by a local Med. Officers. Every major community clinic has a senior consultant, 1-2 ward clinics, 4-7 country health centers (RHCs) and a different number of country sub-RHCs.
Each RHC is headed by a health officer and has a basin of 20,000 inhabitants. Usually, sub-RHCs are run by a volunteer or health worker with a resident community of 5,000. The latter, the most fundamental part of the health care infrastructures, carries out vaccinations and other health programmes.
Whilst this structures work in theoretical terms, locally, with different health care systems and persistent racial tension and force, the realities in many of these provinces are very different. Aung et al (2016), who deal with rustic and municipal imbalances in the search for fevers, have found in an example that "the rustic population needs better accessibility to educated providers" and more information about preventing and treating it.
This survey recommends that more skilled health personnel and health care centers are needed in the countryside and that they should be readily available and affordably located. But in recent years, however, low educational levels in the countryside have led to fewer persons with a country backgrounds having adequate training for access to higher learning.
Fewer villagers are becoming health workers, which also means that fewer persons from ethnically diverse backgrounds are becoming skilled health workers in the state. Overall, Myanmar has an inadequate number of health experts at national levels who are representing the variety of its populations, ethnicities, gender and linguistic skills.
Such shortcomings place ethnical minority groups at a considerable disadvantage. a... From 2011 to 2015, public health care spending rose 8.7-fold. NLD leaders have followed this tendency and drawn up their own plan: Myanmar: A roadmap for general health care in Myanmar. As a comprehensive and challenging paper, it seeks to tackle the health determining factors in society and to strengthen the former army government's ambition for the provision of all-care.
The aspirations to achieve peasant populations and ethnical minority groups are also greater than previously sketched. Myanmar's National Health Plan, developed by the NLD administration, has as its key objective to provide universal health care for all by 2020. In addition, the aim is to enhance the protection of finances and the "convergence" of health care providers in areas of disadvantaged populations in the countryside and among ethnically diverse nationalities.
Generally and disproportionally in metropolitan areas, health care providers will have to fight more and more both transmissible and non-communicable disease. A recent survey found that 59% of Myanmar fatalities are currently due to non-communicable disease, a number that will increase as prosperity rises. The key issue in the short run is equality of service provision, especially between different ethnical groups.
This does not mean that the provision of ser-vices in areas with ethnical minorities is necessarily poorer, on the contrary, in many ethnical areas the provision of ser-vices is very efficient, often backed by the long-term engagement of religious NGOs. For example, in some cases, such as Wa State, which is backed by close links with China, health assistance to local minorities is better than Myanmar's public health systems.
Generally speaking, resources must be allocated more strongly to reduce health care inequalities. Centralization of the health system reinforces these inequalities. The decentralization of the health care system is, however, restricted by the constitution drawn up by the army in 2008, which establishes a system of national or national supervision of health care spending, not state or sub-national supervision.
The differences between the different ethnical groups are so great that an 11-year gulf divides the highest and shortest lifespan in Myanmar. Nevertheless, the general population's mean lifetime at childbirth in 2015 was low - 65 for men and 68 for females, the smallest in ASEAN, as shown by the HOSI (Health Performance Index ) in Graph 1.
The level of health provision in all areas is far below what is accepted. The first year of discussion, both at national and sub-national level, focused on proposals that health interventions in sub-national areas could "converge" under a single, state-controlled and managed health system. While there are still many remaining obstacles to the converging sub-national and national health system, many more are still needed to improve the national health system itself.
Consequently, and in the absence of assistance network, recent immigrants - many of whom come from ethnical minorities - may be more vulnerable to health outcomes. Particularly vulnerable are the vulnerable groups of young, lone and rustic immigrants to STIs, drugs and drinking, and psychological health issues among the majority of young, lone and rustic men who move to the city.
It is also likely that they will be hardest hit by the high health costs. A survey found that men travel twice as often as females from two (non-ethnic) areas in Myanmar. Domestic immigration will remain a source of pressures on health care and other sectors and must be tackled by the state.
Many of the recent and most of the research and information gathered by the Myanmar administration has been conducted in most of Burma's ethnically diverse areas. Politics as such has concentrated on the most part of the population. Sensibilities related to collecting information were identified by the federal authorities in a national survey in 2014.
In fact, others find that much of the information and resources gathered only reach or are unevenly distributed to Burmese and Buddhist areas rather than other people.
In many cases, it is almost entirely ethnical groups that are supported by NGOs from around the world, putting a strain on Burma's relationships with Burma's main government and community. Myanmar's health information system is heavily centralized and discriminates against poorly-presponent ethnic nationalities. More indulgence has been shown since the changeover when the townships have their health care schemes drawn up and implemented within the scope of the objectives set by the MoHS.
Many INGOs are supporting the design and execution of extensive health care schemes in the cities. Myanmar's shortage of infrastructures, which includes inadequate power and, until recently, the shortage of the web, has led many isolated communities, especially in areas with ethnical minorities, to some extent to operate almost independent along the overall governmental objectives.
Finally, a major continuing concern is that health information is not exchanged between health service users in areas with minorities, particularly due to a loss of confidence between health organisations and the state. The answer to these doubts is a four-year piloting programme in Myanmar and other low-resource counties, headed by Bloomberg and the Australian Ministry of Foreign Affairs and Trade to enhance the overall health information gather.
In 2014, a survey conducted on the basis of an interview with members of non-governmental organizations working in Myanmar examined how the health system could be strengthened. These issues included barriers to the provision of services due to health system weakness and red tape, which included staffing, information and logistics issues and not unexpectedly poor or deficient health facilities, infrastructures and ressources.
Hernandez and Myint (2017) suggest that "older persons should be addressed as an attempt to cope with the high levels of exposure to NCD and to create robust health systems. There are clear advantages in terms of the economy, which should also help areas with minorities that are still suffering from conflict-related diseases.
A similar level of awareness should be expanded to all those in need of protection, but in the end all Myanmar's population is best equipped to improve the overall health system and to have general accessibility to health care. Particular emphasis on the three components emphasized in this paper would help to give health care in Myanmar a much-needed opportunity.
Burma still has a long way to go to make its health system better and to make it accessible to all. Further efforts by all in Myanmar's governance and supporting the global fellowship, donor and all communities are needed to achieve SDG 3's objective of "ensuring a healthier life and promoting the well-being of all age groups".
Prior to this, he worked with the Joint Ceasefire Monitoring Committee and the Myanmar Peace Centre in Yangon.