I travelled to Myanmar to learn more about how the health service was functioning after 50 years of severe economic hardship and isolation.
(Photography by Kate Adams)
Following a coup in 1962, when a military junta seized power, years of political oppression and economic mismanagement reduced Myanmar to one of the poorest countries in the world. In 1989 Aung San Suu Kyi was detained under house arrest, where she remained for 15 years. She was finally released in 2010. Her release marked the transition from military rule to civilian democracy. Aung San Suu Kyi became an opposition MP in 2012 — a positive sign to the outside world that the country was beginning to embrace democracy after years of political isolation.
Whilst there is optimism for this newfound democracy, the period under military rule had been economically disastrous for the country, and its health system had been severely under resourced and neglected.
Improving the health of its 59 million people is now a priority for the government, though the country still faces major obstacles and challenges.
Because so little is spent on healthcare, most people have to pay for treatment if they get ill. But a quarter of the population lives in poverty and cannot afford to pay for healthcare.
The cost of healthcare can push people further into poverty, hence many avoid seeking treatment when they need it. Some of the poorest people are the street hawkers, sellers and boatmen who may be forced to sell their kitchen utensils to pay for healthcare.
During my visit, I spent some time with a local family physician in Yangon.
Like most doctors in Myanmar, Myint Oo works privately and his income depends on payments. He has worked alone for 25 years in a Yangon suburb.
Patients pay 3000 Kyat, the equivalent of US$3, for a consultation, which in some cases also includes medicines.
Not everyone can afford to pay, so Myint Oo accepts whatever people can afford — which may be nothing — and has helped some of his patients pay for life-saving operations.
The day I visit people are coming to see him with coughs and colds and abdominal pains. One man has been in a bicycle accident. Another young man is treated for suspected gonorrhoea.
Myint Oo is vice-president of the family physician society of the Myanmar Medical Association and says that the government spends too little money on health — only 2 per cent of GDP (Gross Domestic Product).
Myanmar is the only developing Asian country with a defence budget that is greater than the education and health budgets combined (Ref Myanmar in Transition A report by the Asian Development Bank 2012)
“There are significant disparities in access to health services between regions and certain ethnic groups,” says Myint Oo. He adds that the health system in Myanmar is in need of “urgent life support”. A shortage of doctors and nurses, has meant that the 20,000 midwives in Myanmar are not only responsible for caring for pregnant women and delivering babies, but they also deliver basic primary care services at the village level.
According to Transparency International, Myanmar ranks 156th out of 175 countries on its corruption index, and corruption in the pharmaceutical sector is evident the day I visit New Bogyoke market in Yangon. The market hosts a number of drug wholesalers and it was not difficult for me to find this anti-malarial medication, which I bought over the counter via an intermediary.
The black market in medicines is a serious concern when malaria remains a major cause of death in adults and children. There are already known problems with resistance to artemisinin, the antimalarial drug present in the purchased box of anti-malarial medication.
My last day in Myanmar is spent at the Hanthawaddy U Win Tin Foundation where I witness the strong tradition of supporting those who are less fortunate.
The foundation provides free healthcare advice and support to former political prisoners, journalists and their families.
Aung San Suu Kyi’s political party, the National League of Democracy, set up the National Health Network in 2013 with the aim of providing basic healthcare services and health education across Myanmar. Voluntary donations support the mobile health clinics staffed with volunteer doctors that patrol the areas with no services.
However, evidence suggests that Myanmar cannot continue to rely on volunteers to protect the most vulnerable. Extensive scientific studies showed that investment in primary care is associated with better health outcomes at lower costs with greater equity in health. To improve the population’s health and protect people from extreme poverty, the country needs increased investment in public welfare.