On March 13, 2019, Community Partners International (CPI) and the Myanmar Health CSOs Network organized an information sharing session with 85 Myanmar parliamentarians in Nay Pyi Taw to refocus attention on, and build momentum for, a national health insurance system to help Myanmar attain universal health coverage (UHC).
Myanmar has committed to attaining UHC by 2030, ensuring that all people can access good quality health care without suffering financial hardship. But what does this mean in practice? The World Health Organization (WHO)’s and World Bank’s monitoring framework defines the achievement target for UHC as reaching at least 80% coverage of essential health services, and 100% financial protection from catastrophic and impoverishing health payments. A third, and fundamental, measure of achievement is equity. Countries seeking to achieve UHC must ensure that poorer, less advantaged segments of the population are not left behind.
These targets powerfully illustrate the scale of the challenge facing Myanmar. After decades of underinvestment, Myanmar’s health infrastructure and health workforce remain some way behind the levels required to achieve universal health coverage. The budget allocation for health has increased in recent years, rising from 1% of total government expenditure in 2010-2011, to 5.23% in 2017-2018. However, the majority of health expenditure in Myanmar is still covered by out-of-pocket payments (73.9% in 2015 according to the WHO Global Health Expenditure database) and hundreds of thousands of people in disadvantaged communities have little or no affordable access to government health services.
Government investment and overseas development assistance alone will not be sufficient to resolve the challenges of low health service coverage, high financial risk, and inequalities in access to care in the Myanmar health system. One feasible way to help bridge the gap is the introduction of a national health insurance system that covers the vast majority of the population and focuses particularly on supporting access to health for disadvantaged populations. In June 2017, Myanmar’s House of Representatives (Pyithu Hluttaw) introduced a motion urging the government to establish a national health insurance system to help fund the health system and reduce households’ out-of-pocket expenditure on health care. However, the progress of this legislation has been slow.
In this context, the information sharing session on March 13, 2019, titled ‘Moving Myanmar’s Health System Forward: From Evidence to Policy’, provided an opportunity for parliamentarians and civil society representatives to jointly review progress on UHC, and refocus attention on the need for a national health insurance system.
After opening remarks given by Dr. San Shwe Win (Chairman of the Health and Sports Development Committee of the Pyithu Hluttaw) and U Myint Swe (President of the Ratana Metta Organization), the event featured presentations from four government and civil society sector experts. Dr. Than Tun Sein (Retired Director for Socio-medical Research at the Department of Medical Research) spoke about the importance of health equity in Myanmar. The next presentation was given by Dr. Nilar Tin (Retired Deputy Director General (Public Health), Department of Health) who summarized universal health coverage and reviewed Myanmar’s National Health Plan (2017-2021). She was followed by Daw Nwe Zin Win (Director of Pyi Gyi Khin) who spoke about the role of civil society in achieving universal health coverage in Myanmar. The final presentation was given by Dr. Mya Thet Su Maw (Health Advisor at the UK’s Department for International Development) who provided an insight into the landscape of health development partners in Myanmar.
Following the presentations, the floor was opened to a plenary discussion moderated by Dr. Si Thura, Executive Director of CPI. Discussions ranged over key topics including the need for greater involvement of ethnic health organizations in the implementation of the National Health Plan and formal recognition of the ethnic health workforce; the challenges in meeting the target to deliver a basic Essential Package of Health Services (EPHS) to all by 2021; the need to push ahead with the national health insurance legislation in parliament; and the need for greater decentralization of the health system to enable ethnic and private health providers to play a greater role.
During contributions from the floor, it was confirmed that the legislature is committed to supporting the introduction of a national health insurance system as part of wider health care reforms and that, once the bill is submitted, the House of Representatives would ensure that it progressed quickly into law. It was stressed that achieving UHC will require the involvement of many stakeholders, not just the government, and ethnic and civil society health organizations and the private sector will be important partners to help achieve equity in access to health services. This will require a shift in mindset towards greater decentralization in terms of health service planning and resource allocation. Representatives from health CSOs confirmed that they are ready to support the government to implement UHC in the communities that they serve.
The session closed on a note of optimism, with a renewed sense of the commitment among parliamentarians to introduce a national health insurance system. However, this optimism was tempered by the awareness of the significant challenges that lie ahead for Myanmar as the country seeks to attain UHC.
Community Partners International (CPI) will continue to work with the Myanmar Health CSOs Network to advocate for the national health insurance system, and raise awareness of and support for UHC in Myanmar.