Burma’s new National League for Democracy (NLD)-led government has released its first roadmap to healthcare reform, including plans to introduce Universal Health Coverage (UHC) by 2030.
The report, released last week, was short on details as to what the essential package of health services would include, but marked a first step toward bringing in potentially monumental changes to Burma’s system of healthcare.
Current discussions between the ministries of health, labour, and immigration and population are aimed at determining what services will be prioritised under the plan, based on the criteria of disease burden, cost effectiveness and availability of resources.
The report outlines that the first step of developing the UHC is defining the different population groups and what services they will be entitled to.
According to the report, the population will be divided into three tiers — the poor and vulnerable, the “informal non-poor”, and those in the “formal sector” — according to their socioeconomic status.
The first group will be partially or fully subsidised for services related to reproductive health, maternal nutrition, and communicable and non-communicable diseases, while the other two tiers will be expected to make a voluntary or mandatory contribution for services.
A basic package for the poor will be ready by 2020 under the first wave of the UHC rollout, the report said, adding that one of the greatest challenges facing the introduction of the scheme will be improving access to services.
Noting that Burma has the lowest life expectancy at birth among ASEAN countries, with 282 deaths per 100,000 live births, the report says that “one of the factors explaining this situation is the failure of the health system to ensure the availability and accessibility of essential health services and interventions of quality.”
Improving early access to medical services will be key to any effort to raise health standards in the country, say experts familiar with conditions in the country.
“Helping [patients in rural areas] with medication before their condition becomes too severe can help buy time to refer them” to hospitals where they can receive more thorough treatment, said Kanchana Thornton of the Burma Children Medical Fund.
Another potential hurdle is attracting trained healthcare workers to work in remote areas — a problem that some say could be addressed by integrating ethnic healthcare organisations into a decentralised system that is responsive to local needs.
“The existing healthcare workforce system or ethnic healthcare system needs to be recognised and needs to be empowered in the existing system,” says Dr Cynthia Maung, the director of the Mae Tao Clinic in Mae Sot, on the Thai-Burmese border.
Other challenges include funding — which will likely involve contributions to a single-payer system, combined with external aid — and developing a strong regulatory framework.
One of the recommendations of the report is the establishment of a “Health Reforms Office” within the Ministry of Health or the creation of an independent body to monitor service reforms and assist with drafting legal frameworks of the new UHC policy.