Trans­par­ent multi-sec­toral de­vel­op­ment needed in Myan­mar’s health sec­tor

Mizzima Business Weekly - - CONTENTS - Con­nor Mac­don­ald

Par­tic­i­pants at the first Myan­mar health fo­rum agreed that although the gov­ern­ment is on the right path in de­vel­op­ing its health sec­tor, more needs to be done to achieve uni­ver­sal health care by the year 2030. Mem­bers of the Gov­ern­ment, health ex­perts, in­ter­na­tional or­gan­i­sa­tions, civil so­ci­ety or­gan­i­sa­tions and the pri­vate sec­tor at­tended the inau­gu­ral health fo­rum in Nay Pyi Taw over the 28th and 29th of July to dis­cuss the di­rec­tion of the gov­ern­ment’s health pol­icy.

Most were in agree­ment about the need for a multi-sec­to­rial ap­proach to achiev­ing Uni­ver­sal Health Care; a sys­tem which sees all branches of gov­ern­ment in­volved and col­lab­o­rat­ing with ex­ter­nal stake­hold- ers to re­spond to the needs of the peo­ple rather than du­pli­cat­ing ef­forts due to a lack of co-or­di­na­tion and trans­parency be­tween the groups.

In his open­ing ad­dress, Vice Pres­i­dent of Myan­mar Dr Sai Mauk Kham em­pha­sised the gov­ern­ment’s com­mit­ment to achiev­ing its mil­len­nium de­vel­op­ment goals and high­lighted an in­crease in spend­ing on health, up 8.7 times from 2011-2012, to 602 mil­lion dol­lars in the 2015-2016 fis­cal year. Myan­mar’s econ­omy is pre­dicted to grow by 9.3% this fis­cal year which sees growth in the health sec­tor a re­flec­tion of fis­cal growth rather than spe­cific ini­tia­tives un­der­taken by the gov­ern­ment. Myan­mar still only con­trib­utes only 1.8% of GDP to its health sec­tor, com­pared to mil­i­tary

ex­pen­di­ture at 4.3% GDP.

Dr An­drew Cas­sels, a pan­el­list at the fo­rum, for­mer WHO ad­viser and found­ing di­rec­tor of GH As­so­ci­ates, says more fund­ing is needed for Myan­mar to achieve it’s Mil­len­nium De­vel­op­ment Goals.

“On the spend­ing side, the econ­omy is grow­ing and so there will be some growth any­way. I think where the gov­ern­ment has to show more po­lit­i­cal will is ac­tu­ally in­creas­ing the pro­por­tion of gov­ern­ment spend­ing that goes to health and in­creas­ing the pro­por­tion of GDP. It’s lower than any­where else in the re­gion at the minute.”

A panel dis­cus­sion em­pha­sised the need of a bot­tom up ap­proach to de­vel­op­ment in or­der to de­liver vi­tal health re­sources to peo­ple who live out­side ma­jor ur­ban cen­tres. In Myan­mar 70% of the pop­u­la­tion lives in ru­ral ar­eas. Of­ten these ar­eas are lack­ing in ba­sic health ser­vices, with those in the more re­mote, eth­nic re­gions likely to miss out.

“Myan­mar’s start­ing from a low base. It’s put a lot of at­ten­tion into hos­pi­tals whereas what is re­ally needed is at­ten­tion to lower lev­els of the sys­tem, the dis­trict hos­pi­tals and the clin­ics and so on. So there is a need for a bit of a change in di­rec­tion.” said Dr An­drew Kas­sel.

Deputy Min­is­ter of Health, Dr Thein Thein Htay, echoed this sen­ti­ment say­ing there are in­equal­i­ties de­vel­op­ing in Myan­mar’s health sys­tem and only a “peo­ple cen­tred” ap­proach to de­vel­op­ment will suc­ceed. He em­pha­sised the need for “trans­parency and good gov­ern­ment” to re­form the health sec­tor but “one (the gov­ern­ment’s) hand must be on the steer­ing wheel to steer this de­vel­op­ment.”

A large part of the dis­cus­sions was the dis­pro­por­tion­ate and in­creas­ing bur­den of Non-com­mu­ni­ca­ble dis­eases (NCD’s) in low-mid­dle in­come coun­tries. Myan­mar is clas­si­fied in this group. Eco­nomic growth, ur­ban­i­sa­tion and sub­se­quent lifestyle changes con­trib­ute to NCD’s, which cause 60% of all mor­tal­i­ties in Myan­mar.

“Some of the big prob­lems in Myan­mar are things like di­a­betes, heart dis­ease, and all the non-com­mu­ni­ca­ble dis­eases which are af­fect­ing coun­tries all over the world

... in a coun­try where you have got big in­vest­ments com­ing in in all kind of sec­tors, some of them can be re­ally help­ful and some of them are not go­ing to be so help­ful; fast food, al­co­hol, cig­a­rettes...that re­quires ac­tion from the gov­ern­ment, not just the min­istry of health but at a higher level, from the pres­i­dent down­wards to get other min­istries in­volved.” Said Dr Cas­sels.

Trans­parency and over­sight in the health sec­tor be­tween the gov­ern­ment and in­ter­nal and ex­ter­nal stake­hold­ers was seen as the corner­stone for suc­cess­ful multi-sec­to­rial de­vel­op­ment. Re­cently, ex­treme na­tion­al­ist Bud­dhist group Ma Tha Ba ex­pelled an aid agency in­volved in flood re­lief ef­forts in the Sa­gaing re­gion claim­ing they did not co-or­di­nate aid ef­forts with the group. In­ci­dents like this il­lus­trate the dif­fi­cul­ties Myan­mar faces within the sec­tor.

“The en­cour­ag­ing thing about this meet­ing is that peo­ple both in the in­ter­na­tional com­mu­nity and na­tional com­mu­nity are rais­ing very dif­fi­cult is­sues in public and shar­ing those prob­lems, whereas be­fore the prob­lems have been re­served for gov­ern­ment and there had been very lit­tle dis­cus­sion,” said Dr An­drew Cas­sels, speak­ing on the fo­rum.

“That alone, open­ing up a quite adult dis­cus­sion about some of the prob­lems the coun­try is fac­ing, is a re­ally pos­i­tive sign,” he said.

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