Overview of the healthcare system

Burma ranks 190 out of 191 countries in terms of ‘overall health system performance’ (WHO 2000).[1] With one psychiatric hospital in the country and one doctor for 2772 people, health care is difficult to come by (WHO 2006). It is also inordinately expensive: of all the South-East Asian nations, Burma ranks first in terms of the amount that individuals spend on health care (80.6 per cent of the total expenditure on health in Burma in 2006) and last in terms of government health expenditure (2.8 per cent of gross domestic product or GDP). The Human Security Report (Human Security Center 2005) defines Burma as the world’s most conflict-prone country and the twelfth-least secure in terms of core human rights abuses. Currently, 160 000 refugees from Burma reside in seven refugee camps in Thailand, with a further 400 000 working as illegal migrants in manufacturing, agricultural and sex industries. Many have become political refugees in countries such as the United States and Australia. Medical doctors continue to leave the country in significant numbers and important international healthcare providers, such as Médecins sans Frontières and the Global Fund to Fight Malaria, Tuberculosis, and HIV/AIDS, have recently pulled out of Burma (McGeown 2005), although the Three Diseases Fund is replacing some of their planned activities. The World Health Organisation (WHO 2007) expects HIV/AIDS to become a major cause of death among young adults in Burma in the next decade.

Transparency International (2007) regards Burma as the most corrupt nation on the planet[2] and, while its Corruption Perceptions Index presents a stark picture of Burma as a whole, it is less revealing of the necessity for hospital workers to steal medicines and supplies and sell them on the black market. The WHO’s picture of the Burmese health system is also blunt as it is unable to capture the broad and diffuse effects of corruption and poverty on Burmese health needs and outcomes. These include the existence of up to tens of thousands of child soldiers (CSI 2004), 5000–10 000 female sex workers (Talikowski and Gillieatt 2004:193), human trafficking, food insecurity and extreme poverty (FOWFP 2008), one-third of Burmese children being malnourished (Zeller 2007) and illicit drug production and use (UNODC 2007a:3, 2007b).[3]

A national health committee or council was formed by the new military regime in 1988, and continues to operate with the Prime Minister as its chair. It has responsibility for implementing national health programs, such as the Health Vision 2030 Plan and the current five-year National Health Plan (2006–11). The committee has devised three major changes to health policy since the Ne Win era:

  1. a policy of partnering with international, local and para-statal non-governmental organisations (NGOs) to jointly provide healthcare delivery

  2. beginning in 1993, a cost-sharing mechanism in which patients pay for medical services and diagnostic and laboratory tests

  3. fostering a dual public and private healthcare system. In the public sector, this involves the creation of biomedical and traditional medicine training, licensing, regulation and the provision of hospital, clinic and research facilities. In addition, ministries such as those of defence, railways, mines and industry provide some level of healthcare for their employees. The enabling of a private medical system has recently seen the development of private hospitals such as Pun Hlaing International Hospital and cancer, cardiac and dental clinics.

In terms of national public health, prevention and the regulation of medicines, a major response of the regime has been to enact a series of medical and public health laws in the past decade. These include the Law Relating to Public Health Care Services 2007, the Control of Smoking and Consumption of Tobacco Law 2006, the Body Organ Donation Law 2004, the Blood and Blood Products Law 2003 and the National Food Law 1997. A Department of Medical Research investigates issues such as malaria, snake bites and viral hepatitis. As of 2001, there were 742 hospitals (six hospital beds per 10 000 people), 1412 rural health centres[4] and 348 maternal and child welfare centres, in addition to health interventions provided by international NGOs (WHO 2005). The public health system also bears the brunt of casualties of the country’s significant production and consumption of opium, heroin and methamphetamines. There are 26 major drug treatment centres and 40 minor ones throughout the country.[5]

Traditional medicine has been and remains a priority area for the previous and current military council and the healthcare system is designed to integrate traditional medicine through all levels of community health care, including education, training, registration, licensing and research. Fourteen traditional-medicine hospitals[6] exist in all divisions except for Chin State, and there are 43 district clinics and 213 township medical clinics. The Traditional Medicine Council Law of 2000 requires licensing for traditional-medicine practitioners, and that they hold either a Diploma or Bachelor of Myanmar Traditional Medicine.[7] Such qualifications are obtainable from the University of Traditional Medicine in Mandalay, which opened in 2001.[8] In addition, there is a national herbal park at Naypyitaw, a traditional medicine museum and indigenous medicine pharmaceutical factories.[9] In line with medical training in several other Asian countries, since 2003, the Bachelor of Medicine degree incorporates 36 hours of traditional-medicine teaching in the third year of the curriculum.

This official creation of a two-tier medical system of public and private health care rarely acknowledges a shadow two-tier system that has come to exist: that of the military and civilian divisions of health care. This divide has emerged in the contrast between free or low-cost health care of a reasonable standard in the high-tech military hospitals and the poorly funded public health system.

Military hospitals feature prominently in the state media in terms of receiving donations of biomedical equipment and showcasing the health system to international visitors. This is in contrast with the small amount of information available about the public health system. Recent reports about the general hospital in the capital of northern Kachin State, Myitkyina Government Hospital, offer a rare glimpse of working conditions. A lack of electricity has meant that delivery rooms have operated via torchlight except for two hours each evening. The Kachin News Group (2007) recently reported that patients requiring surgery needed to pay 7500 kyat ($US6) an hour for the use of the hospital-owned generator. This contrasts with the medical health infrastructure that has been created in the new capital of Naypyitaw, including a 1000-bed general hospital and numerous private clinics.

[1] The World Health Organisation (WHO) has not conducted overall health performance rankings since 2000 as the ranking system proved controversial among member states.

[2] The 2007 Corruption Perceptions Index ranks 180 countries in terms of perceived levels of corruption. Burma ranks equal last with Somalia out of the 180 countries assessed.

[3] Opium poppy cultivation has decreased by 83 per cent in nine years, from 130 300 hectares in 1988 to 21 500ha in 2006. Poppy cultivation is, however, again on the rise, with a 29 per cent increase in cultivation in 2007 to 27 700ha and a 46 per cent increase in production due to higher yields. Methamphetamine production appears to be continuing to increase rapidly with 19.1 million pills seized in the country in 2006 compared with 3.6 million in 2005 (UNODC 2007b).

[4] There were also 350 dispensaries, 86 secondary health centres and nine medical institutes.

[5] In addition, there are six Regional Drug Abuse Rehabilitation Centres and two Youth Rehabilitation Centres (New Light of Myanmar 2005).

[6] Two of these hospitals have 50 beds; the remainder have 16 beds.

[7] Related laws are intended to regulate the quality and sale of indigenous medicines.

[8] Before this there was an Institute of Traditional Medicine in Mandalay, which opened in 1976, and later a similar institution in Yangon.

[9] There are an estimated 9000 herbal and medicinal plants now being grown throughout the country.