Are you interested to venture or invest into the Burmese healthcare? Wouldn’t you be curious to know about the scenario of the healthcare sector in Myanmar?
Hospacxx Healthcare Consultancy brings to you through this article, brief details about Myanmar, along with details about its healthcare sector.
ABOUT THE COUNTRY
Myanmar, also known as Burma, is located in the western part of South East Asia. It has a total area of 678,500 square kilometers (262,000 sq mi), bordered by Bangladesh and India to its northwest, China to its northeast, Laos and Thailand to its east and southeast, and the Andaman Sea and the Bay of Bengal to its south and southwest respectively.
The country’s capital city is Naypyidaw, and its largest city is Yangon (Rangoon). Myanmar is also officially known as “The Republic of the Union of Myanmar.” Majority of the Myanmar population follow the religion of Buddhism, with Christianity, Islam and Hinduism as other minority religions followed in the country.
The official language of Myanmar is Burmese, while other languages like English and Hindi are also commonly spoken in the country. Myanmar is famous for its tourism spots like Golden Pagodas, producers of teak wood, tea estates & rice, beaches and for their cultural practices as followers of Buddhism.
DEMOGRAPHIC PROFILE
Population Growth Rate: – As of the year 2022, Myanmar is ranked at the 26th position, in terms of population, with a count of 55,071,224, which is a 0.77% increase from the population count in the year 2021 at 54,806,012, based on Worldometer elaboration of the latest United Nations data. Myanmar population is equivalent to 0.7% of the total world population. Statistics also show that majority of the population reside in the rural areas, with only 31.4 % of the population living in the urban regions.
Sex Ratio: – The sex ratio of the total population is 0.972 (972 males per 1,000 females) which is lower than global sex ratio which is 1,016 males to 1,000 females as of 2021.
Literacy Rate: – According to Statistics reported by UNESCO, Myanmar has a total literacy rate of 89.1%, with the male population at a literacy rate at 92.4% and the female population at a literacy rate of 86.3%.
HEALTHCARE SCENARIO
Though Burma is listed as one of the countries with the poorest healthcare systems, there is still scope for its growth as a sector in terms of its market value and quality of service delivery. Myanmar’s health system is weak and fragile after years of underinvestment and neglect, with the country bearing grave health outcomes. Until 2011, the healthcare sector was drastically deteriorating due to non-availability of sufficient Healthcare facilities, increased Out-of-Pocket expenditure, and delivery of poor-quality healthcare services as a result of the military government’s low priority towards improvement of the healthcare sector. Since 2012, with the Civilian Government in power, there has been a steady advancement in the sector through promotion of privatized medical establishments, increased establishments of public health institutions, universal health coverage, increased demand and supply of pharmaceuticals and medical equipment and other such advancements through the support from neighboring countries and International Regulatory Bodies.
HEALTHCARE EXPENDITURE
As Healthcare was one of the least prioritized sectors for the military government, there had been the least healthcare spending by the government till 2011 which was at 1.92 % of the GDP. After the Democratic Government came into Myanmar’s Political rule, the new government ensured to increase their focus on the growth of the healthcare sector, with increased health care expenditure as one of the goals. Thus, it was observed that the healthcare expenditure had been steadily fluctuating since 2012. As of 2019, the healthcare spending is rated at 4.7% of the GDP, which is a slight decline from the previous year’s rate at 4.9%. The highest healthcare spending was noted in the year 2015, at the rate of 5.47% of the GDP.
A large portion of these funds had been reserved for training medical professionals, purchasing advanced medical equipment and providing free medical treatment for government employees. Though Myanmar’s out of pocket expenditure as a share of current health expenditure fluctuated substantially in recent years, it tended to decrease through 2000 – 2019 period ending at 76 % in 2019.
While public health expenditure ranks as one of the lowest, private healthcare sector expenditures are gradually increasing due to rising demand by the growing middle-class population. Private healthcare accounts for nearly one-third of the country’s total health care expenditure.
To ensure all Myanmar people have access to quality health services without causing financial hardship, the MoH has developed the three-phase National Health Plan (NHP), which was unveiled in December 2016. The NHP aims to strengthen the health system, creating the necessary structures to provide universal care, while benefitting citizens living in poverty.
KEY HEALTHCARE INDICATORS
- Total fertility rate: – Since the 1950’s, the fertility rate has been undergoing a steady decline. As of 2022, the fertility rate for Myanmar is 2.092 births per woman, which is a 0.95% decline from the 2021 fertility rate of 2.112 births per woman.
- Life Expectancy at Birth: – There has been a gradual increase in the years of life expectancy since 1950’s at 34 years. As of 2022, the life expectancy is 67.58 years, which is a 0.3% increase from the 2021 life expectancy age of 67.37 years.
- Mean Mortality rate: – A steady decline in the mean mortality rate has been noted since the 1950’s which was at 30.33 deaths per 1000 population. At present in 2022, the mortality rate is at 8.38 deaths per 1000 population, which is a 0.59% decline from the 2021 mortality rate at 8.33 deaths per 1000 population.
- Infant Mortality rate: – Since 1950’s, there has been a decline in the Infant Mortality Rate which was at 236.4 deaths per 1000 births. The current infant mortality rate for Myanmar in 2022 is 34.417 deaths per 1000 live births, a 2.81% decline from the 2021 infant mortality rate which was 35.412 deaths per 1000 live births.
- Maternal mortality Ratio: – There has been fluctuations in the Maternal Mortality Rate since the 1950’s. As of 2017, the maternal mortality rate is 250 per 100,000 live births. 2.04% increase from the maternal mortality rate for 2016 which was 245 per 100,000 live births.
- Doctor to Population Ratio: – Over the years, there has been an inconsistency in the ratio. As of 2019, the doctor to population ratio is at 0.74 per 1,000 population, which is a small incline from the previous year’s ratio which was at 0.67 per 1,000 population.
- Nurses to Population Ratio: – It was observed that there has been a steady increase in the number of nurses over the years. As of 2019, the nurses to population ratio is at 1.08 per 1,000 population, which is a small incline from the previous year’s ratio which was at 0.99 per 1,000 population.
- Beds to Population Ratio: – The beds to population ratio stands at 1.04 beds per 1,000 population, without any difference from the previous year’s ratio.
DISEASE BURDEN
According to a report by WHO, Myanmar is facing a double burden of communicable and noncommunicable diseases (NCDs). The increase in the incidence of Chronic NCDs are owing to modifiable risk factors like tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol, including cardiovascular disease, diabetes mellitus, cancer and chronic respiratory disorders.
According to a report on Myanmar’s Public Health Situation Analysis from the Health Statistics 2020, in the 2018, the top ten causes of mortality were due to pregnancy and delivery-related causes, septicaemia, head and intracranial injuries, heart failure, stroke, primary hypertension, pneumonia and respiratory Tuberculosis (TB).
Nearly three-fourths of all deaths in 2016-2017, as per the national causes of death survey were attributed to non-communicable diseases (NCDs); whereas only one-fifth were attributable to maternal, nutritional, neonatal causes.
Among deaths due to communicable diseases, leading cause is pneumonia followed by TB, HIV-AIDS and malaria. Among deaths due to NCDs, leading cause is stroke followed by chronic respiratory diseases, ischemic heart diseases, cirrhosis, diabetes. Among deaths due to injuries, leading case is road traffic accident followed by fall.
HEALTHCARE INFRASTRUCTURE
The healthcare system is distributed between the public and private sectors. However, all administrative functions of healthcare are overseen by the Ministry of Health (MoH).
Public Sector: – The country’s public health sector accounts for 86 percent of total healthcare services, with 1,120 public hospitals accommodating 56,700 beds. The public sector also comprises of 87 primary and secondary health centres, 348 maternal and child health centres, 1700 rural health centres, 80 school health teams, 16 traditional medicine hospitals and 243 traditional medicine clinics.
Private Sector: – There are now more than 250 private hospitals across the country, and the number is steadily growing. In addition, there are approximately 200 private specialist clinics, more than 5,000 private general clinics, and 800 private dental clinics, according to a report by the Department of Medical Services. But private hospitals tend to be smaller than public facilities in terms of the number of beds. The largest private hospital in Yangon has 220 beds, for instance, but about 90% of private hospitals have fewer than 100 beds, and are mainly concentrated in the urban areas of Yangon and Mandalay.
Some research studies report that there is a huge disparity in the distribution of healthcare professionals among the private and public sectors. Though 70% of the manpower is employed in public health sector through the Ministry of Health, it was observed that there is an increased turnover of manpower due to higher preference to work in a private healthcare sector with better exposure of medical practice and provision of amenities.
Top Hospitals in Myanmar
1) Sakura Medical Centre.
2) Bahosi Hospital.
3) Yangoon General Hospital.
4) Aung Yadana Hospital.
5) Mandalay General Hospital.
6) Nyaung-Shwe Township Hospital.
7) Yangoon Speciality Hospital.
8) Asia Pacific Hospital.
9) Academy Private Hospital.
10) Pun Hlaing International Hospital.
11) International SOS Clinic Yangon.
12) Australian Embassy Medical Clinic and Dental Surgery.
13) Home Medicare Service Clinic.
OTHER HEALTHCARE SECTORS
PHARMACEUTICALS:
The shortage of medical technology has been a roadblock for the sector, but at the same time it presents large-scale opportunities for foreign suppliers, as the government is gradually reducing regulations over the importation of medical devices from international companies.
According to a report by Oxford Business School, Burma has a very competitive pharmaceutical market compared to other ASEAN countries, and the market is attracting a growing number of foreign pharmaceutical companies and is dominated by imports. Burma imports about 80 percent of pharmaceutical products from other countries. Local supplies are mainly produced by the state-owned Myanmar Pharmaceutical Factory. According to a local market research agency, Burma’s total pharmaceutical spending has been increasing 11 percent every year, and it is expected that the pharmaceutical market value will reach $1.1 billion by 2023.
There are more than 100 pharmaceutical distributors currently operating in Burma. Switzerland’s Diethelm Keller Siber Hegner (DKSH) and Thailand’s Maxxcare are leading the distribution channels. Other drug distribution/pharmaceutical brands such as Zuellig, Sanofi, Pfizer, GSK, Novartis, Roche, Bayer, Servier, and Mundipharma are in the market. In addition, there are many generic brands from India, China, Bangladesh, Pakistan, Thailand, and Vietnam, with significant market shares. The market itself is very price-sensitive, and Intellectual Property Rights (IPR) remains a concern. Counterfeit products are prevalent and stricter regulation and enforcement is needed to stop illegal sales.
The domestic pharmaceuticals industry is still in the early stages of development. Domestically produced supplies account for only 20% of demand and are mainly made by the state-owned Myanmar Pharmaceutical Factory, which operates under the purview of the Ministry of Industry. The country’s first privately operated pharmaceuticals producer, Pacific Medical Industries, commenced operations at its Yangon-based factory in July 2017.
Clinics and hospitals are also known to provide medicines, with each procuring their own supply from a network of preferred distributors. More than 60% of pharmaceuticals sales take place in Yangon and Mandalay. In addition, about 75% of Myanmar’s population utilizes traditional medicines for healing and wellness, according to the WHO.
IMPORT OF MEDICAL DEVICES
According to a report by Privacyshield.gov, Myanmar presents tremendous business opportunities for U.S. exports of medical equipment and supplies. Burma’s private health sector depends on imported medical equipment and supplies to meet the increasing local demand for high-quality health services.
The only legislation relating to medical goods is the 1992 National Drug Law, which is limited in scope and does not cover medical devices. The Food and Drug Administration (FDA) is in the process of drafting legislation for medical devices, which will adhere to the ASEAN Medical Device Directive. Imported medical devices must obtain an import recommendation from the FDA as well as a trade permit from the Ministry of Trade and Commerce. The medical devices legislation, which is expected to comprise one of the country’s first major updated technical regulations, was drafted in collaboration with the US Agency for International Development and a number of other NGOs. When the drafting process is complete, implementing regulations and a Medical Device Registration list will be issued publicly.
The health authorities have, however, recently published a list of medical devices – including CT scanners, MRI machines and X-ray machines – that are exempt from obtaining an import recommendation prior to importation. This exemption list is expected to simplify the procedures for the importation of foreign-owned medical products and ultimately help to promote the growth of the medical device market. The new laws should facilitate both the trade and import of medical equipment, while also reducing the cost of technology by introducing more competition.
OUTBOUND TOURISM
The supply of health services falls short of demand at present. It is common for Myanmar people, especially those in the growing middle and upper classes, to travel abroad for medical care. Around and estimate of $250m is spent annually on outbound medical tourism, with Thailand, Singapore and India the most popular destinations. The challenge lies in public & private hospitals to align the quality of healthcare services to that of international standards so that the expenditure incurred on outbound medical tourism can be subsidized.
INSURANCE
According to a report by Oxford Business School, Myanmar’s private health insurance segment is in its early stages of growth. In FY 2016/17, private health insurance premiums totaled just over MMK98m ($74,900), according to the Central Bank of Myanmar. This low health insurance penetration rate acts as a significant barrier to health care access. As a result, Myanmar has one of the region’s highest out-of-pocket health care expenditure rates: close to 70% in 2015.
The state-owned Myanmar Insurance held a monopoly on the insurance industry until 2013, but health coverage was not part of its portfolio. In 2015 the first such scheme was introduced, but take-up has remained low. Although there are 12 private insurers in the market, only nine offer health lines. By law they offer the same product, which guarantees partial payment of hospitalization costs and covers accidental deaths. Foreign insurance companies have long been prohibited from operating in Myanmar beyond the opening of representative offices, but the Thilawa Special Economic Zone was opened to foreign insurers in 2017 and the government has indicated to a willingness to liberalize the market further.
CONCLUSION
Myanmar’s healthcare sector has been slowly developing since the year 2000, through higher health expenditure, better provision of healthcare facilities and services & promotion of privatized healthcare systems. This could eventually lead to better advancement in the quality of healthcare services in future.
Hospacxx Healthcare Consultancy, likewise, has worked across Indian and International States on Hospital Projects for Business Process Development, Service Quality Assurance, Financial Management and more. For more information, you can visit the company website on www.hospaccxconsulting.com or contact us directly
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