Health care system of myanmar 28 8-2016

Health Care System of Myanmar

Dr.Htet Ko Ko Aung Dr.Thu Naing Dr.Han Tun Khaing Dr.Lynn Thet Su Mon

Presented by

Outline

Myanmar - General Profile

Health System Profile of MYANMAR

Current Status of MYANMAR Health System

Success story in health system

Myanmar / Burma THE REPUBLIC OF UNION OF MYANMAR

Second largest country in Southeast Asia region Total population - 51,419,420 (5th in ASEAN Region)

70 % of population live in Rural areas Literacy rate - 89.5 % (7th in ASEAN) Culture – Religion – Buddhism (87 %) Life expectancy at birth – 66.8 % (9th in ASEAN) Crude birth rate (per 1,000) = 17.8 Crude death rate (per 1,000) = 8.25 In 2015 GDP $ 64.87 billion

GDP per capita 1200 $

GDP growth 7.0%

Inflation 10.8%

2012 2013 2014 201502000400060008000

1000012000

1420 1110 1200 1200

10500 10700 10800 10000

GDP per capita in Myanmar Dollars2012-2015

GDP per capita dollars Myanmar GDP per capita dollars World

Years

GD

P pe

r Ca

pita

, Dol

lars

Source: http://data.worldbank.org

2012 2013 2014 20150

2000

4000

6000

8000

10000

12000

GDP per capita in Myanmar and ASEAN Dollars2012-2015

GDP per capita dollars MyanmarGDP per capita dollars MalasyiaGDP per capita dollars Cam-bodiaGDP per capita dollars ThailandGDP per capita dollars VietnamGDP per capita dollars In-donesiaGDP per capita dollars Phillip-ine

Years

GDP

per

Capi

ta, D

olla

rs


The colonial period (1886–1948)

• Inherited the health system introduced by the British• The focus of the colonial medical department was hospital care, vaccination

against communicable diseases and sanitation.• doctors were non-native as few natives were ready to take the long and

arduous medical course.• Most doctors were concentrated in towns and most of the population

continued• to seek health care from indigenous medical practitioners and traditional

birth attendants in the villages

The parliamentary period (1948–1962)

The BSPP period (1962–1988)

The SLORC and SPDC period (1988–2011)

The democratization period (2011 to date)

Historical background

Source: Myanmar Health system review 2014





• Trained foreign medical and other health personnel were terminated.• After independence, the public health sector was reoriented to a socialist

style of welfare.• A rural health scheme was initiated in 1951 with the establishment of a

Health Assistant Training School in Rangoon (Yangon)• Key parts of the health sector, such as Women and Child Welfare and Child

Health Services, were set up as a separate directorate which were unified into a single directorate called the Directorate of Health Services.









First major reforms in the health sector, designed to achieve universal health care.In order to implement primary health care (PHC), the BSPP introduced voluntary health workers – Community Health Workers (CHWs) and Auxiliary Midwives (AMWs).








National Health Committee (NHC) was formed.Emphasis on expanding health services to the border areas.Community Cost Sharing (CCS) scheme to increase community participation was introduced.








Myanmar entered a new political phase.Expenditure for health was raised considerably in 2012–2013.Community Cost Sharing (CCS) scheme is still in place.The government provides some coverage for the poor through Hospital Trust Funds.



Two main objectives of Ministry of Health and Sports “Enabling every citizen to attain full life expectancy

and enjoy longevity of life” “ensuring that every citizen is free from diseases”

Organogram of Ministry of Health and Sports (MOHS)THE REPUBLIC OF THE UNION OF MYANMAR

Department of Health professional and resource development

Department of Traditional medicine

Department of Medical service

Department of Public Health

Department of Medical research

Department of sport and physical education

Department of Food and Drug administration

Ministry of Health and Sports

Source: http://www.moh.gov.mm/

Health service delivery system in Myanmar

(36) 500-& 1000- bed specialisthospitals

(81) 100-, 150-, 200-& 300- bed district/ region/state hospitals

(65) 50-bed townshiphospitals

(190) 25-bed Townshiphospitals

(572) 16-bed stationhospitals

Hospital care

Primary Curative care

Secondary Curative care

Tertiary Curative care


Health service delivery system in Myanmar

(7581) Sub-RHCs

(1635) RHCs

(87) Urban HCs

(348) MCH centers

Ambulatory care


Sr. Causes Percentage

1 Injuries 10.0

2 Complication of pregnancy and delivery 6.9

3 Single spontaneous delivery 6.0

4 Diarrhoea and gastroenteritis of presumed infectious origin 5.8

5 Other viral diseases 3.8

6 Other pregnancies with abortive outcome 2.6

7 Gastritis and duodenitis 2.4

8 Malaria 2.4

9 Cataract and other disorders of lens 2.4

10 Other acute upper respiratory infections 2.0

Figure : (1) Single Leading Causes of Morbidity (2012) Health in Myanmar-2014

Sr. Causes Percentage1 Human immunodeficiency virus (HIV) disease 6.62 Septicaemia 6.1

3 Other injuries of specified, unspecified and multiple body regions 5.4

4 Slow fetal growth, fetal malnutrition and disorders related to short gestation and low birth weight 4.6

5 Other diseases of liver 4.06 Other diseases of the respiratory system 3.77 Intrauterine hypoxia and birth asphyxia 3.48 Heart failure 3.39 Respiratory tuberculosis 3.2

10 Intracranial haemorrhage 2.9

Figure : (2) Single Leading Causes of Mortality (2012) Health in Myanmar-2014

2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

50

100

150

200

250 237226 218 210 205 201 195 189 184 178

Maternal Mortality Ratio (MMR)

Year

MM

R pe

r 10

0,00

0 Li

ve b

irth


MDG target 150

Figure(3) : Maternal Mortality Ratio

2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

5

10

15

20

25

30

3532.8 32.1 31.7 30.5 29.7 29 28.4 27.7 27 26.4

Neonatal mortality rate (per 1000 live births)

Years

Neo

nata

l mor

talit

y ra

te (p

er 1

000

live

birt

hs)

Source: http://apps.who.int/gho/data/node.country.country-MMR

Figure(4) : Neonatal Mortality Rate

2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

10

20

30

40

50

6051.7 50.2 53.4

47.3 45.8 44.5 43.2 41.9 40.7 39.5

Infant Mortlity Rate

Years

Infa

nt M

orta

lity

rate

(per

10

00 p

op)


Figure(5) : Infant Mortality Rate

2006 2007 2008 2009 2010 2011 2012 2013 2014 20150102030405060708090

100

68.1 65.8

87.2

61.4 59.3 57.2 55.3 53.5 51.7 50

Under-5 Mortality rate (per 1,000 live births) Myanmar 2006-2015

Years

U5M

R (p

er 1

,000

live

bir

ths)


MDG target 37

Figure(6) : Under-5 Mortality Rate

2006 2007 2008 2009 2010 2011 2012 2013 2014 20150102030405060708090

63.1 63.9 64.6 68.2 70.6 73 74.3 74.882 80

ANC coverage in Myanmar 2006-2015

Years

ANC

cove

rage

(%)

Source: Health in Myanmar 2015

Figure(7) : ANC Coverage in Myanmar

Figure (8) : National Immunization Coverage of Myanmar (1980-2014)

1980 1985 1990 1995 2000 2005 2010 2011 2012 2013 20140

20

40

60

80

100

% C

over

age

Source: WHO/UNICEF coverage estimates

Figure(9): HIV Situation in Myanmar

Source: who.int/gho/hiv/en

Figure(10): Number of people living with HIV in Myanmar- 2015

Source: http://aidsinfo.unaids.org

TB Situation in Myanmar• Myanmar is one of the 30 high burden countries for TB, TB/HIV, MDRTB.

Source: Use of high burden country lists for TB by WHO in the post-2015 era

Figure(11,12,13) : TB epidemiology, Myanmar (2014)

Incidence

Mortality Prevalence

Data source: Global TB report (2015)

Figure(14) : Confirmed Malaria Cases per 1000 population/Parasite Prevalence 2014 in SEAR

Source: Global Malaria Report 2014

Figure(15): Trend of Malaria Morbidity and Mortality Rate in Myanmar (1990-2013)


Figure (16): Proportional Mortality (% of Total death, all ages, both sexes)

Communicable , Ma-ternal, Perinatal, and Nutritional Conditions

30%

Injuries11%

Cardiovascular Diseases 25 %

Cancer11%

Chronic respiratory diseases

Other NCDs11%

Diabetes 3%

NCDs are estimated to account for 59% of total deaths.

Total Deaths : 441,000Data Source : WHO : Non-communicable diseases Country profile - 2014

According to WHO data, the probability of dying between ages 30 and 70 years from 4 main NCDs are –

1. Cardiovascular 25 %2. Cancer – 11 %3. Chronic Respiratory Diseases – 9 % and 4. Diabetes – 3 %

24 %

Figure (17) : Health Financing : Myanmar Health Expenditure

• The major sources of finance for

health services are the government.

• Out of pocket expenditure is the

main source of finance.

• Government has increased health

expenditure yearly.


Figure (18) : Health Expenditure by Total GDP of Myanmar VS Other Countries from 2010-2014

2010 2011 2012 2013 20140

1

2

3

4

5

6

7

8

4.02 3.89 4.16 4.21 4.27

3.06 3.16 3.08 2.88 2.82

1.92 1.87 2.22 2.162.28

6.43 6.73

5.895.69 5.805.41

5.916.16

6.18 6.53

ASEANBangladeshMyanmarNepalThailand

Year

% o

f Hea

lth E

xpen

ditu

re b

y To

tal G

DP

Source: www.data.worldbank.org

Health Insurance Myanmar government officially announced that the nation-wide health insurance policies as of

July 1, 2015. State-owned Myanmar Insurance and 11 private domestic companies will offer identical policies. Eligible

- Myanmar citizens and foreign nationals residing in the country

- 6 to 65 years

-in good health Can buy the insurance of between one to five units of coverage (one unit costs approximately 50

USD) Benefits

-approximately 15 USD per day of hospitalization per unit. (30 days per year)

-dies in hospital, their designated beneficiary will receive compensation (~1,000 USD per unit).

Source: Health Care in Myanmar, Nagoya J. Med. Sci. 78. 123 ~ 134, 2016

Social security scheme 1954 Social Security Act by the Ministry of Labor. Factories, workshops and enterprises that have

over 5 employees whether state owned, private, foreign or joint ventures, must provide the insurance for their employees with social security cover.

Benefits: free medical treatment, cash benefits and occupational injury benefit.

Workers’ hospitals, dispensaries, mobile medical units and branch offices have been established nation-wide.

The 2012 Social Security Law was enacted on 31 August 2012.

In this new law, invalidity, old age pension benefit, survivors’ benefit and unemployment benefit systems have been introduced based on international practice.

Employer2.5%

Government

(Capital investment)

Employee1.5%


Figure (19) : Health Facilities in MyanmarSr. Health Manpower 2013-2014

1 Curative and rehabilitative services 1056 General hospitals (up to 2,000 beds) 4 Specialist hospitals (100–1,200 beds) 50

State/district hospitals (200–500 beds) 55 Township hospitals (25–100 beds) 330 Station hospital (16–25 beds) 6172 Preventive and public health services 2199

Primary and secondary health centers 87

Maternal and child health centers 348Rural health centers 80School health teams 3467

3 Traditional medicine 259Traditional medicine hospitals 16

Traditional medicine clinics 243

Figure (20) : Health Care Professional in MyanmarSr. Health Manpower 2013-2014

1 Medical doctor 31542 Public 13099 Co-operative and private 184432 Dentist 3219 Public 782 Co-operative and private 24373 Health Assistant 20624 Nurse 295325 Dental nurse 3576 Midwife 214357 Lady Health Visitor 34678 Health Supervisor(1) 6529 Health Supervisor (2) 4998

10 Traditional Medicine Practitioner 6963 Public 1048 Private 5915

Figure (21) : Health Work Force at National Level (2006/2007) and (2010/2011)

0

0.1

0.2

0.3

0.4

0.5

0.6

2006/20072010/2011

HW/1

000

popu

latio

n

Source: Myanmar health system review 2014

Health information system strategic plan, HISSP (2011-2015)

1st strategic plan for Health Information System Before that, WHO biannual workplan (or) Annual workplan

supported by UNICEF (or) UNFPA on a yearly basis At 2006, Assessment for current HIS and reviewed in 2009 Development of HISSP – begin in 2009 and finalized at 2010

Assessment of Six components of HIS System Category Score

• Resources (Policy, Planning, Institutions, HR & Financing, Infrastructure) 52 %

• Indicators 66 %• Data sources (Census, Vital Statistics, Population based surveys,

Health & diseases Records, Health services records, Administrative records)

49 %

• Data Management 45 %

• Information Products (Mortality, Morbidity, Health System, Data collection methods – timeliness, periodicity, consistency, representation, Disaggregation, Estimation Method )

64 %

• Dissemination and Use (Analysis and use of information, Policy and advocacy, Planning and Priority setting, Resource allocation, Implementation)

52 %

Success Story

• Malaria is one of the priority diseases in Myanmar.

• Malaria is endemic in 284 out of 330 townships in Myanmar.

Malaria Control Program in Myanmar

Specific Objectives 1. To reduce malaria morbidity and mortality by

60% in 2016. (baseline 2009)

2. To contribute socioeconomic development and achievement of health related MDG in 2015.

Activities of Malaria Control Program

1. Information, Education and Communication Dissemination of messages through various media channels

-regular use of bed nets (appropriate use of insecticide treated nets)

-early (ASAP within 24 hours after onset of fever) seeking of quality diagnosis and appropriate treatment.

Production and distribution of IEC materials

-different local languages for various ethnic and different target groups

Advocacy activities are conducted at different levels.

2. Preventive activitiesStratification of Areas for Malaria Control

Malaria area Micro-stratification up to

village level was done in 180 townships.

Effective resource allocation

2. Preventive activities- cont.Insecticide Treated Mosquito Nets ITN Program (area prioritization) distribution of Long Lasting Insecticidal Nets

(LLIN) or impregnation of existing nets. 788,866 LLINs were distributed and 638466 existing

bed nets were impregnated in 2013.

Epidemic preparedness and response Ecological surveillance and community based surveillance One disastrous epidemic in 2001 was estimated to have caused nearly 1,000 deaths. Number of outbreaks decreased during last five years. No malaria outbreak was reported in 2007, 2012 and 2013.

3. Early diagnosis and Appropriate treatment

Case management with ACT (Artemisinin based combination therapy) was practiced in all 330 townships.

Malaria mobile teams Community based Malaria Control Program in

total 182 townships malaria voluntary health workers (3875

volunteers were trained in 2013)

4. Capacity building

Trainings and Refresher trainings Different categories of 6000 health care providers were trained especially

on trained on different technical areas.

Trend of Malaria Morbidity and Mortality Rate in Myanmar (1990-2013)


• It is a remaining public health problem due to climatic and ecological changes and the economic development activities and development of multi-drug resistant P. falciparum parasite.

Thank you for your attention

Health care system of myanmar 28 8-2016

Healthcare

Transcript of Health care system of myanmar 28 8-2016