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Financing Health in the Context of Protecting Poor: Myanmar Experiences Dr. Phone Myint

Financing Health in the Context of Protecting Poor: Myanmar Experiences Dr. Phone Myint. Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011.

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Financing Health in the Context of Protecting Poor: Myanmar Experiences Dr. Phone Myint

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  1. Financing Health in the Context of Protecting Poor:Myanmar ExperiencesDr. Phone Myint Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  2. OutlineFinancing health in Myanmar Evolution NHA EstimatesHealth and Poverty Social protection for reducing poverty Health and social protection Household health expenditures Moving towards universal coverageHow social protection addressed in the National Health PlansWhat for the Future Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  3. Financing health in MyanmarEvolution and ReformsFollowing independence from the colonial rule in 1948 health service provision more or less followed the British systemHealth care services funded mainly by general government tax revenueIn districts local funds were established and managed by the local authorityHealth services were provided free. Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  4. Financing health in MyanmarEvolution and ReformsSocial Security Scheme was started in 1956 according to 1954 Social Security ActComposed of social health insurance services and implemented by the social security board under the Ministry of LaborThe only prepaid system in providing health care services Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  5. Financing health in MyanmarEvolution and Reforms During the 1960s International assistance formed other source for financing healthSupport particularly provided for disease control activities such as TB campaign and Malaria campaignGovernment taxation remained the major source of finance for health sectorPrivate sector started to grow during that period and registered doctors provided health care services both ambulatory and institutional Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  6. Financing health in MyanmarEvolution and ReformsFollowing political changes in 1988 reforms in the health sector took place including financing reformsGenerally financing reforms can be classified into six different types (1) Paying wards or rooms in public hospitals(2) User charges for Government Drug Supplies from CMSD(3)User fees for diagnostic services such as laboratory, X-ray, ECG(4) Community Cost Sharing (CCS) for essential drugs(5) introducing private service by in service staff at public hospitals(6) establishment of Trust FundsHealth services other than curative, i.e. public health services like promotive and preventive services including immunizations are still provided free by the government. Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  7. Financing health in MyanmarEvolution and Reforms Community ContributionImportant source of financing, in Myanmar contextAged old tradition in Myanmar for the community to donate or contribute for the welfare of the societyIndividual donor or collectively by the communityIn cash in or kind and ranging from medicine and hospital equipment to buildings and landA number of hospitals in rural settings (station hospitals) have been built on this basisAmount contributed for the whole country, in monetary value is still to be documented, system of proper and complete recording and registering still to be improved Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  8. Community Based Health Financing (CBHF)Indermohan S Narula, 1998 Review of the Community Health Management & Financing (CHMF) Initiative and the Community Cost Sharing (CCS) Approach in Myanmar: a strategic perspective; Consultancy Report UNICEF Myanmar Mid-Term Review DescriptionCBHF aims to meeting community's financing needs through pooling of resources to pay for health care as a groupMyanmar ExperiencesTypes* Government Sponsored/Initiated* Cooperatives (Government supported/subsidized)* Community Initiated

  9. Government Sponsored/InitiatedCommunity Cost Sharing Schemes implemented with support from various organizations since 1990.* Community Health Management and Financing (CHMF)* Myanmar Essential Drug Project (MEDP)* Human Development Initiative-Extension (HDI-E)* Central Medical Store Depot (CMSD)* Family Planning International Association (FPIA)*Trust Funds

  10. Observations • Lack of clear policy, guidelines and procedures for operating RDFs as the key cost recovery mechanisms • Lack of well designed exemption mechanism that includes guidelines and procedures • Absence of meaningful subsidies at the lower levels of the health care system to support exemptions • Lack of unified mechanism within the DoH to formalize and coordinate the various RDF and cost sharing projects • Lack of coordination between donors supporting/implementing CCS based projects and activities • Involvement of community-questionable

  11. Cooperatives (Government supported/subsidized) • Under the Ministry of Cooperatives • Village/Wards base • Township base • Voluntary Memberships • Agriculture/fishery/commodity production • Health care provision-clinics-price reasonable and affordable ; quality drugs available • Government subsidized • Defunct

  12. Community Initiated Donations (individual/collective) • Land • Building/maintenance • Medicine • Equipment • Furniture • Cash Financial support as a social network • Funeral assistance • Loan for health care payment • Financial support for health care payment

  13. Strength • Community kinship • Willing to help • Altruism Weakness • Fragmented • Unsustainable • Lack/poor capacity in financial and overall management • Weak financial capacity • Lack of leadership

  14. Financing health in MyanmarNational Health Accounts EstimatesTotal (national) health expenditures growing annuallyGovernment health expenditures growing annually-but not as supposed to bePrivate household health expenditure constitutes major (more than 80%) of total health expenditure Virtually all of household health expenditures made from out of pocket paymentPotentially catastrophic (impoverishing) Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  15. Systems of Health Care Financing Health Care Providers Risks-Pooling Entity PHI Social Insurance General Taxation Social Insurance Revenue Collector OOP Tax Collector Employers and Consumers

  16. Health and Poverty Social protection for reducing poverty Health and social protection Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  17. Individuals, Households, Communities, Nations Unforeseen events-natural disasters, economic crisis, internal strife, etc Sickness, Catastrophic Health Expenditure Iatrogenic Poverty SHOCKS Being Poor High level of exposure to risk of adverse events Lack of means to cope with them ABILITY POVERTY To avoid major shocks To mitigate their impact To cope with consequences

  18. Health and Poverty Household health expenditures: protecting poorWaiversTrust fundsSocial networkExpenditures mostly made from existing income and household savingsRelatives and friends also source of financeSome households had to sell their asset the number is not significantly largeTraditionally the households, particularly in rural settings, have a good social network from which they can seek support in time of need. Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  19. Integrated Household Living Conditions Survey in Myanmar (2009-2010) Poverty Dynamics ReportPoverty dynamics-flows of persons into and out of poverty, not simply the stock of poverty at one or more given points of timeStorms, floods and stagnant water- more closely associated with entry into poverty than with chronic povertyChronic poverty more closely associated with droughtsHouseholds escaped poverty-less affected by storms, floods and stagnant waterHealth related shocks are not major causes of impoverishmentChronically poor are not poorest of the poor with respect to health and nutritional outcomes Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  20. Moving towards universal coverageGovernment has increased health infrastructure, facilities and manpower to expand health coverageExpansion of coverage through introduction of prepaid financing methods may not be expected overnightInterim measures, practical and feasible should be attemptedExploring strength and weakness of the existing waiver system followed by modification and improvementIdentification of essential health care package, to be provided through community based health insurance in pilot townships followed by replicationsLimiting benefit package to essential care may lessen financial requirement to some extent Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  21. How social protection addressed in the National Health PlansNHP (2006-2011)Policy FrameworkHFAUniversal access based on PHC concept/approachesPriority to rural and border areasA system for financing health protect financial burden equitable access to all suitable to socio-economic situations of the country Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  22. How social protection addressed in the National Health PlansHCF Component in the NHPObjectiveTo enable to explore and develop an appropriate and sustainable financing mechanism for health that would provide sufficient amount of fundStrategiesPromoting sectoral collaboration in financing healthPromoting collaboration by communityPromoting role of private sector and NGOs in conformity with rules and regulations Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  23. How social protection addressed in the National Health PlansActivities Trainings and workshops National Health Accounts Health financing studies Feasibility study to introduce appropriate health insurance system in the country Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  24. What for the Future Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  25. What for the FutureHealthBasic human rightA battle ground on which competing visions of the ethical and political basis of society are fought, in the struggle for developmental, inclusive and democratically rooted social policyHealth policy is part of a broader social and public policiesHealth systems are the institutional expressions of these policies, rooted in legal rights, values and political commitmentsHealth system health care public health health promotion assessment of health implications of other policies Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  26. What for the Future Aims of health services universal access according to need solidarity in provision and financingHealth sector reforms across the world Using market mechanisms in provision of health services Seeing health care as a private goodCommercialized health care Provision through market relationships to those able to payInvestment in and production of servicesFor cash income or profit Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  27. What for the FutureBasic principles (values) in various ConstitutionsEnhancing the eternal principles of Justice, Liberty and Equality in the Union (2008)Opposing all pernicious systems characterised by exploitationof man by man, and of one national race by another, with a view to promoting justice and goodwill among the people, and to freeing them from apathy and callousness, ignorance, backwardness and want of opportunity (1974)To maintain social order on the basis of the eternal principles of JUSTICE, LIBERTY AND EQUALITY(1947) Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

  28. Seminar on Financing Health Care for the Poor University of Public Health 15,16 November 2011

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