Industry:

Health care service in Yangon, Myanmar

Introduction

The macro environment or the external uncontrollable factors that influence an
organizations decision making and affect its performance and strategies. These
factors include the economic factors, demographics, legal, political and social
conditions, technological changes and natural forces.
As Myanmar is currently reforming its political and economy and sanctions of
the western countries have been lifted, these make inflow of foreign investment
especially in Yangon. The rapid economic development and dramatic growth of
tourism provoke more rural to urban migration because of employment
opportunities. In spite of rapid growing of population size, housing, sanitation
and health services delivery remain unchanged. It would be a mild
understatement to say that over the last fifty years, healthcare outcomes in
Myanmar have not kept pace with those of its neighbors. As the last country in
Southeast Asia to open to foreign investment, by 2013 healthcare in Myanmar
was suffering badly from over fifty years of neglect. When the World Health
Organization (WHO) last ranked Myanmars system against its global
counterparts, the country was pegged dead last out of 190 countries with respect
to what the WHO calls overall health system performance.

Health Care service in Yangon

Both public and private sectors provide health care and medical services. The
public sector includes hospitals and outpatient clinics. The public sector also
undertakes public health programs, which comprise reproductive health, child
survival, Tuberculosis, HIV/AIDS, STIs control and Dengue Hemorrhagic Fever
control, Immunization. However, non-communicable diseases control activities
have not been implemented yet at community level. Central department of
health manages many large specialist and/or general hospitals in the city while
township health department purveys primary and secondary health care
services down to the grassroots level whereby it has to serve 100,000 to 200,000
populations (Ministry of Health, 2013). Under the township health department,
there are small hospital or urban health center, school health team, Maternal and
child health team, rural health centers and sub rural health centers (Ministry of
Health, 2013). A medical doctor oversees urban-based canter though a health
assistant or a midwife manage a rural health center and a sub rural health center
respectively. However, limited human resources and very low expenditure in the
public sector had led to poor public health services and reduced quality of care
(cited in Saw et al., 2009).
The private sector contains private general practitioners (GPs), private hospitals,
private pharmacies, international and local non-government organizations
(NGOs) and traditional medicine practitioners. Private GPs have usually been
trained as general physicians or family health doctors. Nevertheless, public
service physicians also render private medical services outside of office hours. In
general, community prefer to seek care at a GP clinic first irrespective of their
socioeconomic status because of convenient opening hours; proximity to their


residences; and the ability of GPs to provide individualized care (Saw et al.,
2009)

Demographic Characteristics

Yangon is the largest city of Myanmar where over 4.35 million people reside
(2010 UN est.). Although it was the capital of the country, it has become the
center of industrial and commercial development when the government officially
proclaimed its new capital called Nay-Pyi-Taw in 2006. The city area has 777
km2 and accommodated 30% of the urban population of the Union and it covers
33 out of 44 townships within Yangon region (Khaing, 2011).
The total population is around 4.35 million in 2010, with an average annual
growth rate 2.5 percent during 1983 2010 and it is expected increase up to 4.8
million in 2015 (Ngah, 2010). About 30% of the population was under 15 years
old, 65% between 15 and 64 years and 6% over 64 years. In 2009, under-15 age
group proportion further dropped to 28% and it may be due to low fertility level
(Department of Population, 2007). Then, the fertility decline is likely to be
influenced by factors such as increase in first marriage (27.9 year) and age at
first birth (23.6 year), increase in proportion never married, increased modern
contraceptive use (57.2%) and abortion, and a decrease in fertility preference
(35.9%)(Department of Population, 2007). Thus, total Fertility Rate of Yangon
was 1.72 in 2007(UNFPA, 2010).
Although there are no documents related to composition of ethnics in a
population of Yangon city, it is believed that the data in STEPS Non-
communicable Disease Risk Factor survey (2003) Yangon will somewhat reflect
the ethnic proportion of Yangon. In male group, the main proportion (76%) of
the population is Bamar while other ethnic 6%, immigrant 10% and mixed race
8% and in female group, Bamar makes up 77.5% of the population and other
ethnic 8%, immigrant 6.6%, and mixed race 8%.

Geographical and Environmental characteristics

Growing population, urban sprawl, and socioeconomic changes have impact on
the health of the population. These changes also largely effect on environment
resulting in pollution of air, water and land. Moreover, spatial location plays a
major role in shaping environmental risks as well as many other health effects
(Dummer 2008).
Having tropical monsoon climate in the city, a lengthy rainy period falls between
May to October. During the period, street flooding is pervasive due to inadequate
drainage system. As reported by Maplecrofts Climate Change Vulnerability Index
2013, Yangon is placed at the fourth most likely to be exposure to negative
impact of global climate change.
In relation to water quality in Yangon, protected well is main source of drinking
water in 44% of households when 26% have piped water and another 10% get
water from unprotected well (Department of Population, 2007). For sanitation,
large majority of 10 households use Water seal type latrine (87%) and 2.8%
have flush type but 10% of them have no access to improved sanitation (IHLCA
Project Technical Unit, 2011). According to the air quality assessment survey in
Yangon in 2008-2009, air quality was worse in residential zone than commercial


and industrial zones (Aung, 2009). The same assessment ascribed air pollution
to 15 industrial zones, over 200,000 vehicles and electric generators.
Besides, the city generates solid waste over 3000 tons per day. However, city
development committee cannot dispose the waste effectively. It uses collection
and open dumping methods as a main solid waste disposal (Sandar 2001).
Nonetheless, far away dumping sites, inadequate labor and insufficient vehicles
are the barriers for effective waste disposal so that communal disposal points
become sources of illnesses like diarrhea (Sandar, 2001). Then, food safety is
another threatening factor on health. Despite being Food and Drug
Administration system, there is no proper and effective assessment of both
imported and local food products.

Social and economic inequality

Social and economic inequality is detrimental to the health of any society.
Especially when the society is diverse, multicultural, overpopulated and
undergoing rapid but unequal economic growth. The effects of growing socio-
economic inequality in Myanmar population affect on the healthcare system such
as the difficulties in healthcare delivery in an unequal society and its effect on the
health of a society.
People living in slum suffer more than those living in wealthy neighborhoods
(Bai et al., 2012). These health inequalities can be traced back to socioeconomic
differences. An assessment of treatment result, access, equity and financial
protection of TB patients in Yangon (2004) showed that 47.83% of TB patients
were from the lowest socioeconomic status (SES) while 6.72% were from
highest SES; about 46% of them were primary or lower education level; and
67.2% of them had their income less than less than 1US dollar per day
(Lonnroth, Aung, Maung, Kluge & Uplekar, 2006).
About half of the poor use substandard roof and average household size is 5.0
persons per household (Department of Population, 2007). Under IHLCS
Myanmar (2009-2010), 57.6% of the poor and 80.3% of non-poor are accessible
to safe drinking water. In the same study, improved sanitation among the poor
and non-poor is 69.4% and 85.4% respectively and 55.3% of the poor are able to
reach electricity while 88.9% of non-poor gets it.
Additionally, IHLCS Myanmar (2009-2010) discloses that labor force
participation rate (age group 15 and above) is high in both the poor (61%) and
non-poor (57%) as household members increasingly enter the labor force. The
same survey reports 77% of employed poor work as own-account workers or
casual workers; underemployment rate is 38%.
Then, about 25% of males and females population have completed primary
education and around half have lower secondary education; approximately 20%
get university graduation (Department of Population, 2007).
Notably, there is considerable difference in health care access between the poor
and non-poor in Yangon region. IHLCS Myanmar (2009-2010) proves that
immunization coverage between the poor and non-poor is 74% and 96%
respectively and antenatal coverage for the poor is 81% and 97% for non-poor.
Alternatively, due to the lack of quality healthcare services currently available in
Myanmar, many well to do Myanmar and foreign expats frequently fly out to
neighboring countries such as Thailand, Malaysia, and Singapore for medical


treatments. Thailand is thought to be the preferred choice for Myanmars people
due to the close proximity, similar culture and cheap living cost.

Legal, political factors

Challenges to enter the Myanmar healthcare market however remain. Comparing
the healthcare systems worldwide, Myanmar was recently ranked 190th and last
by the World Health Organization (WHO). Rubicons study confirms that
collaborating with a local distribution partner is the only viable means of
efficiently accessing the market in Myanmar. This is due to Myanmars opaque
regulatory environment, the abundance of counterfeit products, complex
channels to market and the extremely fragmented point of sale network.
Myanmars government historically spent around $0.20 per person, per year on
healthcare; plans were to increase this to $2.00 per person, per year by the end
of 2016. If current spending levels hold, by the end of Myanmars 2014 fiscal
year (which is actually in March 2015), they will be spending at a rate of $2.00
per person, per year, a full year before their goal. Admittedly, this level of
spending is still quite small, but it is promising not only to see the governments
spending increase, but also to see the goal get accomplished this quickly.
However, many public health officials are concerned about how the Ministry of
Health will spend its growing budget. Myanmars public health sector was badly
in need of technocrats who understood how to set clear priorities on spending
that will most benefit the countrys citizens. The problem so far is that too much
of the money can easily disappear into the system in the form of corruption and
competing priorities.
Burma mostly imports medicines from India because the country has both small-
scale and multinational Western medicine retailers. Indian traders successfully
captured the medicinal drug market in Burma long ago and the largest exporter
of medicine legally to the country, with Thailand second and China third. In
addition to importing medicines via the international flight routes from Thailand,
medicinal drugs are also imported across the border illegally. To date we have
seen non-registered [illegal] medicines being sold in Myawaddy, Myeik and
Dawei (Tavoy).
Before new liberalization, Myanmar has only one health insurance, which is the
state, owned Myanmar insurance. With the new liberalization in investment
laws in Myanmar, 12 foreign licenses have already been issued by the Myanmar
government to sell insurance products and are expected to commence by mid
2013.
Healthcare and technology evolutions
Healthcare and information are more related than we often realize. So,
healthcare and technology is really about connected healthcare where people,
processes, structures, multiple stakeholders, technology, information and
intelligence (the question how to connect and act upon it all) are all connected
too. There are few areas of society and industries that are so information
dependent as healthcare.


Its one of the reasons why many technology and process improvement efforts
have been going to the digitization of electronic health records (EHR) and other
patient information, healthcare data, processes (with, among others health
information HIM systems), etc. Pure digitization as such is not an end goal as
its part of broader optimization and transformation efforts. However, it comes
with many challenges and has certainly not reached full maturity across the
globe. The state of digitization in healthcare is changing fast in many countries
but in Myanmar it is still a long way to go.
However, a cooperative agreement signed between German biotechnology
company Partec and Myanmar have made on February 2014 to defines key
patient groups and methods for improving Myanmars healthcare system.
German biotechnology company Partec invented the flow cytometry
technology. It offers automated cell analysis systems that are distinguished by
their performance, precision and cost-effectiveness. Flow cytometry has become
an indispensable key technology in the fields of immunology - especially in
HIV/AIDS, leukaemia and lymphoma, in cancer diagnostics and research,
microbiology and a range of industrial applications.
Conclusion

Since Myanmars medical healthcare system is now mostly a private pay system,
the demand for healthcare service and products will go hand in hand with the
economic development and increasing per capital income of the Myanmar
people. As Myanmar continues its economic growth the demand for quality
healthcare will undoubtedly increase.

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