Strong Disease Burden Poses Healthcare Financing Problems
BMI View: We highlight the difficulty Myanmar will face in healthcare financing, given the country's high burden of communicable and non-communicable diseases. The situation is made worse by the majority of its population living in rural areas where there is limited access to healthcare. In addition, because neighbouring South East Asia nations are committed to boosting healthcare services, we believe that private healthcare providers are more likely to invest in these other countries than Myanmar, as they present lower risk for investors.
Myanmar's Ministry of Health has announced plans to distribute 300,000 HIV test kits to rural regions in a bid to identify and contain the spread of HIV. The programme will distribute test kits to medical staff in 250 out of 330 townships in Myanmar over the next two months.
Data from BMI's Burden of Disease Database (BoDD) show that Myanmar will become unhealthier over the next 20 years. The number of disability-adjusted life years (DALYs) lost to non-communicable disease will increase, as the country transits away from a frontier market. While we expect the burden of communicable diseases to decrease over the years, the proportion of DALYS lost to communicable disease will still remain significant - in part due to poor access to essential healthcare services.
|Burden Split Equally Between Communicable And Non-Communicable Diseases|
|Burden Of Disease Projection|
Communicable Diseases And Other Injuries
As a result of years of conflict and violence, bodily injury was one of top causes of morbidity in 2010. Similarly due to poor access to healthcare, maternal and fetal care is poor. However, infectious diseases such as AIDS/HIV, tuberculosis and malaria remain the top causes of mortality in the country.
|Leading Causes of Morbidity||Leading Causes of Mortality|
|Source: Myanmar Ministry of Health|
|Other injuries of specific, unspecific and multiple body regions||9.3||HIV||7|
|Single spontaneous delivery||6.2||Septicaemia||5.7|
|Other complications of pregnancy and delivery||5.2||Other injuries of specific, unspecific and multiple body regions||5.3|
|Diarrhoea and gastroenterities of presumed infectious origin||5||Malaria||4.2|
|Other viral diseases||4.4||Other disease of the respiratory system||3.8|
|Other pregnancies with abortive outcome||2.8||Slow fetal growth, fetal malnutrition and disorders related to short gestation and low birth weight||3.5|
|Other arthropod-borne viral fevers and viral haemorrhagic fevers||2.5||Other disease of liver||3.4|
|Gastritis and duodenitis||2.3||Heart failure||3.3|
|Cataract and other disorders of lens||2.2||Stroke, not specified as haemorrhage or infarction||3.2|
|Other maternal care-related to fetus and amniotic cavity and possible delivery problems||2.1||Intrauterine hypoxia and birth asphyxia||2.7|
|Other conditions originating in the perinatal period||1.7||Other heart disease||1.9|
|Other acute upper respiratory infections||1.6||Toxic effect of substances chiefly non-medicinal to source||1.9|
|Fractures of other limb bones||0.4||Intracranial haemorrhage||1.5|
|Other diseases of the respiratory system||0.4||Pneumonia||1.3|
|All other causes||49.8||All other causes||47.6|
Non-communicable disease have also moved up the ranks of the country's morbidity and mortality list, with diseases such as heart failure, stroke and cataract listed as the top 15 causes in 2010. According to the WHO, non-communicable diseases are estimated to account for 40% of all deaths, with the top killer being cardiovascular disease (21%) followed by cancer (8%).
The Myanmar National Health Plan (2011-2016), seeks to prevent and control communicable and non-communicable diseases. While the Ministry of Health stated that it has control and prevention programmes against diseases such as malaria, tuberculosis, diarrhoea, hepatitis, cardiovascular diseases, diabetes and cancer, BMI believes that it is unlikely the country can provide substantial coverage for these diseases. We cite the government's low expenditure on healthcare and the fact that more than 60% of the population resides in rural regions, making surveillance and prevention work challenging. Dr Tun Nyant Oo, a spokesperson for MOH's HIV department, said that there are no blood test centres in rural regions, making it difficult to check HIV status in these areas.
More critically, we observe that Myanmar is facing a difficult epidemiology trend similar to that of Malaysia and Vietnam. These countries are also facing trends seen in developed countries, characterised by an increasingly ageing population and the consequential increased burden of non-communicable diseases. However, such features are only seen historically when a country becomes developed. The shift of such trends towards developing countries is alarming given that they still have a significant burden of communicable diseases at epidemic levels.
Consequently the country faces a challenging task in deciding how and what to finance to create a balance that can lower both communicable and non-communicable diseases. Unlike countries such as Malaysia and Vietnam, Myanmar is still considered a frontier market, characterised by low pharmaceutical consumption. Therefore, while there may be opportunities for private healthcare providers over the long term, BMI believes that private investors will look to developing neighbouring South East Asia nations instead of Myanmar over the short- to- medium term.