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The Republic of the Union of Myanmar Health System Review

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The Republic of the Union of Myanmar Health System Review Health Systems in Transition Vol. 4 No. 3 2014 The Republic of the Union of Myanmar Health System Review Health Systems in Transition Vol. 4 No. 3 2014 The Republic of the Union of Myanmar Health System Review Written by: Than Tun Sein, Director for Socio-medical Research (Retired), Department of Medical Research (Lower Myanmar), Ministry of Health, Nay Pyi Taw, Republic of the Union of Myanmar Phone Myint, Deputy Director General (Retired), Department of Health Planning, Ministry of Health, Nay Pyi Taw, Republic of the Union of Myanmar Nilar Tin, Deputy Director General (Retired), Department of Health, Ministry of Health, Nay Pyi Taw, Republic of the Union of Myanmar Htay Win, Deputy Director General, Department of Health Planning, Ministry of Health, Nay Pyi Taw, Republic of the Union of Myanmar San San Aye, Director (Planning), Department of Health Planning, Ministry of Health, Nay Pyi Taw, Republic of the Union of Myanmar Than Sein, Director (Retired), Planning, Coordination and Information, WHO Regional Office for South-East Asia, New Delhi, Republic of India Edited by: Viroj Tangcharoensathien and Walaiporn Patcharanarumol, International Health Policy Program, Ministry of Public Health, Nonthaburi, Kingdom of Thailand Asia Pacific Observatory on Public Health Systems and Policies i WHO Library Cataloguing in Publication Data The Republic of the Union of Myanmar health system review (Health Systems in Transition, Vol.4 No. 3 2014) 1. Delivery of healthcare. 2. Health care economics and organization. 3. Health care reform. 4. Health systems plans – organization and administration. 5. The Republic of the Union of Myanmar. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 666 5 (NLM Classification: WA 540JB8) © World Health Organization 2014 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, (fax: +632 521 1036, e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. ii Contents Preface ................................................................................................................ viii Acknowledgements ............................................................................................. x List of abbreviations .......................................................................................... xii Abstract ................................................................................................................ xx Executive Summary .........................................................................................xxii 1 Introduction ................................................................................................... 1 Chapter summary ................................................................................................. 1 1.1 Geography and sociodemography.............................................................. 2 1.2 Economic context .......................................................................................... 8 1.3 Political context ........................................................................................... 12 1.4 Health status ............................................................................................... 15 1.5 Conflicts and natural disasters ................................................................ 26 2 Organization and governance .................................................................. 30 Chapter summary ............................................................................................... 30 2.1 Overview of the health system.................................................................. 31 2.2 Historical background ................................................................................ 32 2.3 Organization ................................................................................................. 36 2.4 Decentralization and centralization......................................................... 41 2.5 Planning ....................................................................................................... 43 2.6 Intersectorality ............................................................................................ 46 2.7 Health information management............................................................. 50 2.8 Regulation .................................................................................................... 53 2.9 Patient empowerment ............................................................................... 59 3 Financing ..................................................................................................... 61 Chapter summary ............................................................................................... 61 3.1 Health expenditure ....................................................................................... 62 3.2 Sources of revenue and financial flows .................................................... 65 iii 3.3 Overview of the statutory financing system ............................................. 68 3.4 Out-of-pocket payments ............................................................................ 70 3.5 Voluntary health insurance ....................................................................... 73 3.6 Other financing ............................................................................................ 73 3.7 Payment mechanisms ................................................................................. 76 4 Physical and human resources ............................................................... 78 Chapter summary ............................................................................................... 78 4.1 Physical resources ..................................................................................... 78 4.2 Human resources ....................................................................................... 92 5 Provision of services ...............................................................................105 Chapter summary ............................................................................................. 105 5.1 Public health .............................................................................................. 106 5.2 Patient pathways ....................................................................................... 116 5.3 Primary/ambulatory care ........................................................................ 117 5.4 Specialized ambulatory care, inpatient care and specialized inpatient care ........................................................................ 118 5.5 Emergency care ........................................................................................ 119 5.6 Pharmaceutical care ................................................................................ 121 5.7 Rehabilitation/intermediate care ........................................................... 124 5.8 Long-term care ......................................................................................... 126 5.9 Palliative care ............................................................................................ 127 5.10 Mental health care .................................................................................... 128 5.11 Dental care ................................................................................................. 130 5.12 Complementary and alternative medicine ........................................... 131 5.13 Health services for specific populations ..............................................
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