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April 20, 2019

Universal Health Coverage (UHC): Essential for sustainable development

The State Counsellor attends the launch of the NHP 2017-2021 on 31-3-2017 at MICC2, Nay Pyi Taw. Photo: MOHS
The State Counsellor attends the launch of the NHP 2017-2021 on 31-3-2017 at MICC2, Nay Pyi Taw. Photo: MOHS

By Dr Aung Tun

April 7 of each year marks the celebration of World Health Day. In 1948, the first World Health Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day. The celebration is marked by activities which extend beyond the day itself and serves as an opportunity to focus worldwide attention on these important aspects of global health. Each year World Health Organization selects a theme highlighting a particular priority area of public health. The theme of World Health Day 2019 is: Universal Health Coverage: Everyone, Everywhere.

Universal Health Coverage (UHC): Essential for sustainable development
Universal health coverage (UHC) may be defined as all people and communities have access to quality health services where and when they need them, without suffering financial hardship. It includes the full spectrum of services needed throughout life—from health promotion to prevention, treatment, rehabilitation, and palliative care—and is best based on a strong primary healthcare system.
Primary health care covers the majority of our health needs throughout our life including services such as screening for health problems, vaccines, information on how to prevent disease, family planning, treatment for long and short-term conditions, coordination with other levels of care, and rehabilitation. It is about caring for people and helping them improve their health or maintain their well-being, rather than just treating a single disease or condition. Primary health Care is the most efficient and cost effective way to achieve universal health coverage around the world.
Achieving UHC is one of the key targets of the 2030 Agenda for Sustainable development , and it is the focus of World health day in 2019. All UN member states have accepted to try to achieve UHC by 2030, as part of Sustainable Development Goals. Some countries have already made significant progress towards UHC. But half the world’s population still do not have full coverage of essential health services. About 100 million people are still being pushed into extreme poverty (defined as living on 1.90 USD or less a day) because they have to pay for health care. Over 800 million people (almost 12% of the world’s population) spent at least 10% of their household budgets to pay for health care.
In Myanmar, large health coverage gaps remain, in particular for the poor and marginalized segments of the population. The health status of the Myanmar population is still poor and does not compare favorably with other countries in the region. Life expectancy at birth, for example, is 64.7 years in Myanmar, the lowest among ASEAN countries. Moreover, hidden behind the national averages are wide geographic, ethnic and socioeconomic disparities.

Strengthening strong health systems for UHC in Myanmar
The Myanmar health system currently faces many challenges. These relate to the availability and distribution of inputs (e.g. human resources, physical infrastructure, essential medicines and supplies, financial resources) and to weaknesses in key functions such as supportive supervision, referral, supply chain, health management information system, and public financial management. Limited oversight, leadership and accountability further exacerbate these challenges.
Myanmar is undergoing rapid demographic, health and social transition. The country’s 70% of the population lives in rural areas and out of pocket health expenditure is relatively high though it has started declining due to the government’s consistently increasing health expenditure in recent years. There is available evidence that poor accessibility to health care services is associated with locations, socioeconomic status and with education level. There is triple burden of communicable diseases, an unfinished agenda for women’s and children’s health, and a rise in conditions related to injury and diseases of aging.
Health System strengthening is the principle pre-requisite for UHC, which is not merely about health financing. Achieving UHC critically hinges on ensuring the supply of sufficient quantity and quality of the needed services-from the public and the private providers of health care. To achieve the target goals of strengthening the healthy system towards the provision of equitable universal coverage it is vital to focus on ways to improving health outcomes, enhancing the financial protection and ensuring the consumer protection
The Government of the Republic of the Union of Myanmar prioritizes the needs of the people and the voices of the people. The government recognizes the importance of healthy individuals and populations for sustainable development. The Government of Myanmar is committed to moving towards Universal Health Coverage (UHC) by 2030. The Mission and Goals of Myanmar Universal Health Coverage(UHC) are : to strengthen the health systems towards the provision of equitable universal coverage through(1) improving health outcomes; (2) Enhancing financial protection, and (3) Ensuring consumer satisfaction. Realizing the current critical challenges and to achieve the aspirational goals, nine strategic areas have been identified.
This may be an ambitious goal, but many acknowledge the importance of the ‘journey’ as a mean to achieving people-centered development. UHC is also one of the main targets for the health-related Sustainable Development Goal (SDG) 3, and Myanmar has subscribed to reaching the SDGs by 2030. With critical momentum at the global, regional and national levels, the Ministry of Health and Sports has a unique opportunity further to improve the lives of the people by building a responsive and efficient health system.

National Health Plan (2017-2021): Making progress towards UHC in Myanmar
Efforts to move towards UHC will be guided by three successive National Health Plans (NHPs), starting with the NHP (2017-21). In collaboration with key stakeholders including the government, ethnic nationalities, civil society, private sectors, and development partners, the Ministry of Health and Sports has formulated the National Health Plan (2017-2021) with an overall aim of achieving the UHC by 2030. The NHP (2017-2021) was launched in March 2017 at
MICC II in Nay Pyi Taw. The opening speech was delivered by the State Counsellor Daw Aung San Suu Kyi. This event was attended by the Speaker of the House of Representatives, Members of Parliament, Peace Commission Chair, Union Ministers, Ambassadors, Development Partners, Ethnic Health Organizations, Civil Society Organizations and Private Sector.

The NHP( 2017-2021) presents a unique opportunity that outlines a new path for the health system and it will help the country move towards Universal Health Coverage in an equitable, effective, and efficient manner. The NHP 2017-2021 aims to strengthen the country’s health system and pave the way towards UHC, choosing a path that is explicitly pro-poor. The main goal of the NHP( 2017-2021) is to extend access to a Basic Essential Package of Health Services(EPHS) to the entire population by 2020-2021 while increasing financial protection.

The NHP also aims to promote further alignment at several levels:
• Among programs (e.g. by encouraging more integrated training, joint supportive supervision, better aligned referral mechanisms, a more streamlined health information system)
• Among development partners (DPs), through stronger oversight and coordination
• Among the different types of providers, through the engagement of Ethnic Health Organizations (EHOs), Non-Governmental Organizations (NGOs),
Civil Society Organizations (CSOs) and private-for-profit providers
• Among implementing agencies by ensuring that projects and initiatives contribute to the achievement of the NHP goals.
Extending the Basic EPHS to the entire population needs substantial investments by MoHS in supply-side readiness at Township level and below and in strengthening the health system at all levels. It also requires active engagement of health providers outside the public sector, including private-for-profit GP clinics, EHOs, NGOs and CSOs. Services and interventions need to meet the same minimum standards of care, irrespective of who provides them.
The National Health Plan (2017-2021) has set the overall approach for the next five years and what can and should be done, with the bigger goal of achieving Universal Coverage by 2030. The plan also aims to deliver a basic Essential Health package by 2020, and also build foundations for the next 15 years, bringing Myanmar closer to Universal Health Coverage.

UHC and Non-Communicable Diseases ( NCDs): a mutually reinforcing agenda
Non-Communicable disease are collectively responsible for almost 70% of all death world wide. In Myanmar, according to Hospital Inpatient Statistics in 2013, NCDs accounted for more than half of all morbidity and mortality. With regards to the leading causes of NCDs mortality, Cardiovascular Disease (CVD), Diabetes Mellitus (DM), Cancer and Chronic respiratory diseases represented the majority of NCD deaths.
The updated policy brief of NCD Alliance’s 2014 brief UHC and NCDs: a mutually reinforcing agenda reflects the development in both the NCD response and UHC agenda since the adoption of the 2030 Agenda for Sustainable Development and the SDGs. It makes the case for including NCDs in national UHC benefit packages in order to fully achieve the 2030 Agenda target of healthy lives and well-being for all at all ages.
The National Strategic Plan for Prevention and Control of NCDs in Myanmar (2017-2021) was developed by the Ministry of Health and Sports in consultation with all other relevant stakeholders with the aim of “Everyone in Myanmar lives a healthy and productive life- free of avoidable disability and premature death due to NCDs.” Ministry of Health and Sports in Myanmar has consistently focused on addressing NCDs. NCDs have been recognized as public health priority in NHP (2011-2016) as well as in new NHP (2017-2021). NCD National Policy and plan of actions were developed in 2012. A dedicated unit for NCD was established under Department of Public Health since early 2015 so as to accelerate NCD prevention and control activities in country with public health approach reaching up to grass root level.
Package of Essential NCD interventions (PEN) has been implemented in 90 townships and it is planned to cover the whole country by the end of 2019. These interventions include screening of Hypertension, Diabetes, CVD and treatment of uncomplicated cases, early detection and referral of oral, breast and cervical cancers by BHS and mainly target to people especially living in rural areas.

More Intense Efforts are needed
UHC enables everyone to access the services that address the most significant causes of disease and death, and ensures that the quality of those services is good enough to improve the health of the people who receive them. Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children. Myanmar aspires to achieve as part of its vision 2030 for a healthier and productive population. However, for the aspiration to be fulfilled there is much work that needs to be done, both in terms of Health System Strengthening(HSS) and in terms of changing peoples’ behaviors and other social determinants of Health.
Universal coverage requires the involvement of all sectors of society. Myanmar should ensure that UHC meets the needs and aspiration of Myanmar people, with their participation.

References:

– Ensuring Healthy Lives for All, NCDs and UHC, NCD Alliance, December 2018
– Health in Myanmar 2014, MOHS
– Health SDG Profile: Myanmar, 2017 WHO
– NHP (2017-2021), 2016 MOHS
– National Strategic Plan for Prevention and Control of NCDs (2017-2021) Myanmar, July 2017, NCD Division, DOPH, MOHS
– Strategic Directions for UHC, Myanmar, 2014 MOHS
– Together on the road to universal health coverage, WHO, 2017. -WHD 2019 Fact sheets, WHO 2019

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