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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. - PowerPoint PPT Presentation
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Financing Health in the Context of Protecting Poor:
Myanmar Experiences
Dr. Phone Myint
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
Outline
Financing health in MyanmarEvolutionNHA Estimates
Health and PovertySocial protection for reducing povertyHealth and social protectionHousehold health expendituresMoving towards universal coverage
How social protection addressed in the National Health Plans
What for the Future
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
Financing health in MyanmarEvolution and Reforms
Following independence from the colonial rule in 1948 health service provision more or less followed the British system
Health care services funded mainly by general government tax revenue
In districts local funds were established and managed by the local authority
Health services were provided free.
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
Financing health in MyanmarEvolution and Reforms
Social Security Scheme was started in 1956 according to 1954 Social Security Act
Composed of social health insurance services and implemented by the social security board under the Ministry of Labor
The only prepaid system in providing health care services
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
Financing health in MyanmarEvolution and Reforms
During the 1960s International assistance formed other source for financing health Support particularly provided for disease control activities such as TB campaign and Malaria campaign
Government taxation remained the major source of finance for health sector
Private 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 PoorUniversity of Public Health 15,16 November 2011
Financing health in MyanmarEvolution and Reforms
Following political changes in 1988 reforms in the health sector took place including financing reforms
Generally 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 Funds
Health 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 PoorUniversity of Public Health 15,16 November 2011
Financing health in MyanmarEvolution and ReformsCommunity Contribution
Important source of financing, in Myanmar context
Aged old tradition in Myanmar for the community to donate or contribute for the welfare of the society
Individual donor or collectively by the communityIn cash in or kind and ranging from medicine and hospital equipment to buildings and land
A number of hospitals in rural settings (station hospitals) have been built on this basis
Amount 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 PoorUniversity of Public Health 15,16 November 2011
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 group
Myanmar ExperiencesTypes
* Government Sponsored/Initiated* Cooperatives (Government supported/subsidized)* Community Initiated
Government Sponsored/Initiated
Community 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
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
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
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
Strength• Community kinship• Willing to help• Altruism
Weakness• Fragmented• Unsustainable• Lack/poor capacity in financial and overall management• Weak financial capacity • Lack of leadership
•
Financing health in MyanmarNational Health Accounts Estimates
Total (national) health expenditures growing annually
Government health expenditures growing annually-but not as supposed to be
Private household health expenditure constitutes major (more than 80%) of total health expenditure
Virtually all of household health expenditures made from out of pocket payment
Potentially catastrophic (impoverishing)
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
Systems of Health Care Financing
Health Care Providers
Risks-Pooling Entity
Tax Collector Social InsuranceRevenue Collector
Employers and Consumers
General Taxation
Social Insurance PHI
OOP
•
Health and PovertySocial protection for reducing povertyHealth and social protection
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
Individuals, Households, Communities, Nations
Being Poor
High level of exposure to risk of adverse events
Lack of means to cope with them
ABILITY
To avoid major shocks
To mitigate their impact
To cope with consequences
POVERTY
Unforeseen events-natural disasters, economic crisis, internal strife, etc
Sickness, Catastrophic Health Expenditure
SHOCKSIatrogenicPoverty
•
Health and PovertyHousehold health expenditures: protecting poor
WaiversTrust funds
Social networkExpenditures mostly made from existing income and household savings Relatives and friends also source of finance
Some households had to sell their asset the number is not significantly large
Traditionally 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 PoorUniversity of Public Health 15,16 November 2011
•
Integrated Household Living Conditions Survey in Myanmar (2009-2010) Poverty Dynamics Report
Poverty dynamics-flows of persons into and out of poverty, not simply the stock of poverty at one or more given points of time
Storms, floods and stagnant water- more closely associated with entry into poverty than with chronic poverty
Chronic poverty more closely associated with droughts
Households escaped poverty-less affected by storms, floods and stagnant water
Health 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 PoorUniversity of Public Health 15,16 November 2011
•
Moving towards universal coverage
Government has increased health infrastructure, facilities and manpower to expand health coverage
Expansion of coverage through introduction of prepaid financing methods may not be expected overnightInterim measures, practical and feasible should be attempted
Exploring strength and weakness of the existing waiver system followed by modification and improvement
Identification 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 PoorUniversity of Public Health 15,16 November 2011
•
How social protection addressed in the National Health Plans
NHP (2006-2011)Policy Framework
HFAUniversal access based on PHC concept/approachesPriority to rural and border areasA system for financing health
protect financial burdenequitableaccess to allsuitable to socio-economic situations of the country
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
•
How social protection addressed in the National Health Plans
HCF Component in the NHPObjectiveTo enable to explore and develop an appropriate and sustainable financing mechanism for health that would provide sufficient amount of fund
StrategiesPromoting 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 PoorUniversity of Public Health 15,16 November 2011
•
How social protection addressed in the National Health Plans
ActivitiesTrainings and workshopsNational Health AccountsHealth financing studiesFeasibility study to introduce appropriate health insurance system in the country
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
•
What for the Future
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
•
What for the FutureHealthBasic human right
A 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 policy
Health policy is part of a broader social and public policies
Health systems are the institutional expressions of these policies, rooted in legal rights, values and political commitmentsHealth system
health carepublic healthhealth promotionassessment of health implications of other policies
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011
•
What for the Future Aims of health services
universal access according to needsolidarity in provision and financing
Health sector reforms across the world Using market mechanisms in provision of health servicesSeeing health care as a private good
Commercialized 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 PoorUniversity of Public Health 15,16 November 2011
What for the FutureBasic principles (values) in various Constitutions
Enhancing 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 PoorUniversity of Public Health 15,16 November 2011
Seminar on Financing Health Care for the PoorUniversity of Public Health 15,16 November 2011