Health inequity in the post-conflict ethnic regions of northeastern Myanmar: a cross-sectional survey

Abstract

Abstract Background The health system in the Myanmar–China border regions has undergone complex changes and the population has experienced ongoing political turbulence. Limited service points, poor financial protection mechanisms, and gender-based inequity restrain the population's access to health-care services. This study aims to analyse health inequity in the ethnic regions of northeastern Myanmar from three perspectives: geographical barriers, gender-based disparities, and financial consequences of receiving health services. Methods A multistage-stratified random cluster survey was conducted in Shan State Special Region 2 and Eastern Shan State Special Region 4 of northeastern Myanmar between January and March, 2016. 4235 participants with complete information were recruited into the survey, including Wa, Dai, Aini, and other ethnicities. Data were collected on demographics, health status, household economic status, and service use. Interviews were conducted by a trained interviewers from a non-governmental service-providing organisation. Linear and logistic regressions were performed to understand the association between geographic distance, gender, and household income and inpatient/outpatient service use as well as the subsequent financial burdens. Findings Residents living within 5 km of any health-care facility paid more outpatient visits (90·06 visits per 1000 population) in the past 2 weeks, than did those living 5–20 km and over 20 km away (54·84 and 54·02 per 1000 population, respectively). A similar but less significant difference was found for inpatient service use. Average costs for outpatient visits were US$46 in rural health centres, $40 in private clinics, $205 in township hospitals, and $449 in health facilities, whereas average costs for inpatient visits were $201, $223, $411, and $1415, respectively. Adults with a household income of above $720 per year were more likely to seek outpatient services than those with an annual income of less than $360 (odds ratio 1·43, 95% CI 0·98–2·10). After adjusting for other covariates, women were less likely to seek inpatient treatment (0·55, 0·35–0·84) and outpatient services (0·86, 0·64–1·15) than men. Interpretation Geographical barriers, gender-based disparities, and financial burdens significantly restrict the ethnic people's access to health-care facilities. Tackling health inequity in the Myanmar border areas requires a better primary health-care system, proper financial protection mechanisms, and a special focus on women. Although the study is exposed to several limitations, including potential interviewer bias and respondents' recall bias, the present study is the largest and one of the few studies of health inequity in the Myanmar–China border area. Funding None.