Myanmar: can a new government give health to the people?

Abstract

Last week's general election in Myanmar brought an end to more than 50 years of military rule (incorporating a nominally civilian government since 2011). The incoming National League for Democracy (NLD) party, led by Aung San Suu Kyi, brings a historical opportunity to move administration away from military dominance and to return health to the people. Myanmar is a rural and ethnically diverse country of extreme poverty, with one of the most poorly funded state health-care systems in the world. The 2014 census confirmed a population of 51·4 million people, and a recent Lancet paper noted a maternal mortality ratio of 178 per 100 000 livebirths in 2015. Myanmar is prone to natural disasters, has a longstanding civil war during which human rights abuse and violence were and are commonplace, and the education system has an unstable infrastructure. Karen Eggleston and colleagues write in a letter this week about disparities in health and health care in Myanmar. Acknowledging that the meagre 3·38% of overall government expenditure assigned to health has increased by 8·7 times between 2011 and 2015, the authors explain that achieving universal health coverage by 2030 remains undermined, because “resource allocation does not seem to be closely aligned with the goal of reducing health disparities”. The gap in life expectancy starkly illustrates this, with a range of 11 years between the highest and lowest values across Myanmar. A daunting transition period lies ahead for the incoming government, and it is not yet known how or whether health or education will be prioritised. There will be several issues of coordination for new and old donors, and increased presence and investment growth will likely follow. The NLD faces many challenges, including the stateless and marginalised Rohingya people, remote rural communities, and malaria resistance. The Lancet will be publishing a country Series on Myanmar next year that will explore these areas further. With Aung San Suu Kyi, a Nobel Peace Prize laureate, this is a moment for courageous new leadership to heal and rebuild, and to present all people in Myanmar with a right to secure and healthy lives. Disparities in health and health care in MyanmarMyanmar (Burma) is undergoing a complex political and economic transformation, from a long civil war and military regime to a peace process and democratisation. Since 2011, the Myanmar Ministry of Health has started to rehabilitate the fragile health system, setting the goal of achieving universal health coverage by 2030.1 To achieve this target, Myanmar will have to face substantial challenges; arguably one of the most important difficulties is how to allocate limited health-care resources equitably and effectively. Full-Text PDF Open Access