Abstract
Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection. We used nationally representative data from the Myanmar Demographic and Health Survey (2016) and the Integrated Household Living Condition Assessment (2010) to examine 26 health service indicators and explored the incidence of catastrophic health payment and impoverishment caused by out-of-pocket payments. We used logistic regression models of inequalities in, and risk factors for, indicators of universal health coverage. Nationally, the coverage of health service indicators ranged from 18·4% (95% CI 14·9-21·9) to 96·2% (95·9-96·5). Coverage of most health services indicators was below the universal health coverage target of 80%. 14·6% (95% CI 13·9-15·3) of households that used health services faced catastrophic health-care payments. 2·0% (95% CI 1·7-2·3) of non-poor households became poor because of out-of-pocket payments for health. Health service coverage and financial risk protection varied substantially by region. Although the richest quintiles had better access to health services than the poorest quintiles, they also had a higher incidence of financial catastrophe as a result of payments for health care. Of the indicators included in the study, coverage of adequate sanitation, no indoor use of solid fuels, at least four antenatal care visits, postnatal care for mothers, skilled birth attendance, and institutional delivery were the most inequitable by wealth quintile. Attainment of universal health coverage in Myanmar in the immediate future will be very challenging as a result of the low health service coverage, high financial risk, and inequalities in access to care. Health service coverage and financial risk protection for vulnerable, disadvantaged populations should be prioritised. Japanese Ministry of Health, Labour and Welfare, Ministry of Education, Culture, Sports, Science and Technology of Japan.
Highlights
Universal health coverage (UHC) is a global health priority, and a core element of the Sustainable Development Goals (SDGs) adopted by the UN in September, 2015.1 Goal 3 sets an ambitious agenda to “ensure healthy lives and promote wellbeing for all at all ages”
To measure progress towards UHC, WHO developed a framework that consists of three dimensions: essential health service coverage, financial risk protection, and population coverage.[3]
Like many WHO member countries,[4,5] the Myanmar Government has committed to achieving UHC by 2030.6 The Ministry of Health and Sports launched the 5-year National Health Plan (2017–21) in December, 2016
Summary
Universal health coverage (UHC) is a global health priority, and a core element of the Sustainable Development Goals (SDGs) adopted by the UN in September, 2015.1 Goal 3 sets an ambitious agenda to “ensure healthy lives and promote wellbeing for all at all ages”. Like many WHO member countries,[4,5] the Myanmar Government has committed to achieving UHC by 2030.6 The Ministry of Health and Sports launched the 5-year National Health Plan (2017–21) in December, 2016. The major goals are to ensure access to a basic essential package of health services (EPHS) for the whole population by 2020, and to increase financial risk protection.[6] The Myanmar health system is a pluralistic mix of public and private systems in terms of both financing and service provision.[7] After the transition to a civilian government in March, 2011, investments in the health sector have increased. Because of an www.thelancet.com/lancetgh Vol 6 September 2018
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