Public Hospitals Offer Free Medicine for Burma’s Poor

By Reform, Samantha Michaels 6 June 2013

RANGOON — Burma’s public hospitals are for the first time offering free medicine to poor patients, in a major break from the previous policy of charging for all medicine and equipment used during treatment, as the country begins to reform its underfunded health care system.

The government’s public hospitals, which have long been prohibitively expensive for the majority of people in Burma, started offering financial aid earlier this year after receiving a budget from the Health Ministry specifically reserved for medicine and equipment for the first time, a hospital medical superintendent told The Irrawaddy on Thursday.

“The country is reforming not only politically and economically, but also in the health sector,” said Dr. Zaw Htun from San Pya General Hospital, a public hospital in Rangoon’s Thingangyun Township, adding that the hospital’s new budget for medicine came with an increase in the Health Ministry’s own budget.

“Before this, the central level [government] bought medicine and medical equipment, and they distributed it. Hospitals didn’t have their own budget to buy drugs, and patients had to pay for almost all their own medicine,” he said. “Now we can buy medicine and medical equipment, and then distribute it freely to patients who cannot afford it, especially poor patients and emergency patients.”

The budgets for medicine and equipment vary depending on the size of the hospital, he said, with the 300-bed San Pya Hospital receiving 120 million kyats (US$126,000) for the 2012-13 year. The hospital started offering free medicine and equipment to poor patients in February this year and has gradually increased its distribution since then.

“As of April, we’ve been able to provide for almost all our poor patients,” Zaw Htun said, though he could not immediately offer detailed statistics. “About 50 percent of our patients receive financial aid.”

More patients are now coming to the hospital for treatment, he said, with the bed occupancy rate increasing from 128 percent in 2012 to 143 percent this year.

But many people are still not aware of the government’s financial aid, according to health care providers at a charity hospital in downtown Rangoon.

“Patients don’t know about it,” said Sandy, a medical officer at the Muslim Free Hospital, which offers free health services to patients of all religions and classes. “The public hospital in Insein Township also started offering financial aid, but patients from Insein still come here [to the Muslim Free Hospital] because they do not know. We have to tell them.”

Sandy, 23, learned about plans to offer free medicine and IVs at public hospitals last October during an internship at the government’s North Okkalapa General Hospital, which she said rolled out financial aid in January.

In the Muslim Free Hospital’s surgical wing, 41-year-old Haronbi from Rangoon said he had never before been to a hospital because they were too expensive. He went to the Muslim Free Hospital for a hernia operation, but said in the past he had always treated himself with over-the-counter medications whenever he fell ill. “I cannot afford much,” said the laborer, who earns about 5,000 kyats ($5.30) a day, which is more than the average daily income in Burma.

Several other patients at the charity hospital said they had never been to a public hospital and usually treated themselves at a pharmacy or by going to a neighborhood doctor.

The Muslim Free Hospital’s head of surgery is Dr. Tin Myo Win, the personal physician of opposition leader Aung San Suu Kyi. He said patients continued to flock to his charity hospital because they could not afford the public hospitals, and that with the high demand, he often performed 10 to 15 surgeries in a single day. “Theoretically, you should only perform about five major operations a day as a surgeon,” he told The Irrawaddy last month.

The charity hospital, which has 25 beds in its surgery wing, must often refer patients to other institutions for more complex procedures like heart surgery, brain surgery and kidney surgery. Tin Myo Win, the hospital’s only surgeon, said he tries to send patients to the government’s Central Women’s Hospital in Rangoon, which he said began offering some free services this year. However, he added that he was not aware of other public hospitals also offering free services.

“They [patients] cannot afford to go to the other hospitals,” he said. “At the [Rangoon] General Hospital, unlike here, patients have to pay for all the fees. You have to buy your own medicine. For operations, you have to buy your own cotton wool and the bandages.”

Zaw Htun said San Pya Hospital did not advertise the financial assistance inside or outside the hospital. “It’s not necessary,” he said, adding that local magazines, newspapers and journals had written about the free services and that patient numbers were climbing.

The medical superintendent said he would travel to Burma’s capital next week to meet Health Minister Pe Thet Khin and discuss the hospital’s budget for medicine and equipment, which he expected to increase in the coming fiscal year.

“All the medical superintendents from the whole country will meet in Naypyidaw on June 14 to talk about the budget,” he said.

He said he was not sure if the goal was to eventually provide free medicine for all patients, but added that the Health Ministry had started studying the possibility of creating a health insurance system in the country.

“We don’t have that yet in Myanmar,” he said. “I was told that he [the health minister] has plans and they are doing research about how to set up health insurance.”

The new budget for medicine and equipment at public hospitals comes amid a greater push to reform Burma’s health care system, which experts say is broken after decades of underfunding. The former military regime, which handed power to a nominally civilian government in 2010, spent less than $1 per person on health care in 2007, according to statistics from the Health Ministry.

Private spending constitutes the major share of health spending in Burma, according to National Accounts Data from the Ministry of Health in 2008-09, which said the Health Ministry was responsible for 10 percent of health spending while private households accounted for 82-85 percent, with additional funding from other ministries and NGOs.

The Health Ministry says it aims to achieve universal health care by 2030, according to its 30-year plan for the country’s health development, Myanmar Health Vision 2030.

That would be no small feat, according to Dr. Vit Suwanvanichikij, a public health researcher who has worked with Burmese migrants on the Thai border for more than a decade, and who visited hospitals in Myanmar last year. He described Burma’s current health care system as “probably the most privatized health system in the world.”

Although the government’s health budget has increased, it remains at about 3 percent of the total state budget, an amount Tin Myo Win and other health experts have described as “very insufficient.”