Call me old fashioned. But 'shake ups' are not enough.

In the years left out in the cold and in the long period between being elected and coming to power, has the NLD not developed a platform for reform or a plan for reform of the health sector? If not, why not? If so, then who was consulted and where is the plan?

Without a plan for health sector reform, how will the informed public know if the new government is performing well? Spending more money will not necessarily lead to better performance or better health. Simply appointing a reformist minister for health will not lead to change.

Today the people of Myanmar deserve more.

Jamie

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NLD aims for health sector shake-up
Shwe Yee Saw Myint
Monday, 14 March 2016

As the incoming National League for Democracy government prepares to take over next month, concern is growing over how much influence government ministers will have over policy. While the constitution, drafted by the military, makes it clear that security-related posts will be largely beyond the reach of the elected government, indications are emerging that the new government could struggle to assert authority even over functions nominally under civilian control.

In January, parliament passed a K24 trillion budget for financial year 2016-17, which starts on April 1, the first day of the incoming government. In other words, the spending patterns and constraints under which the incoming NLD government will operate have already been determined by the outgoing Union Solidarity and Development Party, which was defeated at the polls last November. Only 3 percent of the budget was devoted to healthcare, among the lowest amount in the region but a significant boost from previous years which saw as little as 1pc allocated.

Senior officials in the Ministry of Health, who requested anonymity, have told The Myanmar Times that they are already preparing to implement plans for the coming year, leaving it unclear how much say the next health minister will have in the ministry’s activities. Reportedly, the ministry has already turned down a request from NLD to view its plans.

Though U Htin Kyaw yesterday emerged as president-designate, pending confirmation by a parliamentary vote, no other members of the next government have yet been identified.

Dr Chit Soe, head of the rheumatology department at Yangon’s University of Medicine-1, said the incoming health minister should listen to front-line health workers rather than ministry bureaucrats.

“I call on the new government to improve the quality of doctors and provide a better learning structure for medical students,” he said, adding that rural and suburban health centres were in need of an upgrade after years of underfunding.

Dr Taza Kyaw, a senior consultant orthopaedic surgeon at a public hospital in Loilin/Loileng, Shan State, said he looked forward to changes under the new government. The outgoing health minister, Dr Than Aung, is a former military officer, as are many senior bureaucrats in the ministry.

Last year, medical staff launched a “black ribbon campaign” to protest against the large number of former military officers they said had been parachuted into the health ministry without proper qualifications or experience. Many of the permanent under-secretaries appointed last year to run government departments are also former military officers, suggesting that military influence will remain potent even as the NLD appoints new ministers.

Dr Kyaw Zwe, a central committee member of the NLD health network, told The Myanmar Times the party already has plans to more than double the allocated health budget. He did not clarify how the party would accomplish the funding feat.

“The 2015 government budget provided 3.2pc to the health sector, but in 2016 we will want 7pc,” he said. “We plan to increase the health budget by 3pc every year. So according to our policy, by 2020 the government is going to allocate 12pc of the budget for health and achieve Universal Health Coverage by 2040.”

He added that current Minister for Health Dr Than Aung dedicated much of the annual spending to updating hospitals, but the NLD intends to devote more of the resource to improving public health access.

Dr Kyaw Zwe conceded that re-allocating funds could be tricky.

“Policy is easy to draw up, but financing is the problem. If we have no budget we cannot implement the plans,” he said. “So we are going to work on health programs together with international donors and local donors especially in conflict areas like Kachin and Kayin states.”

To meet public expectations, the new government will need to increase access to quality healthcare throughout the country, especially in rural areas, while bringing down costs payable by patients. Dr Kyaw Zwe also acknowledged that the NLD would not be able to institute quick fixes like providing free healthcare for all immediately, but would work on using the limited funds to support healthcare for impoverished families.

Another major issue the NLD will have to combat according to industry experts is the proliferation of unqualified people providing medical care, often prescribing fake or illegal medicines.

“We hope for change, but it’s not easy to change the mindset of health staff,” said U Myint Swe, president of the Ratana Metta charitable organisation.

He added that many high-ranking medical officials resented assistance provided by medical NGOs, though such assistance was often badly needed.

“Both local and international NGOs are criticised, but the standards of medical care in each case are different,” he said.

“Most people living in the countryside, that is, about 70pc of the population, do not have access to good medical care. Many rural practitioners are not trained above the midwife level, and some are not qualified,” he said.

Dr Sid Naing, country director of Marie Stopes International Myanmar, warned against inflated expectations regarding the incoming government, adding that it would be unrealistic to apply a 100-day test. The government should be able to empower health administrators to implement initiatives that would lead toward quality, better coverage, respect and security, he said.

The health sector across the board, whether public or private, required higher investment and high-level attention, he said. Service availability and quality for even the most disadvantaged communities in the most inaccessible locations must be ensured.

“A national fund should be mobilised and pooled in advance to pay for healthcare for anyone as and when needed. To make health services relevant and useful for clients as well as to get public support, effective and proactive communication channels should be kept open.”

Amid the host of challenges, the new leaders would also have opportunities to improve healthcare in Myanmar, he said.

http://www.mmtimes.com/index.php/national-news/yangon/19446-nld-aims-for-health-sector-shake-up.html