Han SM, et al. - In order to assess the progress of the Myanmar Government commitment regarding the attainment of Universal health coverage (UHC) by 2030, researchers estimated national and subnational health service coverage and financial risk protection. As per findings, overall coverage of essential health services is far from the 80% target by 2030. They noted a wide variation in coverage across states and regions. Many households were identified sustaining catastrophic and exhausting health expenditure. In addition, all states and regions showed substantial wealth-based inequality in both coverage of health services and catastrophic health payments. Findings thus suggest that in Myanmar, attainment of UHC in the immediate future will be very challenging. They recommend prioritizing health service coverage and financial risk protection for vulnerable, disadvantaged populations.

Methods

• Using nationally representative data from the Myanmar Demographic and Health Survey (2016) and the Integrated Household Living Condition Assessment (2010), researchers examined 26 health service indicators and determined the incidence of catastrophic health payment and impoverishment caused by out-of-pocket payments.
• Logistic regression models of inequalities in, and risk factors for, indicators of universal health coverage were used.

Results

• Findings revealed the national coverage of health service indicators ranging from 18·4% (95% CI 14·9–21·9) to 96·2% (95·9–96·5).
• Most health services indicators had coverage below the universal health coverage target of 80%.
• Catastrophic health-care payments were experienced by 14·6% (95% CI 13·9–15·3) of households that used health services.
• Because of out-of-pocket payments for health, 2·0% (95% CI 1·7–2·3) of non-poor households became poor.
• Substantial regional variation was noted in health service coverage and financial risk protection.
• The richest quintiles had a higher incidence of financial catastrophe as a result of payments for health care despite a better access to health services than the poorest quintiles.
• 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 identified to be the most inequitable by wealth quintile.