POVERTY: MYANMAR: Rural healthcare "in crisis"

 Photo: Back Pack Health Worker Team
Most villages lack basic healthcare

YANGON, 28 January 2011 (IRIN) - Myanmar is one of 57 countries worldwide facing a critical shortage of medical staff, defined as fewer than 23 health workers per 10,000 people, the minimum needed to provide 80 percent coverage for births and measles immunizations, according to the UN World Health Organization (WHO).
At the agency's second forum on human resources for health in Bangkok from 25-29 January, experts are again asking how to attract and retain health workers in remote underserved areas.
Half the world's population live in rural areas, but fewer than 38 percent of nurses and 25 percent of doctors work there, according to the world health body.
For example, in rural Myanmar - where 70 percent of the country's 58 million people live - most villages lack basic healthcare. Patients travel hours - in some hilly regions nearly an entire day - to reach hospitals or clinics located only in towns.
Nationwide, there are 1,504 rural health centres covering more than 65,000 villages, according to a 2010 Health Ministry report.
"Due to [the] remoteness between their villages and towns, patients come to the hospital only when they cannot stand their deteriorating health conditions. While some arrive [at the hospital] in time, some arrive [too] late," said a local doctor working in the country's second-largest city, Mandalay, who gave only his last name, Htway.
"Due to a lack of healthcare services, there are normally just two options for many rural people: rely on local traditional remedies or seek treatments from untrained [health workers]," he added.
"Some people rely on quack doctors, though they know that is not a good choice. It's because they need not pay medical fees immediately; they can pay later after they reap their harvest or crops."
In an effort to fill the gap, a dozen health international NGOs are providing free medical care, but the demand far outstrips their capacity, according to one NGO.
Myanmar had an estimated 13 doctors and nurses/midwives per 10,000 residents, according to a WHO 2010 calculation. As of 2010, there were about 26,000 doctors, 23,800 nurses and 19,000 midwives nationwide, according to the government.

Learning gap
In Myanmar, medical students tend to come from wealthy urban families and are unwilling to "serve in poor... rural areas", said a local health worker.
There are 14 public (but no private universities) offering medical courses in Myanmar, which enrolled 3,780 students, split between medicine (2,400), dental, pharmacy and medical technology (300 each) and community health (180), according to a 2009 government survey.
"In rural areas, communication is unreliable, while transportation is uncomfortable. There is no medical journal or internet access for us to learn [the] latest medical science there," said another government health worker posted four hours south of Yangon in the Ayeyarwady region.
Health workers told IRIN that rural pay for doctors was not "respectable" and "discouraging".
Most health workers prefer working in cities where private hospitals and clinics pay higher salaries; others emigrate.
"While the government needs to give incentives to the health workers so they want to go and work in the poor rural areas, at the same time, the government needs to spend more [on the overall] health sector," said Htway.
The government spent 1.9 percent of its gross domestic product (GDP) on health in 2007, the lowest rate among countries for which WHO had data.
Participants at the human resources for health conference are reviewing a draft outcome statement that calls for "better financial management and monitoring mechanisms" to "foster accountability, and improve equity and efficiency".
In 2010, WHO published 16 recommendations to boost the odds of rural residents accessing lifesaving care, including recruiting medical students from rural areas, compulsory rural health service, improving living conditions and offering financial incentives to rural health workers.

http://www.irinnews.org/report.aspx?ReportID=91761