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Myanmar's health leaders stand against military rule
... As seen in Fig. 1, 4266 or 46% of all refugees in Nebraska originated from Myanmar (categorized as Burma) from 2010 to 2020 compromising the majority of refugees in the state [10]. Even before the recent military coup in Myanmar which has thrust the country into a health system crisis [11], cervical cancer contributed to 18% of all new cancers in Myanmar in 2018 with over 6400 women being diagnosed and over 3800 succumbing to the disease. Additionally, the Myanmar government does not sponsor a national cervical cancer screening program [12]. ...
... Rights reserved. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] 17 [13][14][15][16][17][18][19][20][21] 0.521 21 [13][14][15][16][17][18][19][20][21][22][23][24] 17 [13][14][15][16][17][18][19][20][21] 0.308 21 [13][14][15][16][17][18][19][20][21][22][23][24] 17 [13][14][15][16][17][18][19][20][21] 0.313 Entry to USA 15 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] 11 [8][9][10][11][12][13][14][15] 0.446 14 [7][8][9][10][11][12][13][14][15][16][17][18][19] 11 [9][10][11][12][13][14][15] 0.582 14 [8][9][10][11][12][13][14][15][16] 11 [9][10][11][12][13][14][15] access, or that the providers conducting these examinations more strongly recommended uptake of the HPV vaccine. Interestingly, from 2010 to 2020, our data showed only 32.1% of women had a Pap smear within the last three years. ...
... Rights reserved. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] 17 [13][14][15][16][17][18][19][20][21] 0.521 21 [13][14][15][16][17][18][19][20][21][22][23][24] 17 [13][14][15][16][17][18][19][20][21] 0.308 21 [13][14][15][16][17][18][19][20][21][22][23][24] 17 [13][14][15][16][17][18][19][20][21] 0.313 Entry to USA 15 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] 11 [8][9][10][11][12][13][14][15] 0.446 14 [7][8][9][10][11][12][13][14][15][16][17][18][19] 11 [9][10][11][12][13][14][15] 0.582 14 [8][9][10][11][12][13][14][15][16] 11 [9][10][11][12][13][14][15] access, or that the providers conducting these examinations more strongly recommended uptake of the HPV vaccine. Interestingly, from 2010 to 2020, our data showed only 32.1% of women had a Pap smear within the last three years. ...
While human papilloma virus (HPV) vaccinations and Pap smear screenings are known to improve the survival rates and incidence of cervical cancer, refugee populations have traditionally been disadvantaged within this arena. Due to past and recent political issues in Myanmar, Burmese refugee women in Nebraska may be at particular risk due to their increasing numbers. This study examined 65 female Burmese refugees who were candidates for HPV vaccinations and 106 female Burmese refugees who could have received Pap smear screenings between 2010 and 2020. Of the 65 patients aged 11–26, 49.2% initiated the HPV vaccine series and 30.8% completed the series. In patients aged 13–17, 86.4% initiated the vaccine series and 54.6% completed the series. Of the 106 patients over 18 years of age, 32.1% had a Pap smear within the last 3 years. The need to improve HPV vaccine and Pap smear rates in refugee populations is clear. While focusing on the designated refugee exam may have improved HPV vaccine rates, it is important to examine gaps in knowledge with regards to attitudes surrounding HPV vaccines and Pap smears within the Burmese refugee population.
... 2 The CDM has spread throughout the health workforce, resulting in closure of public hospitals, leading to a health system suddenly in crisis. 3 Furthermore, the military takeover is leading to increased violence, further persecution of ethnic minorities and further difficulties for humanitarian access already hampered by the COVID-19 pandemic. 3 4 While the global community has been fighting COVID-19, Myanmar citizens are also fighting for their freedom from oppression. 3 This necessary response to protect their human rights risks increasing the spread of COVID-19 at a time when coordinated efforts to manage COVID-19 are hampered by political restrictions. ...
... 3 4 While the global community has been fighting COVID-19, Myanmar citizens are also fighting for their freedom from oppression. 3 This necessary response to protect their human rights risks increasing the spread of COVID-19 at a time when coordinated efforts to manage COVID-19 are hampered by political restrictions. 3 Now it has been almost 2 months since the day of coup d'état, many peaceful protestors have been killed, injured or threatened, 4 and the planned COVID-19 vaccination programme was disrupted by the coup d'état. ...
... 3 4 While the global community has been fighting COVID-19, Myanmar citizens are also fighting for their freedom from oppression. 3 This necessary response to protect their human rights risks increasing the spread of COVID-19 at a time when coordinated efforts to manage COVID-19 are hampered by political restrictions. 3 Now it has been almost 2 months since the day of coup d'état, many peaceful protestors have been killed, injured or threatened, 4 and the planned COVID-19 vaccination programme was disrupted by the coup d'état. 3 Will Myanmar reach herd immunity through vaccination and win the democracy during this dual fight? ...
... The healthcare system, already fragile due to years of underinvestment, has nearly collapsed. Hospitals have been attacked or repurposed for military use, while healthcare workers face violence, arrests, and persecution [11][12][13][14]. These conditions, combined with critical shortages of supplies and personnel, have left millions without access to essential care, increasing disease burdens and undermining public health [12,[15][16][17]. ...
... In response, students and educators have turned to alternative pathways, including online courses and community-led training initiatives, but these efforts face significant logistical and resource challenges [20,21]. Targeted violence against healthcare workers and institutions has not only deepened the immediate health crisis but also jeopardized the long-term resilience of the healthcare system [13,14,22]. The loss of trained professionals, coupled with the systematic dismantling of health infrastructure, threatens to create lasting gaps in healthcare delivery and education. ...
Background: In the wake of Myanmar’s 2021 military coup, the University of Parma, in partnership with Myanmar and Brazilian institutions, developed an asynchronous e-learning program to sustain healthcare education amid severe disruptions. The program aimed to address urgent training needs in emergency medicine, public health management, and mental health, aligning with Sustainable Development Goals. Methods: An educational needs assessment involving 298 surveys and 10 interviews identified training priorities. Based on these findings, a four-module e-learning course was created, covering basic life support, trauma care, pediatric emergencies, and psychological assistance. The course utilized prerecorded high-fidelity telesimulations with multilingual support to ensure accessibility. Evaluation included participant satisfaction using the MSSE questionnaire and knowledge acquisition through post-module quizzes. Results: Over 750 students participated, with significant knowledge acquisition observed—60% scored 8 or higher across all modules. The MSSE questionnaire, completed by 152 students, revealed high satisfaction, with 88% agreeing that the course enhanced clinical reasoning, decision-making, and self-reflection Conclusions: This program demonstrates the value of international partnerships and e-learning in sustaining medical education during crises. High student engagement and strong learning outcomes affirm its efficacy. Future iterations will aim to improve completion rates, refine feedback mechanisms, and expand accessibility. This scalable model offers a blueprint for addressing healthcare training needs in conflict-affected and resource-limited settings, contributing to global health resilience and the achievement of Universal Health Coverage.
... After the military coup in February 2021 [4,[7][8][9][10], the health system began to disintegrate [8,[10][11][12][13][14][15] when senior medical leaders were persecuted for opposing the coup, and medical staff at all levels left their now military junta-controlled jobs and joined the Civil Disobedience Movement [16][17][18]. The EPI collapsed when its director was imprisoned, and other staff fled [16,18,19]. ...
... After the military coup in February 2021 [4,[7][8][9][10], the health system began to disintegrate [8,[10][11][12][13][14][15] when senior medical leaders were persecuted for opposing the coup, and medical staff at all levels left their now military junta-controlled jobs and joined the Civil Disobedience Movement [16][17][18]. The EPI collapsed when its director was imprisoned, and other staff fled [16,18,19]. The proportion of children who received their third dose of diphtheria-containing vaccine declined rapidly, falling from 84% in 2020 [20] to 37% in 2021 [20]. ...
Background
After the military coup in Myanmar in February 2021, the health system began to disintegrate when staff who called for the restoration of the democratic government resigned and fled to states controlled by ethnic minorities. The military retaliated by blocking the shipment of humanitarian aid, including vaccines, and attacked the ethnic states. After two years without vaccines for their children, parents urged a nurse-led civil society organization in an ethnic state to find a way to resume vaccination. The nurses developed a vaccination program, which we evaluated.
Methods
A retrospective cohort study and participatory evaluation were conducted. We interviewed the healthcare workers about vaccine acquisition, transportation, and administration and assessed compliance with WHO-recommended practices. We analyzed the participating children’s characteristics. We calculated the proportion of children vaccinated before and after the program. We calculated the probability children would become up-to-date after the program using inverse survival.
Results
Since United Nations agencies could not assist, private donations were raised to purchase, smuggle into Myanmar, and administer five vaccines. Cold chain standards were maintained. Compliance with other WHO-recommended vaccination practices was 74%. Of the 184 participating children, 145 (79%, median age five months [IQR 6.5]) were previously unvaccinated, and 71 (41%) were internally displaced. During five monthly sessions, the probability that age-eligible zero-dose children would receive the recommended number of doses of MMR was 92% (95% confidence interval [CI] 83–100%), Penta 87% (95% CI 80%–94%); BCG 76% (95% CI 69%–83%); and OPV 68% (95% CI 59%–78%). Migration of internally displaced children and stockouts of vaccines were the primary factors responsible for decreased coverage.
Conclusions
This is the first study to describe the situation, barriers, and outcomes of a childhood vaccination program in one of the many conflict-affected states since the coup in Myanmar. Even though the proportion of previously unvaccinated children was large, the program was successful. While the target population was necessarily small, the program’s success led to a donor-funded expansion to 2,000 children. Without renewed efforts, the proportion of unvaccinated children in other parts of Myanmar will approach 100%.
... Since the military takeover, however, the COVID-19 response has stalled. 8 Junta forces, meanwhile, hunted down medical professionals resisting military rule, whereas the virus continued destroying families and communities, which means the junta attacked the virus and medical professionals at the same time. Their actions proved they are far beyond reason, for every thinking person knows that one cannot attack the pandemic and medics concurrently. ...
This article explores how the Burmese, traumatized by deepening political crisis and state violence resulting from the military coup in February 2021, have endured the devastation of the virus, how that staggering virus shattered churches, and how churches, with modest assets, managed to help each other to survive together. Amid an inexpressible health crisis tearing them apart, churches epitomized grace, compassion, resilience, and hope by caring for and serving people, especially the most vulnerable and poorest in society. Sharing suffering together, keeping each other as brothers and sisters, and moving on, despite everything, represent the best in the Christian tradition.
... After Myanmar military coup on 1 February 2021, medical professionals and other government staff went on strike, joining the civil disobedience movement (CDM). 1 The junta's security forces brutally suppressed CDM doctors and nurses providing voluntary medical services in the community even during the third wave of the COVID-19 pandemic. [2][3][4] Medical university boards and professional bodies were replaced by promilitary persons. ...
... 16 Doctors, nurses and health care workers have been involved in Civil Disobedience Movement (CDM), resulting in immediate deterioration of health services and COVID-19 responses during crisis. [16][17][18] An empirical study revealed that vaccination is the best practice as the vaccines, one of the most powerful disease prevention tools, offer life-saving against COVID-19 disease. 19 The preventative measures are key to control pandemics and vaccine acceptability could be a key preventative behaviour for COVID-19 during the spring revolution. ...
Background: During the spring crisis, the coup and COVID-19 have led to a weakening vaccination program and Myanmar’s coronavirus prevention measures have been collapsed. The objective of this study was to determine the COVID-19 vaccine acceptance and assess its associated factors among the general adult population in Myanmar.Methods: A cross-sectional, web-based survey was conducted with a total of 301 participants. The association between vaccine acceptability and its determinants was assessed by binary logistic regression analysis.Results: The majority (90.4%) responded that they would like to accept vaccination if it is successfully developed and approved for listing in the future. Among the respondents, two-fifths (40.5%) had already received 1st dose of the COVID-19 vaccine, and 86.4% of the respondents thought that doctor’s recommendation is a crucial factor in vaccination decision-making, while 70.4% responded that vaccine price is an essential factor. If the younger age of participants who possessed lower monthly household income and agreed that the doctor’s recommendation is an important factor in vaccine decision making, the probability of accepting vaccine was more chance than those of older age participants.Conclusions: The study highlighted that majority of the respondents wanted to accept the vaccine although they were concerned about the side effects and political unrest. It is the recommended to develop a strategy successfully to strengthen vaccine convenience.
... To voice their disagreement with the coup this time, the citizens hold demonstrations and engage in civil disobedience movement (CDM) (Bowyer et al., 2021;Osada, 2021;Soe et al., 2021;The Lancet, 2021), inclusive of the teachers ( BBC News, 2021b;Waa, 2021b). However, the junta started to crack down harshly on civilians engaging themselves in CDM (BBC News, 2021a). ...
... CDM health personnel used private and charity clinics to provide medical assistance at reduced fees, collaborated with general practitioners, ensured HIV and TB services, and organized staffing ambulances and clinics in the street. 11 Representatives of the democratic health and university institutions continue to work to create the conditions for a resumption of the call for peace throughout the country and strengthen the resilience of the health system. The federal National Unity Government (NUG) appointed by the Committee Representing Pyidaungsu Hluttaw (CRPH) and representing the democratically elected parliamentarians, with its Minister of Health (MOH) has devised an interim health service delivery plan to provide people-centered health care during the revolution against all challenges. ...
In this viewpoint, we examined the ongoing crisis of the Myanmar health system following the military takeover of 1 February 2021, the health challenges faced by the population, and the tragic conditions in which the health professionals find themselves. We describe the efforts undertaken by representatives of the democratic health and university institutions to create the conditions for a resumption of the call for peace throughout the country and strengthen the resilience of the health system. In particular, we present the interim health service strategy devised by the Myanmar Ministry of Health (MOH), as appointed by the democratic government. The MOH’s plan represents the entry point to use health as a bridge for peace and restoration of democracy and human rights, showing that the health sector of a country can be reshaped and revitalized in times of great adversity.
... 3 In addition to the collapsed COVID-19 testing and response, the COVID-19 vaccination progress in Myanmar has trickled down since the ousting of Aung San Suu Kyi's government, as frontline health workers refused to get vaccinated unless there is no involvement from the military junta. [8][9][10] The healthcare system has been disorganised as some health sectors in Myanmar continue to strike along with the uneven boycott system from the public. 9 Consequently, the trust in the vaccination process has also declined as a result of the widespread anger at the Myanmar regime, with more of its people refusing to get vaccinated. ...
In Myanmar, during the civil war following the February 2021 military coup many medical students suspended their studies. The University of Parma is committed to organise alternative courses for Myanmar medical students. The aim of this study was to examine through a mixed method the current educational needs of Myanmar medical students and the feasibility of alternative training courses. The quantitative research revealed that many students can attend educational activities online. The main difficulty concerns training through clinical practice, although some of them believe in the possibility that online simulation can partially make up for this deficiency. The training areas of main interest are: Mental Health, Emergency Medicine, Public Health, Healthcare Management. The qualitative study revealed that the students are confident that foreign universities can provide online training activities not only during the civil war, but also when peace has been established, and that such activities may be legally acknowledged. These results, in addition to documenting the resilience of the students involved in this research, respond well to the need to direct training to the effective actual needs whilst addressing the need to understand the specific context in which students will have to benefit from training, even in war situations.
A claim is often made that medical neutrality requires that health workers practicing in conflict settings or in situations of political violence refrain from taking a position on controversies of a political, racial, religious, or ideological nature. The admonition is also applied to human rights documentation and reporting and advocating for political change. That position, however, is highly problematic, in part because the phase is “medical neutrality” is not contained in international law and because has at least three different meanings: immunity from attack, impartiality, and political neutrality. More importantly, refraining from political engagement is inconsistent with contemporary medical ethics, including obligations to prevent abuses, report those that take place, and advance health equity. Moreover, the humanitarian principle of humanity, on which the purported obligation is predicated, is not morally grounded and lacks the status of the companion principles of humanity and impartiality. These principles both justify and encourage health professionals to engage in political matters that can protect the rights and health of patients and the larger populations. In taking such stances, health professionals can employ decision-making processes that account for possibly conflicting values and obligations and assessing the benefits, burdens, and risks of alternative courses of action.
Background. After the military coup in Myanmar in February 2021, the health system began to disintegrate when staff who called for the restoration of the democratic government resigned and fled to states controlled by ethnic minorities. The military retaliated by blocking the shipment of humanitarian aid, including vaccines, and attacked the ethnic states. After two years without vaccines for their children, parents urged a nurse-led civil society organization in an ethnic state to find a way to resume vaccination. The nurses developed a vaccination program, which we evaluated.
Methods. A retrospective cohort study and participatory evaluation were conducted. We interviewed the healthcare workers about vaccine acquisition, transportation, and administration and assessed compliance with WHO-recommended practices. We analyzed the participating children’s characteristics. We calculated the proportion of children vaccinated before and after the program. We calculated the probability children would become up-to-date after the program using inverse survival.
Results. Since United Nations agencies could not assist, private donations were raised to purchase, smuggle into Myanmar, and administer five vaccines. Cold chain standards were maintained. Compliance with other WHO-recommended vaccination practices was 74%. Of the 184 participating children, 145 (79%, median age five months [IQR 6.5]) were previously unvaccinated, and 71 (41%) were internally displaced. During five monthly sessions, the probability that age-eligible zero-dose children would receive the recommended number of doses of MMR was 92% (95% confidence interval [CI] 83%-100%), Penta 87% (95% CI 80%-94%); BCG 76% (95% CI 69%-83%); and OPV 68% (95% CI 59%-78%). Migration of internally displaced children and stockouts of vaccines were the primary factors responsible for decreased coverage.
Conclusions. This is the first study to describe the situation, barriers, and outcomes of a childhood vaccination program in one of the many conflict-affected states since the coup in Myanmar. Even though the proportion of previously unvaccinated children was large, the program was successful. While the target population was necessarily small, the program's success led to a donor-funded expansion to 2,000 children. Without renewed efforts, the proportion of unvaccinated children in other parts of Myanmar will approach 100%.
Globally, the COVID-19 pandemic has been in effect since 2019. It has impacted people’s lives differently, and education is one of the biggest challenges. In Myanmar, apart from the pandemic, the Coup d'état in 2021 crippled development across many sectors, including education. Consequently, they interfered with Myanmar’s progress toward inclusive education in line with Sustainable Development Goal Four (SDG 4). A brief overview of
Myanmar’s progress and challenges in implementing inclusive education is provided in this chapter. Furthermore, it aims to bring ideas on how inclusive education in Myanmar could improve in the aftermath of the pandemic and coup.
COVID-19 is a nonhuman threat that has thrust disease to the center of discourses about geopolitics, security, and national sovereignty. This chapter examines the multilateral, regional, and national dimensions of COVID-19 as the pandemic has played out in Southeast Asia. National vignettes are utilized to reveal different geopolitical dimensions of COVID-19 responses and influences. COVID-19 has had enormous implications for migrant workers worldwide, which may reinforce preexisting prejudices and practices of exclusion. In Singapore’s case, migrant infection clusters have generated a growing state and public recognition of the nation’s dependence on foreign workers as part of its political economic drive for growth and survival. The use of “war metaphors” as national propaganda against the disease and as a means for state-nation-building are explored in the case of Vietnam. Even a force as deadly as a global pandemic cannot prevent humanmade geopolitical rifts from becoming deeper. The chapter explores how the military in Myanmar have exploited the timing of pandemic and targeted public health workers in order to strengthen a hold over the country following a military coup. Finally, the chapter considers “ways forward,” and suggests that we draw inspiration from frontline workers, everyday struggles, and the realm of public health in order to seek sustainable meanings of justice and security.KeywordsMedical diplomacyMilitary coupMigrant workersASEANNational geo-bodiesSingaporeVietnamMyanmar
Ever since the military staged a coup, differing narratives have divided institutions and people into at least four main forces within the changing political power dynamics in response to the military rule and return the country to democracy.
Background: Worldwide, the COVID-19 pandemic hit weakest populations
hardest, with socioeconomic (SE), racial and ethnic disparities in COVID-19
burden. The study aimed to analyze patterns of socioeconomic and ethnic
disparities in morbidity, hospitalization, and vaccination throughout four
pandemic waves.
Methods: A retrospective-archive study was conducted in Israel from 11/3/20-
1/12/21, with data on confirmed cases, hospitalizations, mortality and
vaccinations (3 doses), obtained from the Israeli Ministry of Health's open
COVID-19 database, covering 98.8% of the population, by SE and ethnic
characteristics of localities.
Findings: At the outbreak of the pandemic, there was a higher caseload in
Jewish, compared with Arab localities. In the second and third waves, low SE
and Arab minority populations suffered 2-3 times higher morbidity, with a
similar but attenuated pattern, in the fourth wave. A similar trend was
observed in hospitalization of confirmed patients. COVID-19 associated
mortality did not demonstrate a clear SE gradient.
A strong social gradient in vaccine uptake was demonstrated throughout the
period, with 71% and 74% double vaccinated in the two highest SE clusters,
and 43% and 27% in the two lowest clusters by December 2021. Uptake of
the third dose was 57%-60% in the highest SE clusters and 31%-25% in the
lowest clusters. SE disparities in vaccine uptake were larger among the
younger age groups and gradually increased from first to third doses.
Conclusions: Israel was among the first to lead a rapid vaccination drive, as
well as to experience a fourth wave fueled by diminishing immunity and the
delta variant. SE and ethnic disparities were evident throughout most of the
pandemic months, though less so for mortality. Despite higher COVID burden,
vaccine uptake was lower in disadvantaged groups, with greater disparities in
the younger population which widened with subsequent doses.
Objectives
To describe the safety of vaccines against SARS-CoV-2 in people with inflammatory/autoimmune rheumatic and musculoskeletal disease (I-RMD).
Methods
Physician-reported registry of I-RMD and non-inflammatory RMD (NI-RMDs) patients vaccinated against SARS-CoV-2. From 5 February 2021 to 27 July 2021, we collected data on demographics, vaccination, RMD diagnosis, disease activity, immunomodulatory/immunosuppressive treatments, flares, adverse events (AEs) and SARS-CoV-2 breakthrough infections. Data were analysed descriptively.
Results
The study included 5121 participants from 30 countries, 90% with I-RMDs (n=4604, 68% female, mean age 60.5 years) and 10% with NI-RMDs (n=517, 77% female, mean age 71.4). Inflammatory joint diseases (58%), connective tissue diseases (18%) and vasculitis (12%) were the most frequent diagnostic groups; 54% received conventional synthetic disease-modifying antirheumatic drugs (DMARDs), 42% biological DMARDs and 35% immunosuppressants. Most patients received the Pfizer/BioNTech vaccine (70%), 17% AstraZeneca/Oxford and 8% Moderna. In fully vaccinated cases, breakthrough infections were reported in 0.7% of I-RMD patients and 1.1% of NI-RMD patients. I-RMD flares were reported in 4.4% of cases (0.6% severe), 1.5% resulting in medication changes. AEs were reported in 37% of cases (37% I-RMD, 40% NI-RMD), serious AEs in 0.5% (0.4% I-RMD, 1.9% NI-RMD).
Conclusion
The safety profiles of SARS-CoV-2 vaccines in patients with I-RMD was reassuring and comparable with patients with NI-RMDs. The majority of patients tolerated their vaccination well with rare reports of I-RMD flare and very rare reports of serious AEs. These findings should provide reassurance to rheumatologists and vaccine recipients and promote confidence in SARS-CoV-2 vaccine safety in I-RMD patients.
Improvements in special education and the implementation of inclusive education are a significant focus in Myanmar. Legislation toward these goals was officially enacted in the National Education Law, which was amended in 2015. While the Ministry of Education has adopted a policy of inclusive education, which states that all students with disabilities could attend mainstream school classes, classroom settings are not adequately equipped to support students with disabilities. The Department of Social Welfare does not have an inclusive education program. The department’s role is to support the training of schools as a part of special education for such students, providing primary special education via different teaching methods and appropriate therapies for students with disabilities. After students pass the primary education exam, they can join middle school, high school, and higher education levels of inclusive education, which run under the Ministry of Education. All special schools in Myanmar focus their different occupational therapies on enhancing students’ physical and mental capabilities and collaborating with outside professionals in relevant areas. The Ministry of Education aims to develop the knowledge and skills of teacher educators and teachers, so they can effectively adopt more inclusive teaching practices. Currently, Myanmar’s basic education reforms are being carried out through the National Education Strategic Plan (2016–2021). The ministry is currently working to implement a new 4-year pre-service degree program as well as the Basic Education School Quality Assurance Standards Framework. Such a movement to enhance the quality of teachers became a bridge to collaborate between inclusive and special education within two ministries.
One year has passed since the Sars-CoV-2 infection diagnosis was made in a patient hospitalized in Codogno unveiling the outbreak of coronavirus in Italy and the start of one of the worst pandemics in history. Today, we know a lot more about Covid-19 infection than we did a year ago. We know that the fight against the spread of the virus, when not correctly done, favours the development of variants of the original covid-19 strain and, we also know that these variants especially the one defined as the "English" variant, has the ability to spread much more and more quickly than the original strain. We know that people, even at lethal risk of complications, are especially old aged, but we also know that those who are oligosymptomatic or asymptomatic patients can spread the infection. Grossi E. et al. report in the following pages the results of a research conducted on pregnant women which shows how the risk of contracting the infection is higher in pregnancy although in an asymptomatic form and that the risk is also transmitted to the unborn child. This data makes the report here provided by Intraccolo U. et al. even more interesting according to which the Italian female population tends to excessively medicalise low-risk pregnancies. [...].
Funding sources: None.
Conflicts of interest: The authors are Trustees of the Burma Skincare Initiative charity.
Dear Editor, Myanmar (Burma) is a Southeast Asian country that suffered over 50 years of military dictatorship with global isolation and systematic disinvestment in the public sector. This resulted in one of the poorest healthcare systems in the world, with limited or no access to skincare, particularly for disadvantaged communities. The transition of the country to a civilian government in 2011 initiated notable progress in healthcare, with strategic plans to develop universal health coverage.¹ The Burma Skincare Initiative (BSI) is a UK‐based charity established under the Aung San Suu Kyi‐led civilian government of Myanmar in 2018. The mission of the BSI is to promote excellence in skincare for the people of Myanmar.² With the support of the international dermatology community, the BSI has worked in close partnership with Myanmar dermatology colleagues and the civilian government‐led Myanmar Ministry of Health and Sports, to provide training, fellowships, funded research studies and the first international dermatology meeting in the country in February 2020.
Myanmar's health sector has received low levels of public spending since 1975. Combined with the country's historic political and economic isolation, poor economic management and multiple internal armed conflicts, these limited resources have translated into low coverage of even the most basic services and into poor health outcomes with wide disparities. They have also resulted in out-of-pocket payments for health as a proportion of total health spending being among the highest in the world. The Government of Myanmar has now affirmed its commitment to moving toward Universal Health Coverage. This commitment is reflected in the National Health Plan 2017-2021. Drawing upon analysis of data from the Myanmar Poverty and Living Conditions Survey 2015 and using the country's revised methodology to estimate poverty, this paper explores some of the consequences of Myanmar's excessive reliance on out-of-pocket funding as the main source of health financing. Around 481 000 households in Myanmar experienced catastrophic health spending in 2015. Of this group, 185 000 households lived below the national poverty line. Households that experienced catastrophic health spending spent, on average, 54.7% of their total capacity to pay on health. Of all Myanmar households that went to a health facility in 2015, ∼28% took loans and ∼13% sold their assets to cover health spending. In that same year, ∼1.7 million people fell below the national poverty line due to health spending. The paper then discusses how ongoing reforms could help alleviate the financial hardship associated with care-seeking. With current political will to reform the health system, a conducive macro-economic environment, and the relatively limited vested interests, Myanmar has a window of opportunity to achieve significant progress towards UHC. Continued high-level political support and strong leadership will be needed to keep reforms on track.
Background:
Around the world, millions of people are impoverished due to health care spending. The highest catastrophic health expenditures are found in countries in transition. Our study analyzes the extent of financial protection by estimating the incidence of catastrophic health care expenditure in Myanmar and its association with sociodemographic factors.
Methods:
We performed a secondary analysis of data from the household surveys conducted by the Livelihoods and Food Security Trust Fund (LIFT) in 2013 and 2015 in Myanmar. To estimate the magnitude of catastrophic health care expenditure, we applied the definition of catastrophic payment proposed by the World Health Organization (WHO); a household's out-of-pocket payment for health care is considered catastrophic if it exceeds 40% of the household capacity to pay. We also examined the changes in catastrophic payments at three different threshold levels (20, 30, 40%) with one equation allowing for a negative capacity to pay (modified WHO approach) and another equation with adjusted negative capacity to pay (standard WHO approach).
Results:
In 2013, the incidence of catastrophic expenditure was 21, 13, 7% (standard WHO approach) and 48, 43, 41% (modified WHO approach) at the 20, 30, 40% threshold level respectively, while in 2015, these estimates were 18, 8, 6% (standard WHO approach) and 47, 41, 39% (modified WHO approach) respectively. Geographical location, gender of the household head, total number of household members, number of children under 5, and number of disabled persons in the household were statistically significantly associated with catastrophic health care expenditures in both studied years 2013 and 2015. Education of household head was statistically significantly associated with catastrophic health expenditure in 2013. We found that the incidence of catastrophic expenditures varied by the approach used to estimate expenditures.
Conclusions:
Although the level of catastrophic health care expenditure varies depending on the approach and threshold used, the problem of catastrophic expenditures in Myanmar cannot be denied. The government of Myanmar needs to scale up the current Social Security Scheme (SSS) or establish a new financial protection mechanism for the population. Vulnerable groups, such as households with a household head with a low-level of education, households with children under the age of 5 years or disabled persons, and low-income households should be prioritized by policymakers to improve access to essential health care.
Capacity building for emergency care: training the first emergency specialists in Myanmar.
- Phillips GA
- Soe ZW
- Kong JHB
- Curry C
Phillips GA, Soe ZW, Kong JHB, Curry C.
Capacity building for emergency care: training
the first emergency specialists in Myanmar.
Emerg Med Australas 2014; 26: 618-26.
Published Online
February 19, 2021
https://doi.org/10.1016/
S0140-6736(21)00457-8