Interview: Dr. Aye Aye San

What measures could attract a higher number of specialist doctors to private sector hospitals?

DR. AYE AYE SAN: The current situation of Myanmar’s health care sector is a reflection of the country’s current stage of development. It lacks adequate funding, it has the lowest ratio of beds per capita of the ASEAN countries – currently less than one bed per 1000 habitants, compared to the average of 2.5 for the region – and it has a shortage of doctors, specialists and nurses.

The lack of qualified health care professionals makes it difficult for private entities to improve their quality care and business models. In our case, more than 95% of our specialists are external and they generally come in the evening after finishing their shifts in public hospitals. Typically, they work in more than one private hospital because we are all grappling with the same problem. In Myanmar all private medical institutions have a very low number of in-house specialists, because most of them work full-time in the public sector. The problem is exacerbated by the fact that private practices are not allowed to train new doctors, since medical schools are all public and general physicians who wish to study and start specialising in a particular area have to do that in a public institution. Furthermore, it is too costly to hire foreign specialists, such as in-house specialists and visiting specialists, as the temporary registration fees are too expensive for the hospitals to pay.

To address this issue, private hospitals, through the MPHA, have requested the government to allow physicians from their institutions to receive specialty training without having to leave for the public sector. At the moment few specialisations, such as accident and emergency, are open to private sector physicians to join government training, limiting the chances of private hospitals to keep higher numbers of in-house specialists. Since private nursing schools are not permitted in Myanmar, local hospitals also face a shortage of nurses because all hospitals have to rely on those trained in the public sector. Private hospitals are working together and requesting the government relaxes the rules so that private hospitals can run their own nursing schools.

How will the liberalisation of the insurance sector impact the financing of private hospitals?

AYE AYE SAN: Private hospitals will certainly welcome the liberalisation of the insurance market, since the development of health insurance will provide them with a very important source of financing which they don’t currently have. Running a hospital is extremely costly, but the recent relaxation of trade rules for medical equipment is likely to improve competition and bring prices down. Furthermore, since sanctions were lifted, all technologically advanced medical equipment is now imported from the US, whereas before products from Japan and Europe occupied the market. However, purchasing this equipment is difficult due to poor access to financing. At the moment our largest source of financing is patient payments. The problem is that most of those payments are made out of pocket, meaning that in a low-income society such as Myanmar, patients simply do not have the means to spend a lot of money. Given this, the liberalisation of the insurance market could be a game changer for the health care sector.

Could public-private partnerships (PPPs) help improve the quality of the national health care system?

AYE AYE SAN: Health care is one of the sectors prioritised by the current government and the National Health planning pledges for continuous spending increases in public health until 2030. While increased government spending is necessary to boost the quality of the sector, Myanmar has limited financial resources to develop so many areas of the economy. To overcome the challenge of limited human resources, land and buildings, PPPs can provide an interesting and efficient solution to improve the quality of the health care system. If well designed, PPPs could turn private practices into a good alternative to overloaded public hospitals.