A Health System on the Brink of Collapse – The Military Coup and Healthcare in Myanmar
By Thet Win Aung, Programme Support for Myanmar
In this blog Thet describes the sustained repression of healthcare professionals and the tragic impact this could have on healthcare provision, now 16 weeks after the coup.
Thet was born and raised in Yangon, Myanmar. Now residing in the East of England, Thet is a member of the Myanmar diaspora community living in the UK. Thet plays a key role in the development of the CGHP’s Myanmar health partnership – CYTIP. He has extensive experience working for local and international NGOs and development agencies based in Yangon.
Just before going to bed around 11 p.m. on 31st January 2021, I received a short message on my phone. The message said: ‘Coup in the Capital, Nay Pyi Taw’. My eyes were wide open in shock, and I felt angry and concerned.
It has been nearly 16 weeks since the coup in Myanmar. Despite thousands of health care workers refusing to work under a military regime and being threatened and arrested, the military has not succeeded in bringing together health care workers to restore health care system. Instead, they continue to arrest health care workers and raid many charity-run clinics across the country.
According to Dr Kyaw Swar, assistant surgeon from government hospital in Kachin State: “The Military Council keeps arresting doctors and nurses, but it is not possible to frighten and put all health care professionals behind the bars.” “Few senior doctors went back due to enormous pressure from military but without junior doctors, hospitals will not be functioning. We have determined not to return to hospitals until National Unity Government comes and governs us.”
Myanmar’s health system has been under-staffed for many decades due to military dictatorships’ mismanagement. Factors such as poor facilities, extremely low incentives, imbalanced doctor-patient ratios and an overall bureaucratic system means freshly graduated doctors decide not to join public service after completing medical school. According to the National Health Plan (2017-2021), there were 1.33 health workers (doctors, nurses, and midwives) per 1,000 people in 2016. This is below the WHO’s recommended threshold of 4.45 per 1,000 population required to achieve Universal Health Coverage. Myanmar is still far from reaching this target.
Due to the COVID-19 pandemic, medical and nursing schools have been closed and the supply of human resources has been interrupted since last year. Approximately 1,800 medical doctors are being trained by four universities every year. But one senior public health doctor reported that less than 40 % of graduates join government service and that is not enough to meet the demand. I am not surprised by his comment because the Ministry of Health announced that there were nearly 1,000 vacant positions across the country and that less than 100 doctors applied in January 2021.
Although the military has arrested many senior medical doctors, including Professor Khin Maung Lwin and Professor Kyaw Min Soe, both of whom have previously visited Cambridge University Hospitals on partnership visits, they are now trying to reopen medical universities as soon as possible. Ko Sithu, a final year medical student from Mandalay said “No way to return to university under this military administration. They killed; they arrested my friends, my juniors, and my seniors. Some of my friends are fleeing to safe areas. I believe other students will refuse to come back to classrooms as well.”
So far, at least 97 health care workers have been arrested and 10 killed after the military coup. Arresting the doctors would be continuing by military but they will not easily knee down in front of the military junta. Pointing guns at doctors and medical students to return to hospitals and medical schools is not the right solution. It will not be successful. Myanmar will be facing a serious shortage of health care professionals that will, in turn, exacerbate an already collapsing health system.
To learn more about our response to the military coup, please read the CGHP Statement.
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