Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis

Background Universal health coverage (UHC) encompasses 2 main components: access to essential healthcare services and protection from financial hardship when using healthcare. This study examines Myanmar’s efforts to achieve UHC on a national and subnational level. It is a primer of studying the concept of UHC on a subnational level, and it also establishes a baseline for assessing future progress toward reaching UHC in Myanmar. Methods and findings The study uses the Demographic and Health Survey (2015) and the Myanmar Living Conditions Survey (MLCS; 2017) and adapts a previously developed UHC index to provide insights into the main barriers preventing the country’s progress toward UHC. We find a negative correlation between the UHC index and the state/region poverty levels. The equity of access analysis reveals significant pro-rich inequity in access to all essential healthcare services. Socioeconomic status and limited availability of healthcare infrastructure are the main driving forces behind the unequal access to interventions that are crucial to achieving UHC by 2030. Finally, financial risk protection analysis shows that the poor are less likely to use healthcare services, and, once they do, they are at a greater risk of suffering financial catastrophe. Limitations of this study revolve around its correlational, rather than causal, nature. Conclusions We suggest a 2-pronged approach to help Myanmar achieve UHC: Government and state authorities should reduce the financial burden of seeking healthcare, and, coupled with this, significant investment in and expansion of health infrastructure and the health workforce should be made, particularly in the poorer and more remote states. Zlatko Nikoloski and colleagues provide analytical insight into Myanmar’s efforts to achieve universal health coverage on a national and sub-national level. Author summary Why was this study done? The UN Sustainable Development Goal (SDG) 3 encompasses achieving universal health coverage (UHC), including financial risk protection, access to quality healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. More specifically, SDG Target 3.8 stipulates achieving UHC, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. While to date, cross-country progress toward UHC has been gauged by constructing indices, to the best of our knowledge, no such index has been constructed on a subnational level, particularly in the context of a large and heterogeneous country such as Myanmar. What did the researchers do and find? We adapt a previously developed UHC index, and we apply it to the context of Myanmar while using the most recent nationally and subnationally representative data. Our analysis yields robust links between socioeconomic development and UHC at subnational level in Myanmar. More importantly, our analysis also suggests significant pro-rich inequities in access to essential healthcare services, which are driven by both wealth and availability of healthcare. Finally, we find robust evidence that the poor, in addition to having a more limited access to healthcare, are more likely to spend higher share of their domestic budgets on healthcare, thus having a greater risk of suffering a financial catastrophe. What do these findings mean? There is a significant heterogeneity in UHC progress in Myanmar broadly reflecting socioeconomic disparities across states and regions. Progress toward UHC could be achieved by investing in healthcare as well as by adopting protective measures that would reduce the financial burden of seeking healthcare. Our results could provide a benchmark for assessing Myanmar’s efforts toward UHC, particularly given the uncertainties with the recent political turmoil