A Review on the Healthcare system & Pharmaceutical Market of Myanmar

A report by Shivani Chauhan*

AbstractThis report intends to consolidate the main developments of the pharmaceutical market in Myanmar over the last decade. Even the global pharmaceutical market is decreasing at it pace, pharma-emerging markets keep on being an imposing factor of development; crosswise over Asia, Africa and South America, and these business sectors are gloating a CAGR of 12-17%. Among the APAC Markets, Myanmar is catching the most attention after the Vietnam. With the fruition of parliamentary elections in the March 2016, there are positive signs that the force for change and market progression will quicken. Undoubtedly, Myanmar looks like the beginning of some of today's leading Asian creating markets, for example, Vietnam and Indonesia. However, while understanding the similitudes is certainly valuable, the enticement to merely duplicate entry strategies and market assumptions should be resisted. Myanmar’s underinvested healthcare services, sizeable talent gaps, and noteworthy regulatory and affordability hurdles, require an educated approach, and managed expectations.In the recent years, the demand for healthcare services has risen among the Myanmar populations. The report provides in-depth information on the healthcare medical system along with regulatory & ministry environment of Myanmar.The report also suggest that the market growth will mainly be driven by factors, like changing regulatory environment, increasing disposable incomes, rising prevalence of lifestyle diseases, and significant developments in the field of contract manufacturing, particularly in APIs. The OTC sector in the region has also been expanding rapidly. Keywords: Myanmar healthcare market, emerging markets; healthcare statistics, regulatory & ministry environment, Govt. healthcare structure, Food & Drug control authority, escalating healthcare cost, Health insurance.

*Corresponding Author: Shivani Chauhan. MIET, Meerut U.P., IndiaEmail: shivanichauhan232@gmail.com

Introduction

As Myanmar grasps a market economy, the country is slowly making progress. Gross domestic product and life expectancy have both become relentlessly, with compensations, disposable income and financial open doors all on the rise. For foreign investors, indications of monetary and political change are generating confidence in proceeded growth and market expansion. Undoubtedly, this appears as an impression of being stand out bearing to go upward. However, this development will be organic and prolonged. In healthcare sector, a recorded absence of speculation has resulted in low levels of health personnel and infrastructure with respect to population. This has, in turn, prompted to a significant health burden. As indicated by the World Health Organization, for example, Myanmar suffers some of Asia's highest rates of childhood malnutrition and under-five mortality (56,000 deaths for every year), and high (though improving) maternal mortality (200 for each 100,000 live births).Moreover, from both a social and regulatory perspective, Myanmar is still struggling to embrace the transparency and responsibility that were prominently missing before. Since the country currently ranks high on the Transparency International corruption scale, conservative caution will be important to ensure compliant, and sustainable, business growth.Myanmar's pharmaceutical market will see robust growth over the coming years. A growing economy is a central factor underpinning this trajectory as is the country's gradually improving healthcare infrastructure. In terms of value pharmaceutical market is growing from MMK458bn (USD391mn) in 2015 to MMK525bn (USD409mn) in 2016; +14.6% in local currency terms and +4.5% in US dollar terms whereas healthcare expenditure is also growing from MMK1,608bn (USD1.4bn) in 2015 to MMK1,796bn (USD1.4bn) in 2016; +11.6% in local currency terms and 1.7% in US dollar terms.

Myanmar healthcare and economy

As the economy keeps on developing in Myanmar, one of the areas that has seen a noteworthy upgrade is the healthcare industry. The new government in Myanmar has increased government spending on its medicinal services spending plan. However, the government spending on healthcare is still one of the least in the ASEAN region with an aggregate budget of 5% which is roughly $600 million USD of the government’s budget in 2015 in contrast with 3.9% in 2013. The healthcare sector in Myanmar is likewise open to foreign investments with 70% of foreign ownership now being permitted in hospitals and clinics. Healthcare spending in Myanmar is essentially being paid for by out of pocket (OOP) cost by the general population.

Structure of Myanmar Health Ministry

Myanmar Ministry of Health is the official government healthcare provider in the country. There are also some government ministries that have their own hospitals to provide healthcare services for their staff and families. The Ministry of Industry is responsible for the Myanmar Pharmaceutical Factory which has previously manufactured medicines for use here in Myanmar.

The above committees/departments are very well connected with all the ministries along with the below mentioned societies –

Myanmar Woman’s Affairs Federation Myanmar Maternal & Child Welfare Association Red Cross Society Medical Association Dental Association Nurses Association Health Assistant Association Traditional Medicine Practitioners Association Community Based Organization Faith Based Organization Parent-Teacher Association

Healthcare Facilities in Myanmar

The primary care hospital specialties are located in Yangon and Mandalay. Healthcare facilities situated outside of these two regions of Myanmar are more cut back with hospital station giving basic healthcare services for people living in those rustic locales. The government gives equal opportunity healthcare services in Myanmar paying little heed to ethnicity. In any case, regions which still have some armed civil conflicts such as northern Kachin State, Northern Shan State, Eastern Kayin State, and Southern Mon State don’t have entry to government healthcare providers because of the way that these locales are as of now out with the national governance arrangements. Myanmar practices both modern and traditional medicine practices with no particular remedies confined to a geological locales.

Classification of Myanmar Healthcare servicesPublic Healthcare

Private Healthcare

Healthcare facility location by region in Myanmar

Major specialist hospitals located in Myanmar, including children’s hospitals and women’s hospitals, are located in Yangon & Mandalay. Second level urban communities- capitals of different states and divisions- may have couple of specialist hospitals located in the area. The vast majority of these areas will have general hospitals with specialist services available on location. Townships have hospital sizes (beds) as per their individual township size with very rural areas having station hospitals. Patient care is referred up the healthcare system when esteemed essential, with the most critical cases referred to Yangon where primary healthcare providers are located. Private clinics and pharmacies serve primarily as ambulatory healthcare in Myanmar. The “Township Health System” was introduced in 1964 as part of the healthcare education plan and is now the core of the Myanmar Healthcare System for both promoting and preventive healthcare services.

Traditional healthcare services framework in Myanmar The Myanmar health system still offers traditional herbal medicines alongside modern therapeutic practices, which may come as an amaze to a few. The government supports scientific ways of evaluating the benefits of therapeutic agents while sustaining famous and uncommon medicinal plants. The government additionally bolsters the investigation, sustentation, and propagation of treatises and practices. Altogether there are 14 traditional medicine hospitals worked by the Myanmar government. Traditional medical practitioners are trained at the Institute of Traditional Medicine and now a University of Traditional Medicine has been established for further advancement in this field.

Number of Government Hospitals in Myanmar (2016)

Types of Hospitals NumberTotal Government Hospital 795 HospitalsGovernment Hospital (Above 25 bedded) 366 Hospitals

Figure 1: Showing the number of Govt. hospitals (above 25 bedded)

Number of Doctors in Myanmar (2016)

Number of Doctors in State Service 7652Number of Doctors in Private Practice 13578Total 21230

In the new Capital of Myanmar, Nay Pyi Taw, 1000 bedded General Hospital is providing general medical and special care facilities including cardiology, pulmonary, urology, neurology, gastrointestinal and hepatology. Intensive Care Unit with emergency medical and surgical services are now available to those residing in middle Myanmar.In addition, new five Township hospitals (50 Bedded) are providing curative and public health services in Nay Pyi Taw district. For specialist services, four 500 bedded specialist hospitals such as Central Women Hospital, Children Hospital, Orthopaedic Hospital and Eye, Ear, Nose, Throat Hospital are being planned to be opened in Nay Pyi Taw.Based on religious and social customs, Myanmar people are eager to provide assistance for social works. Local community and private donors have contributed for curative health service in terms of cash or fulfilled hospital needs including medical equipment. The Hospital Management Committees led by local administrative authority and members from related departments are organized and are then making coordinated effort to fulfill needs of the hospitals according to functional requirements. Public hospitals throughout the country are stipulated to raise and establish trust fund and interest earned from these funds are used for supporting poor in accessing needed medicinal supply and diagnostic services where user charges are practiced. By 31st March 2016, 164 Private hospitals (136 General hospitals and 28 Specialist hospitals), 211 Special Clinics and 2910 General Clinics have been licensed to provide quality health care. Myanmar Health Care System is thus strengthened through augmenting the role of private health sector as stated in the National Health Policy to fulfill the public needs.Outreach cataract surgical teams, reconstructive surgery teams and general medical and surgical teams from Eye, ENT hospitals, central, state/regional and 200 bedded hospitals have provided their services throughout the country. The services are free and costs for out-reach services were borne by NGOs and other individual donors.

List of Major Hospitals and Health Care Centers in Yangon, Myanmar

New Yangon General Hospital West Yangon General Hospital People's Hospital (East) Pun Hlaing International Hospital Sakura Medical Centre Shwe Gon Dine Specialist Centre Academy Private Hospital Asia Royal Cardiac & Medical Care Centre Australian Embassy Health Clinic Central Women’s Hospital

Hlaing Thayar General Hospital Home Medicare Service Clinic International SOS Clinic Pacific Medical Centre

International Hospitals in Myanmar

The Pun Hlaing International Hospital

It is the first international hospital in Myanmar. The history of this Hospital starts with the hospital development team from Washington D.C., Singapore and Myanmar. There are over 200 highly dedicated physicians and specialists from Myanmar together with a professional team of nurses and residential medical officers and highly efficient management teams. In addition, overseas doctors in 7 specialties such as cardiology, cardiac surgery, joint replacement surgery, plastic surgery, general surgery, breast and thyroid surgery and eye cataract surgery are regularly practicing their skills to obviate the need for Myanmar patients to travel abroad for medical services and provide the Myanmar medical specialists, opportunities to closely collaborate with their oversea counterparts.

Bangkok Hospital Office, Myanmar

Bangkok Hospital Myanmar Office has been representing JCI-accredited Bangkok Hospital, Thailand since 2002. The office assists those who would like to get medical treatment and health check-ups at Bangkok Hospital, the flagship the Bangkok Hospital Group, the largest private hospital group in Thailand. It arranges a variety of services from basic consultation to facilitating treatment at Bangkok Hospital.

Myanmar Pharmaceutical Market

The country holds only 4 local pharmaceutical production units as the domestic industrial production for all the sectors is in its nascent stages. In sharp contrast, there are 100 odd distributors of foreign drug companies, importing over 5000 kind of allopathic formulations. Inevitably local demand for medicines & health supplements is fed by imports.

For the country’s population of 57 million, per capita expenditure on medical needs is low and access to medical care is difficult in rural/village areas where people have to travel long distances to get treatment and medicines. According to the World Health Organization, 93% of all medical expenses are given by patients themselves since government cover and health insurance have yet to be initiated. Unlike other countries where pharmacies, drug stores and medicine shops are seen around every corner, the number of such medicine outlets in Myanmar is very small. It is customary for all doctors, clinics, polyclinics and hospitals to provide

medicines, and they have their own sources of procurement from a network of preferred distributors. Over 60% of drug sales take place in the two big cities, Yangon and Mandalay.

According to market research agencies the total pharmaceutical expenditure in Myanmar has been growing at 13 -14% per annum, and has increased from USD 391 million in 2015 to USD 409 million in 2016. However, these values are lower than most ASEAN nations including Singapore whose population is one tenth that of Myanmar. Growth prospects with governmental initiatives are high and the market is expected to touch USD 1.12 billion by 2023. However, most of the pharmaceutical products sold come from countries like India, Bangladesh, China, Indonesia, Pakistan, Thailand and Vietnam. Research figures indicate that total pharmaceutical imports accounted for 85% of the drug market and India takes the lead with a strong 40-45% market share. All imported drugs have to be registered and authorized by the FDA that inspects pharmaceutical plants and importers and also tests the quality of drugs. At present, approximately 5000 drug varieties are imported into Myanmar. Major shares of therapy wise segments in Myanmar are Anti Infective, Vitamins, and Analgesics, with the market share of 27%, 31%, and 13% respectively.

Conclusion:

Despite the small size of Myanmar’s pharmaceutical market, Myanmar offers the pharmaceutical companies or drug-makers strong revenue-earning opportunities. Generic and over-the-counter drug companies in particular stand to benefit, as the population’s per capita expenditure on pharmaceuticals and healthcare remains low but set to rise.

References:

1. www.medgadget.com 2. http://www.imshealth.com:90/zh_TW/thought-leadership/asia-pacific-insights/white-papers/myanmar-in-

transition

3. http://www.pharmaceuticalsinsight.com

4. http://www.industry.gov.mm

5. www.bmiresearch.com

Author’s Biography

“Shivani Chauhan is a content marketing professional, who helps to an inbound marketing and sales companies to attract visitors, convert leads, and close customers. Previously, Shivani worked as a product executive for a pharmaceutical company. She graduated with honors in Pharmacology with a dual certification in Brand Management and Creative Writing.”