Myanmar has an area of 676,577 square kilometres. Administratively, the country is divided into 14 states and divisions. There are 52 districts, 324 townships, 13,762 village-tracts, and 65,235 villages. The population is estimated at 46 million with a growth rate of about 1.87%. About 60% of Myanmar's population is aged between 15 and 59 years. There is a slight preponderance of females over males. The population density is 65 per sq. km, and 75% of the population resides in rural areas. The country's gross domestic product (GDP) was Ks 603,601 million from 1995 to 1996 (with a growth rate of 6.9%). The Government budget allocated in 1995-1996 was Ks 108,511 million for current expenditure and Ks 41,035 million for capital expenditure, amounting to a total of Ks 149,546 million.
Drug financing in public sector
The main source of drug financing in the public sector is government revenue. The budget allocated by the health department for drugs from 1995 to 1996 was Ks 47.20 million. In the National Health Policy, exploring and developing alternative health care financing systems is clearly defined. Some alternative drug financing mechanisms have therefore been adopted and implemented in hospitals and in some townships.
User charges for selected drugs in hospitals
Cost-sharing drug shops are opened in hospitals, with 43 drug items supplied by the Central Medical Stores Depot (CMSD). Drugs are sold at maximum 15% profit margin on the original CMSD price. Among the cash recovered from the drugs, the actual or original CMSD cost of drugs has to be returned to the Government budget. The remaining cash can be used by the respective hospital drug shop for its further development. The total amount of cash recovered from CMSD drugs was Ks 8 million for 1994-1995, Ks 12 million for 1995-1996, and Ks 12 million for 1996-1997.
User charges for essential drugs in project townships
Myanmar Essential Drugs Project (MEDP)
This project was started in 1989, and essential drugs distribution started in 1991, with the assistance of the Finnish Government. A cost-recovery scheme for drugs was introduced in January 1994. The MEDP is now implemented in 86 townships. Total cash recovered so far from 54 townships is Ks 23 million. This recovered cash is used as a revolving drug fund (RDF) for replenishing essential drugs supplies. So far, Ks 13 million have been used for essential drugs replenishment.
Community health management and financing project (CHMF)
With the assistance provided by the Nippon Foundation, and in close collaboration with UNICEF, the implementation of CHMF was started in 1994. Essential drugs were supplied by the Nippon Foundation. Sixty-six townships are now implementing a project whereby patients are charged only for drugs. The total amount of cash recovered from 44 townships so far is Ks 19 million. This recovered cash is used as RDF for replenishing essential drugs supplies. So far, Ks 3 million have been used for drug replenishment.
Drug financing in private sector
There are two sources of drug financing in the private sector.
(a) Private household
A household expenditure survey was conducted in Yangon from March 1978 to January 1979. It found that 2.48% of household expenditure was used for medical care. A similar survey conducted in 1989 showed a result of 2.58%, and a rural survey conducted in 1996 showed a result of 2.23%.
(b) Community contribution
Government health institutions are allowed to accept private donations. Many townships have successfully raised trust funds for the overall development of the institutions, including purchasing drugs.
Main problems in drug financing
The main problems in drug financing in Myanmar include: (1) increasing price of drugs; (2) limited budget allocation for drugs; and (3) slow progress in decentralizing drug financing.
Drug pricing policies and/or mechanisms in the public and private sector
The price of drugs should not be higher than those available on the outside market. The government has exempted 76 essential drugs items from commercial tax and custom duties, so that its citizens can enjoy a proportional reduction in drug prices.