Who benefits from hospital equity fund in Myanmar?

Open Access

Abstract

Although Myanmar has committed itself to achieving Universal Health Coverage (UHC), with public spending on health of less than 1% of GDP, poor households face serious problems accessing healthcare services in Myanmar. Partly to address these concerns, in 2012 the Ministry of Health together with GAVI introduced the Hospital Equity Fund (HEF) project. The program was introduced in 20 townships/districts in 2012, gradually expanding to cover 180 townships by end of 2015. The goal of HEF was to increase the inpatient care access of the poor via targeted financial support for specific inpatient care needs. The effectiveness of the targeting strategy under the HEF project in reaching the poor was assessed. Data were collected in 2014 for 2 townships where HEF had been launched in 2012, using a household survey (204 households) and focus group discussions and in depth interviews among local government officials, health staff at the village level, NGO representatives and managers of HEF. Information on socioeconomic status, healthcare use, possession and knowledge of HEF memberships, HEF benefits received and administrative processes governing HEF was collected in each township. In a population segment that was mostly poor, 77% of the surveyed households had not heard of HEF. Among those that had, only one-half knew about the benefits available under HEF. Remarkably, only 1.7 % actually possessed an HEF card; and only 25% of hospitalized cases received HEF benefits. Bottlenecks in HEF fund transfers across government departments further restricted access to poor patients. Little staff effort went into disseminating information about HEF in local communities, as no budgetary allocations were available for this. Although HEF increased hospital use and lowered the financial burden for some households, poor targeting meant that needs of the poor were not well served in the two townships.