Health Outcome Indicator To Measure The Developmental Status Of A Population

Though economy plays a key role in measuring the developmental status of a population, the data contributed by health sector and education is making it more comprehensive. When it comes to calculation of a country’s GDP (Gross Domestic Product) too, it is also mandatory to account health expenditure into the process to analyze not only the healthcare system but also the situation of a country as well.

We can see, from these, that health information is as important as other indicators for classifying the developmental level of a country. Therefore, lower to middle-income countries are struggling in order to improve their health system which, in turn, will enhance citizen’s well-being. Usually, they are relying on the financial support from international communities where the sustainability seems clouded. Myanmar, as one of the lower to middle-income countries, is facing the same situation too. According to Human Development Index Reports by UNDP, the country ranked at 148 among 189 countries. In regard to the information extracted from National Health Accounts in World Health Organization, it can infer that most of the budget for the country’s health sector is coming from external funding. Besides, Myanmar also placed in second behind Thailand with the highest number of HIV infected population in the South East Asia Region. The government has been endeavoring this issue with the support from international communities both in cash and in-kind since the disease was discovered in a country 30 years ago, however, the trend of the prevalence is still uprising eventually.

Also, the treatment coverage rate is 66% among the estimated 220,000 patients. Despite the significant increment in coverage in 2015 when the government set up many treatment initiation centers and decentralized sites, the rise in 2017 is not so satisfied by comparing to 2015. Thus, the country needs to prioritize in addressing the pitfalls to that issue in order to meet the 90-90-90 target by UNAIDS in 2020. Furthermore, it will be also feasible and easier to monitor the progress as well with the existence of baseline data.

Several obstacles and challenges are diagnosed related to low coverage. One of them is accessibility to treatment initiation centers where the push factors are socio-economic issues, inadequate knowledge, and quality of care. The presence of discrimination and stigmatization; especially for high-risk groups like female sex workers, men who have sex with men and injecting drug users; is preventing patients from going to treatment facilities. Even the nature of themselves is hidden population. Lack of legalization and decriminalizing is also another factor hesitating them to go for a regular checkup and follow up. Additionally, difficulty in transportation is also one of the causes due to a poor economic status where patients cannot afford to travel to healthcare facilities. From my previous working experience in Doctors without borders (MSF – H), newly HIV infected patients from Mabein township in Northern Shan State were unable to go to ART initiation center in Mogok for receiving treatment. Poverty is one of the reasons whereas they have to stay there for at least 2 weeks to be initiated on treatment until all the investigations had been done unless they can manage for frequent follow up. This is where accommodation becomes challenging for them as well. Therefore, we advocated for upgrading the ART decentralized site in Mongmit which is located nearby them. However, the promise from township medical officer was vague by that time because of the bureaucratic process.

Based on the report from the Demographic and Health survey conducted in 2015-2016, there seems to be less problem with the health-seeking behavior of the patients. Because it has reported that 92% of the respondents are aware of nature of HIV/AIDS while the assumption can be the presence of the problem in quality of care related to the attitude of healthcare personnel. For tackling the above issues, parallel advocacy needs to be done such as promoting and enhancing legalization and decriminalizing where the mechanism will be slow and time-consuming to become legitimate. Besides that, the more logical ways forward are strengthening health education via different dimensions such as mass media education, distribution of IEC materials, awareness campaign, making a good use of social media to share the knowledge and information in order to abolish the community’s perception on discrimination and stigmatization. Creating an income generation initiative is also another suitable way as well. On top of that, establishing available treatment centers towards population through upgrading the existing health posts is way more cost-effective and practical than constructing new facilities as well as recruiting new healthcare works which take a longer process. Because a major portion of the expense for the health sector is contributed by external funding institutions and that money are mainly used for service delivery. For the administrative department, there is a budget constraint for raising the salary to motivate the staff as domestic finance is originated from taxes and natural resources were mostly allocated to the military department due to civil war. For this reason, it can’t be an impetus to escalate the coverage. So, the most feasible and effective way of optimizing the treatment coverage without deteriorating the morals of the employee is adapting the differentiated model of care in both parties.

From the aspect of the health sector, implementing task shifting does have a positive impact. While decentralization diminishes the accumulation of patients in treatment initiation centers, task shifting reduces the workload of healthcare professions seeing stable patients so that they can have more time to consult the sickest ones as well as absorb new patients more. To deal with manpower shortage vs workloads in ART decentralized sites is mobilization and strengthening PLHIV group assisting the sites as well as practicing community-based model anti-retroviral therapy in order to share and minimize the additional workload in decentralized sites too. In order to reach our goal, overall, it is required to explore the available system or technique to confront with the health-related dilemmas from external sources apart from our own ideas and creativity. It is also worthy to learn from other countries with similar context had conquered the same predicaments as ours so that we can determine its adaptability to our nation too. Moreover, this community-based model of care is also written in National Strategic Plan for HIV/AIDS, then it shows that there is an interest among the central government leaving a reformer easier to convince them for a change as well as implement in the field level.