Social health protection

Social Security Board Reforms Enhance and Extend Health Protection in Myanmar

Myanmar’s Social Security Board (SSB), which provides social health protection for formal workers, is implementing a series of reforms to address coverage gaps and implementation barriers, with a goal of achieving Universal Health Coverage by 2030.

Article | 13 February 2020
Political transformations in Myanmar have catalysed far-reaching reforms of domestic social policies. In particular, the Social Security Law underwent significant reforms in 2012, which initiated vast improvements to the country’s social health protection system. However, many challenges remain, which the Government is addressing through the progressive implementation of a series of administrative, legal and technical reforms.

These reforms are expected to prompt notable progress. Currently, out of pocket health expenditure in the country is among the highest in the region, accounting for an estimated 74 percent of total health spending (GHED, 2016). This results in significant access barriers for those without the financial means to pay for medical treatment.

In recognition that health care is a human right, the International Labour Organisation (ILO) is working against such disparities by ensuring that strong health protection systems are in place around the world.

In Myanmar, health protection is administered through the Social Security Board (SSB), which is managed by the Ministry of Labour, Immigration and Population, with representation from employers, workers and government stakeholders. The SSB scheme is contributory, financed by 2% of members’ monthly salaries, along with a 3% contribution from employers. Membership is open to all formal sector workers in registered enterprises with 5 employees or more.

Contributing members receive income security in cases of sickness, maternity, death of a breadwinner, or work related injury or disability. In addition, members can access health care free of charge at SSB facilities, which include 3 Worker’s Hospitals, 96 clinics, 58 enterprise clinics and several mobile units across the country.

To date, 1,450,000 workers from around 34,000 establishments are covered by the SSB medical scheme, 4,000 of which are voluntarily registered. This amounts to only 2.5% of population.

For many of its beneficiaries, this vital protection has proven life changing. However, gaps and implementation challenges persist. Most notably, SSB membership is currently limited to the formal sector, and only covers 116 of Myanmar’s 330 townships. As such, much of the population remains unprotected against catastrophic health expenditures.

Those without access to a regular income from formal employment are reliant on the few services available free of charge at public health facilities. When patients’ needs exceed these services, out of pocket payments for private health care are necessary. As a result, many are unable to access the treatment they need.

In addition to the scheme’s coverage gaps, the SSB currently faces a number of implementation challenges. Procedures and administration of claims and payments require significant improvements, and the scheme’s reliance on a paper based information system limits the effectiveness of compensation, which decreases members’ trust in the system. Furthermore, ILO research has shown that workers are often unaware of their entitlements as contributors to the SSB. This results in low levels of protection for workers.

In order to overcome these obstacles, the ILO has been working alongside the government to extend population coverage of the SSB and strengthen the provision of financial protection and services. Currently, the ILO is implementing the Grand Duchy of Luxembourg funded regional project, “Support to the extension of Social Health Protection in South-East-Asia”. The project’s interventions in Myanmar aim to support the SSB to improve the management and administration of health insurance; build the capacity of national stakeholders in the field of social health protection and provide evidence based policy recommendations.

To this end, the ILO Luxembourg project is assisting efforts to significantly modernise SSB administration. With support from the project, a new information management system is being implemented and data on SSB members is being digitalized. Alongside these interventions, a major administration reform is currently underway to streamline and simplify SSB procedures so that members can access benefits more easily. Additionally, the project is collaborating with Vision Zero Fund to support the development of a comprehensive Monitoring and Evaluation framework for Employment Injury Insurance and Health Insurance.

In tandem with administrative reforms, efforts to extend population coverage are ongoing. An actuarial analysis is currently being led by ILO experts to assess the feasibility of extending SSB coverage to members’ dependents. To enhance provision in line with expansion, the network of SSB health facilities available is being expanded.

To fill remaining infrastructural gaps at SSB facilities, the project has supported the process of contracting private facilities. This means that treatment under the scheme is now available at a number of private clinics and hospitals across the country. The pilot phase of this process yielded promising results, facilitating increased utilization of services in a cost-controlled manner. This is achieved through capitation- a health care payment system designed to lower high treatment costs for patients by setting fixed payment amounts.

The Government recognizes that sustainable development cannot be achieved without breaking down access barriers to health care. Such barriers perpetuate cycles of poverty for families, communities and for the nation as a whole.

Although there are remaining obstacles to be overcome, the Government is committed to advancing towards UHC by 2030 along a pro-poor trajectory. There is no single path to UHC, but all journeys begin with a bold commitment to equity, non-discrimination and the right to health. The ILO will continue to accompany Myanmar along its own course, until the entire population is able to access healthcare without financial hardship.