Health inequity on access to services in the ethnic minority regions of Northeastern Myanmar: a cross-sectional study

Abstract

Objectives: To evaluate health inequity on access to services in the ethnic regions of Northeastern Myanmar from three points of analysis: geographic barrier, gender-based disparity and financial burden of health services.

Setting: A multistage-stratified random cluster survey was conducted in Shan State Special Region 2 and Eastern Shan State Special Region 4 of Northeastern Myanmar in 2016, including a total number of 774 households.

Participants: A total number of 4235 participants were recruited during the survey.

Primary and secondary outcome measures: Geographic distance, gender, household income and inpatient/outpatient service utilisation.

Results: The study results showed that residents living within 5 km of any form of healthcare facilities paid more outpatient visits (90.06 visits per thousand population) in the past 2 weeks, compared with those living 5-20 km and over 20 km (54.84 and 54.02 per thousand population, respectively) from healthcare facilities. A similar trend with little significant differences was found for inpatient service use. Regarding household income, adults with an annual household income of above US$720 were more likely to seek outpatient service (OR=1.43, 95% CI 0.98 to 2.10) compared with those with an annual income of <US$360. After adjusting for other covariates, female adults were less likely to seek inpatient treatment (OR=0.55, 95% CI 0.35 to 0.84) and outpatient services (OR=0.86, 95% CI 0.64 to 1.15) than male adults.

Conclusions: Geographic barrier, gender-based disparity and financial burdens were identified as key causes that significantly restrict ethnic people's access to healthcare facilities. The study concludes that tackling health inequity in Northeastern Myanmar ethnic regions requires an improved primary healthcare system, proper financial protection mechanisms and a special focus on women.

Keywords: conflict; ethnic minority; health equity; myanmar.

Figure 1

Average cost for inpatient and outpatient visit in US$.

Figure 2

Adjust means of frequency to inpatient and outpatient service by physical distance*. *Adjusted for age, gender, household income and ethnicity.  SR4, Special Region 4; WA region, Shan State Special Region 2.