After the 1950s, most of the countries in the Mekong region started to develop their social protection policies. Myanmar started the social security for the formal sector with the Social Security Act in 1954, while Lao PDR and Viet Nam had their first social security initiative implemented in 1975 and Cambodia, in 1979 after their political landscapes had changed. Initially, the formal scheme only covered civil servants and government employees. From the figure below, the public social protection expenditure made by the Vietnamese government is more than 5%, which was highest among the four countries followed by Lao PDR and Cambodia; whereas Myanmar’s expenditure on social protection is the lowest.
Figure: Public social protection expenditure as a percentage of GDP and by guarantee in Asia and Pacific in 2014
Source: ILO Social Protection Department database in Schmitt et al, 2014.
The healthcare component of social protection is highly prioritized by governments and international donors and the four countries have made significant progress in improving their health coverages, in particular low-cost healthcare schemes. Vietnam’s social protection policies are considerably more progressive. The government fully subsidizes health insurance premiums for children under 6, the elderly, and the poor, and partly subsidizes premiums for the near-poor and students. With the involvement of donors and development partners, Myanmar, Cambodia and Lao PDR has set up the Health Equity Fund (HEF) which provides free healthcare services for people in the low-income bracket. In Lao PDR, HEF, created under Lao Curative Law, facilitates access to healthcare services for the poor which offers a safety net against catastrophic health expenditure. For Cambodia, HEF operates through the ID Poor Program that poor households can use the Equity Cards to access a range of services provided, including medical services by the Government and other organizations. In Myanmar, HEF has supported poor patients through public hospitals across the country, with aims of expansion to more areas.
As indicated by the qualitative results, it primarily shows that there are positive effects as well as some challenges from the low-cost health care services/activities in the four countries.
Low-cost health insurance has played a critical role in improving the quality of lives for low-income households. Access to health care services enables those who are struggling to maintain a decent standard of living, to have a better quality of life. Healthcare services are delivered in district and community levels, so it is more accessible for the people who do not live close to hospitals. With the community-based approach, healthcare volunteers have not only carried out door-to-door services in the communities, but also work to share and transfer useful information related to simple self-care practices. In addition, there are several healthcare related activities provided from NGOs and INGOs which target different groups of people.
“The state provides periodical health examinations in(sic) every few months, and now we have our own health station here. They also inform through loudspeakers. Now the commune authority cares about us and send a health station staff to work here, so we are proud of our current living situation. Medicines are available anytime here.”
Woman, Viet Nam
“The project helps to improve the villagers’ health, they vaccinated women and children, provided gravity water supply to the village and taught women how to take care of their health.”
Woman, Lao PDR
On the other hand, the low-cost healthcare coverages are still evidently ineffective in the four countries. The quality and availability of health care in the countries are not only limited by the lack of trained medical staff, but also the poor national coverage of basic health service. As the interview below shows, some patients from Cambodia, Lao PDR and Myanmar did not have good experiences from the services as they felt that they were being discriminated against, by doctors and staff.
“I do not trust the government hospital. I have experience. My nephew had appendicitis. He is really poor and has an ID poor card (health equity fund card). When he reached to hospital the doctor did not pay attention because he is poor. They do not like ID poor people.”
“The community doctor did not pay attention to patients. I want to change the health workers in the health care center if possible. Most villagers work in the farm and buy medicine themselves; no one helps them.”
Woman, Lao PDR
“My opinion is that the doctors don’t care for us (from the refugee camp) as much as they do their outside patients because we have no money. I’m afraid of medical emergencies like abortion or bleeding. There is no doctor or nurse in the camp clinic if emergency cases happen.”
All four countries make serious efforts to develop, and continue to enhance equity access to healthcare coverage for all members of society, especially those in low-income areas. The governments are also aware of challenges that prevent target groups from receiving effective services and treatments. However, our interviews suggest that what appears on paper is not always implemented well, so the services may not be available to the target group as stated.
This study is part of an Empowerment and Security Project, “What is Essential is Invisible’: Empowerment and Security in Economic Projects for Low-Income Women in Four Mekong Countries (Cambodia, Laos, Myanmar, Vietnam)”, and was funded by Australian Aids.
This blog post is published as part of the Ambassador Series, which presents insights into social protection around the world from the viewpoint of our Ambassadors, a group of international online United Nations Volunteers who support the online knowledge exchange activities, networking and promotion of socialprotection.org.
Htet, Soe. (2016). Who benefits from Hospital Equity Fund in Myanmar? (Unpublished Doctoral dissertation). School of Public Health and Preventive Medicine, Monash University, Australia.
Khwon, S. (2011). Health Care Financing in Asia: Key Issues and Challenges. Asia-Pacific Public Health, 23(5), pp. 651-661.
Schmitt, Valerie; Paienjton, Qimti; De, Loveleen. (2014). UNDG Asia-Pacific Social Protection issues brief / ILO Regional Office for Asia and the Pacific; United Nations Development Group Asia-Pacific (UNDG A-P). – Bangkok: ILO, 2014
Cover photo credit: HealthCare Asia (HCA)