Image: A patient has their blood sugar level tested at Nae Thit Kyan Mar’s clinic in Amarapura, Myanmar. (Aye Pyae Sone/CPI)
When the March 2025 earthquake hit central Myanmar, mobile health teams from Nae Thit Kyan Mar, or New Day Health, went into Amarapura and other quake-affected communities near Mandalay. The Myanmar social enterprise was one of several partners Community Partners International (CPI) supported on the ground. Those teams treated injuries and acute illness. They also screened and treated people for diabetes and high blood pressure.
Emergency response is short-term by definition. Funding windows are fixed, mandates are narrow, and teams withdraw once the acute phase closes. But CPI and Nae Thit Kyan Mar approached it differently. Alongside urgent medical needs, the teams identified deeper community health care gaps that would outlast the emergency.
Over the following year, they recorded more than 10,000 visits related to non-communicable diseases (NCDs), most involving diabetes or hypertension. Both conditions need treatment for life. The mobile care teams could not provide that, but they built a foundation of trust that could support future activities.
Those mobile teams could hand out medicine. But they couldn’t offer the deeper care that NCD patients need: regular clinical and laboratory monitoring, adjusting treatment when results change, adherence support, structured education in self-care, watching for complications, and continuity with the same care team over years.
Nae Thit Kyan Mar noticed something revealing during that period. Many people treated receiving medicine as though it were the same thing as receiving care for their condition. That assumption makes sense where medicine is the only thing on offer. Still, it leaves patients managing a lifelong illness without the monitoring or the knowledge to do it well.
That gap, rather than the number of people living with diabetes, is what made Amarapura the place to try something. Demand was already clear from the response. What the community lacked was continuity, monitoring and the support to manage a condition day to day.
NCDs account for roughly two out of every three deaths in Myanmar, according to World Health Organization country data. Nationally, the 2014 WHO STEPS survey of Myanmar put adult hypertension at about 26.4% and diabetes at 10.5%. Yet awareness stays low, and treatment costs deter people from starting at all.
Dr. Hein Htet Aung coordinates programs and partnerships at Nae Thit Kyan Mar, which now runs the NCD service. He describes a widespread assumption that pills alone will do the job. “There is a common misconception that age-related diseases are simply a part of growing older,” he says. Some patients only seek medicine once symptoms worsen. “By that point, damage to their internal organs may have already occurred,” he adds.
Cost accounts for much of the rest. Nae Thit Kyan Mar surveyed households in Amarapura before opening. “During our assessment, we discovered that most patients did not purchase a month’s worth of medication. Instead, they typically bought only a single card of 10 tablets at a time,” Dr. Hein Htet Aung says. Patients were buying their treatment in fragments, whenever cash allowed.
This is what happens when a country has no functioning health insurance system. Myanmar has no meaningful risk pooling for households like these. Public facilities are often unavailable, and where they do operate, patients still meet costs out of pocket. Private clinics charge more.
For chronic diseases, the lack of sustained and appropriate care can have real consequences, as health impacts accumulate quietly in the background.
Strategic purchasing is a procurement model traditionally used by governments to purchase health services on the basis of performance and population health needs. It involves making deliberate decisions about what services to buy, from whom, and how to pay for them.
For example, a government may negotiate service packages for specific NCDs with private healthcare providers, and then purchase them in bulk for their national health service. This enables the government to commission services at scale and at an agreed cost, scope and quality outside of their own care infrastructure to affordably meet evolving population health needs.
CPI started investigating this model for decentralized community-based health care delivery more than a decade ago. The motivation was to give local organizations serving poverty- and conflict-affected communities control and flexibility in health service delivery and increase quality and efficiency.
In place of rigid and bureaucratic traditional grant mechanisms, this model enabled CPI and partners to identify the cost of delivering agreed service packages to predefined populations. The partners then had complete freedom to manage service delivery, and adapt to the changing circumstances on the ground. Instead of detailed expenditure and narrative reports, measurement is simple: verification through service provision data and independent monitoring.
In Amarapura, CPI and Nae Thit Kyan Mar are using a strategic purchasing model for the delivery of NCD care to earthquake survivors.
Back in Amarapura, Nae Thit Kyan Mar developed an NCD care subscription package called, in Burmese, “Cho Pyone”. The first offer asked for about 30,000 kyats a month, covering medication, equipment, service fees and consultations.
“We did not receive a single registration,” Dr. Hein Htet Aung says.
So the team went back out. They visited wards individually, worked through community groups and ran further outreach. Then they cut the price. “Ultimately, we decided to reduce the NCD patient co-payment to 10,000 kyats per month,” he says. Registrations began to come in, accelerated by word of mouth as people started seeing the results.
Free care was not a sustainable option. The cost of a monthly package starts at 50,000 kyats, so patients initially paid a fifth and CPI covered the remaining 80% through a strategic purchasing agreement. Cost-sharing on those terms does two things at once. It puts the price below what most local alternatives charge and builds a revenue line to improve sustainability.
“We chose to implement this co-payment to ensure that patients are committed to lifelong treatment for their condition,” Dr. Hein Htet Aung says.
Patients tend to compare the figure to what they paid before. U Aung*, 54, has lived with diabetes for around 15 years. “To be honest, the amount I paid for the package was less than the consultation fee for any specialist or general practitioner,” he says. Before enrolling, single visits cost him “40,000 to 50,000 kyats per visit,” with tests on top.
Closing the gap between medicine and management is what the package was designed to test, so it covers considerably more than a month of pills. Patients receive eight essential medicines for diabetes and hypertension, drawn from Nae Thit Kyan Mar’s pharmacy network. They also get digital blood glucose meters, test strips and blood pressure monitors, plus 11 laboratory tests including ECGs.
The package also includes telehealth components to bring care closer to service users. Patients can access consultations with doctors online, saving them a journey to a clinic. Each patient is assigned a Patient Journey Partner who handles questions through a Viber channel between appointments and helps set up telehealth consultations between patients and doctors.
“Through our Viber channel, we monitor patients’ conditions at night, although we cannot commit to handling acute or emergency situations,” Dr. Hein Htet Aung says. Patients also send in their own readings. “We can communicate through a Viber channel to send our diabetes test results and blood pressure readings regularly,” U Aung says.
Daw May*, 73, had known she had diabetes since she was 50. Monitoring was never possible. “I did not have any testing equipment at home, so I was unable to monitor my blood sugar levels,” she says. Medication came and went with her finances. “I would purchase it when I had money and go without it when I didn’t,” she says.
She came to the clinic and staff enrolled her as the last patient in the first treatment group. She now measures her own readings twice a day. “Since I can’t write, I memorize the readings and ask someone else to record them in my medical records,” she says. What she notices most is not her readings but her mobility. “The most significant improvement is my mobility. I can walk much easier than before.”
Daw Aye*, 63, sold beef soup as a street vendor with her husband until he died. Her diagnosis came after a bout of illness she blamed on mangoes. Her first reaction was not fear. “I felt somewhat relieved to have diabetes, thinking that having the illness would help me lose weight, as I had seen others with diabetes lose weight,” she says. The weight loss never came, and in time she grew breathless and began using a walking stick.
Her medicines had been costing 70,000 to 80,000 kyats a month, pieced together from her sister, her children and whatever pocket money came her way. Six months into the package, she describes a straightforward change. “I can now walk to the clinic without assistance, whereas before I needed a cane,” she says.
U Aung found his own diagnosis through folk knowledge. “When I tested my urine and found it sweet, I suspected I had diabetes and visited a clinic, where I discovered my blood sugar was over 500,” he says. He was 39.
Fifteen years later, he trades for a living and cannot ride his motorcycle due to problems with his arms and shoulders caused by diabetes. Income has been thin since the earthquake. He has borrowed at interest and sold belongings as collateral. His diabetes, though, is finally steady, because he checks his own readings each morning and again two hours after eating.
Nae Thit Kyan Mar capped enrollment in the first phase of the program at 180 people. Dr. Hein Htet Aung is explicit about the trade-off. A thinner package with fewer consultations would reach more people. “We prioritize the quality of care,” he says. Selection weighs affordability, diabetes status, occupation, household size and breadwinner income, benchmarked against a 2023 survey of household expenditure.
A small number of patients dropped out, mostly over medication side effects, and Patient Journey Partners followed up with each one. Several returned.
The subscription has since risen. To strengthen the program’s financial footing, Nae Thit Kyan Mar doubled the fee for enrolled members to 20,000 kyats a month.
The response is the part worth pausing on. Nobody left. Every existing member absorbed the doubling and stayed.
Nae Thit Kyan Mar recently opened a second registration window with an additional 180 spaces and a subscription fee of 40,000 kyats. Thirty-five patients have already joined.
Set that against the beginning, when not one person would pay 30,000 kyats for the same package. What changed is that the package is no longer an unproven proposition. Patients have seen what regular monitoring, laboratory work and a Patient Journey Partner actually do, and they have decided it is worth the money.
The comparison patients themselves make helps explain it. Even at 40,000 kyats, a month of comprehensive care costs roughly what U Aung once paid for a single specialist consultation, before any tests were added.
None of this means affordability has stopped mattering. A higher fee will exclude people that the lower one did not, and the program still depends on the strategic purchasing agreement to hold the price below local alternatives. But willingness to pay more for the same service tells you something the original price experiment could not. It points to growing trust, and to a community coming to understand that managing a chronic condition takes more than a monthly supply of tablets.
With more than three-quarters of Myanmar’s population living below or near the poverty line, the monthly subscription fee remains out of reach for some.
Daw May makes that plain. She has no home of her own and lives with neighbors who took her in. Even the original fee was beyond her. “So, I reached out to my neighbor for help in contributing some money for my treatment,” she says. Her enrollment depends on other people’s generosity, month after month.
She also saw who was getting left out. “I also share this information with others who have diabetes, but some of them cannot afford the 10,000 kyats per month,” she says.
Daw Aye faces a different challenge. After a recent blood test, her doctor prescribed additional medicines costing more than 50,000 kyats, outside the package. “I informed them that I would return later when I had saved enough money,” she says. Her core treatment continues while the rest waits.
Patients who cannot afford the subscription fees are not simply turned away. Amarapura has a small number of charitable NCD service points offering free consultations and basic medicines, and these remain a real option. Their limits are also real. Diabetes treatment there runs largely to basic agents such as metformin and gliclazide, which will not control every patient’s condition, and comprehensive follow-up is thin.
Since July 2026, people outside the subscription can also use Nae Thit Kyan Mar’s Amarapura clinic on an out-of-pocket basis and, in some cases, can receive free care. Nae Thit Kyan Mar is candid that none of this closes the affordability gap, and a future subsidy or cross-subsidy arrangement is where they see the answer lying.
This is the honest arithmetic of chronic disease in a low-income community. Any price is a barrier when incomes are irregular and shrinking. The key question is practical. Given that some contribution keeps the service alive, how low can it go, and how many people can it reach?
Patients worry about how long Nae Thit Kyan Mar’s subsidized NCD care subscription service will last.
“We need to continue taking diabetes medication for life, but we simply cannot afford it,” U Aung says. Daw Aye has the same concern.
Some of that fear should now ease, because the project runs to December 2027. The underlying question stays open, and it is getting harder rather than easier. Global aid and health financing are being cut sharply, so models that depend entirely on external funding are vulnerable.
That is the argument for cost-sharing, and the fee increase is that argument being tested in practice. It is an ongoing effort to balance sustainability and affordability. As patients cover more of the cost, the service gains a foundation that full subsidy cannot give it. It will never cover everyone, and it does not pretend to. But it stands a better chance of still being there in five years, which is an important consideration for lifelong conditions.
CPI supported Nae Thit Kyan Mar to establish the Amarapura site, which opened as a pharmacy. In July 2026, the team was granted a clinic license, so it can now offer consultations for acute and primary care alongside NCD treatment.
A parallel model already runs in Yangon. “With the strategic purchasing package provided by CPI in Yangon, we can offer a primary healthcare (PHC) service package that includes a complete set of doctor consultations and medications for just 7,000 kyats,” Dr. Hein Htet Aung says. His team wants to bring that to Amarapura too, and the new license is what makes it possible.
Strategic purchasing is usually a tool of national health systems, not community-based programs. CPI’s experience in Amarapura and other parts of Myanmar shows that it can work at a smaller scale too.
Community Partners International (CPI) strengthens, equips and connects local organizations in Myanmar, Bangladesh and Thailand providing health, humanitarian relief and well-being services to conflict- and poverty-affected communities.
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