Making NCD Care Affordable: “It got so bad I had to have my leg amputated.”

Despite high mortality rates, non-communicable diseases like diabetes, hypertension, and cardiovascular disease are often neglected in Myanmar due to low levels of public awareness and concerns about long-term treatment costs. We visit a clinic in Yangon supported by Community Partners International, which offers affordable treatment solutions to low and middle-income households.

“I didn’t know I was ill.”

“Three years ago, I had severe headaches and lost consciousness,” recounts Daw Thwin, 67, who lives in South Dagon Township in Yangon, Myanmar’s commercial capital. “I went to a private clinic, and they diagnosed me with hypertension and diabetes,” she continues. “Until that point, I didn’t know I was ill.” Daw Thwin’s husband, 72, was also diagnosed with hypertension and diabetes, as well as kidney disease.

Daw Thwin’s situation is common in Myanmar, where non-communicable diseases (NCDs) are estimated to account for two out of every three deaths.

“Almost every household in the country is affected by at least one type of non-communicable disease,” reveals Dr. Win, a physician at the Nae Thit Kyan Mar (“New Day Health”) clinic in South Dagon. “I have hypertension,” he shares, “and both of my parents suffer from hypertension and heart disease.”

New Day Health receives support from Community Partners International (CPI) to provide affordable primary health care to low and middle-income households in peri-urban areas of Yangon. Their clinics’ services include NCD prevention, diagnosis, and treatment.

“The New Day Health clinic offers treatment at affordable prices.”

“In our culture, many people don’t maintain a healthy diet and lifestyle,” continues Dr. Win. “There’s a preference for sweet, fatty, and salty foods, which worsens the problem. This lack of a healthy lifestyle can significantly increase the incidence of NCDs in the community.”

The clinic operates as a social enterprise and keeps treatment affordable thanks to a cost-share model in which patients and donors share the cost of treatment. Care is provided free of charge for those without the means to pay.

The clinic is a lifeline for Daw Thwin and her husband, who no longer work and rely on their daughter for survival. “Our daughter is our main support,” she confirms. “She’s a small trader, and her hard work sustains us. We have four children, but the others can’t help as they’re also struggling.”

“Long-term treatment at a private clinic isn’t financially possible for us,” Daw Thwin continues. “The New Day Health clinic offers treatment at affordable prices. That’s why we chose it, and we have been coming for three years now.”

“We visit the clinic once every 45 days,” Daw Thwin confirms. “‘They check on us and provide medicine for the next 45 days. We can buy medicines for diabetes and hypertension at affordable prices. Sometimes, they provide check-ups free of charge.”

“I lost a leg because I didn’t follow the clinic’s advice.”

For U Aung Min, 44, another patient at the clinic, the impacts of NCDs have been more severe. “Twelve years ago, the clinic treated me for free for TB,” he explains. “At the time, I felt dizzy. The doctor recommended a diabetes test, and the results were positive. Two years later, I was diagnosed with hypertension.”

“To be honest, I didn’t follow the lifestyle changes recommended by the clinic,” he reveals. “In 2021, the clinic closed temporarily. When it re-opened, I didn’t go back for two years. A small wound on my foot wouldn’t heal properly. Eventually, it got so bad I had to have my leg amputated. I lost a leg because I didn’t follow the clinic’s advice.”

U Aung Min’s health issues and disability mean he can’t work. “I live with my sister’s family,” he confirms. “I rely on my sister and nephews for living and medical expenses.”

As Myanmar’s economy deteriorates, pushing nearly half the population below the national poverty line, keeping health services affordable is a constant challenge, particularly with rising inflation.

“As of June 2024, about 400 patients have enrolled for NCD services at our clinic,” reveals Dr. Win. “More patients are coming to us because private pharmacies have become more expensive due to the country’s situation. We are trying to stabilize prices and minimize drug shortages to the best of our ability.”

“We plan to introduce a subscription model to broaden affordable access to NCD diagnosis and treatment,” Dr. Win continues. “For example, patients could pay an affordable monthly subscription and enjoy unlimited health care services at the clinic.”

For now, patients like Daw Thwin and U Aung Min continue to rely on their affordable model of care.

“If we had to go to a private clinic, we wouldn’t be able to sustain long-term treatment,” confirms Daw Thwin. “The clinic staff are very kind and helpful and provide excellent care. I feel better now – no dizziness or other symptoms. I take medicine regularly and avoid sweets and salty food.”

“Losing a leg was a big shock,” reveals U Aung Min. “Now, I’m committed to following the clinic’s advice. I eat healthier food and take better care of myself. The staff are professional, careful, and patient. They help me manage and treat my illnesses. If I went to a private clinic, I wouldn’t be able to afford it.”