Key Takeaways:
Myanmar’s polycrisis has collapsed NCD care through underfunding, health worker shortages, medicine scarcity, and attacks on healthcare.
Existing responses show resilience but remain severely limited by resources and access constraints.
Restoring NCD care requires not only technical health interventions but progress toward peace, stable governance, and intersectoral coordination.
Understanding NCDs
Non-communicable diseases (NCDs) are long-lasting conditions arising from genetic, physiological, environmental, and behavioural factors, driven by modifiable risk factors including tobacco use, physical inactivity, unhealthy diet, and harmful alcohol use. NCDs require long-term management to prevent exacerbation and complications. NCDs are responsible for 74% of all global deaths, and a 2023 WHO report estimated that 25% of deaths among those aged 30 to 70 in Myanmar were NCD-related. Low- and middle-income countries with fragile health systems bear a disproportionate burden, and Myanmar is no exception.
Responses and Their Limitations
State Administration Council (SAC)
Myanmar’s health system comprises public and non-state actors (NSAs), with the public sector delivering around 86% of services. In 2017, the Ministry of Health and Sports adopted the WHO’s Package of Essential NCD (PEN) interventions, integrating screening, treatment, and referral into primary healthcare (PHC). However, the coup accelerated the collapse of Myanmar’s fragile health system, severely weakening PEN and causing Myanmar to miss key NCD targets. Contributing factors include equipment shortages, health worker shortages, frequent medicine stock-outs, and low public awareness, all driving high loss to follow-up, a key challenge for successful implementation.
Despite improved health outcomes and spending over 2010–2020, the junta has since allocated only 2.5% of the union budget to health while committing at least 1,846 incidents of violence against or obstruction of healthcare. Healthcare professionals who lost trust in the junta joined the civil disobedience movement (CDM), withdrawing from public service, a shortage further compounded by the junta’s detention, arrest, and killing of medical professionals, and barring facilities from hiring staff who opposed SAC or forcing them to shut down, with no state effort to address the gap.
Essential medicines are in short supply, available only in select private pharmacies at tripled price, driven by import licensing delays, customs restrictions, and barriers on goods movement. When supplies run out, clinicians rotate to alternative medications, but differing side effects destabilise patients and increase complication risks, creating critical gaps in care continuity. Community clinics could not open for new case-finding, and cancer patients were transferred to private facilities for continued treatment. Compounding this, the junta has denied prisoners access to basic NCD treatment, a violation of fundamental human rights. Security concerns and deep mistrust of the public sector further deter people from seeking care.
National Unity Government (NUG)
The NUG Ministry of Health (MOH) has adopted a decentralised approach, empowering local communities and frontline health workers. Although no NCD-specific data is available, the NUG delivers PHC through on-ground services in governed areas and Telekyanmar, a free telemedicine platform. Since 2021, over 1,000 facilities have been established across 190 townships, and underground, bomb-resistant hospitals are being constructed to protect staff and patients. Telekyanmar reaches 322 townships domestically and users across 50 countries, while health education content is regularly distributed online. To address workforce gaps, the NUG has invested in training, workshops, and volunteer recruitment, with 5,098 healthcare professionals currently serving nationwide.
The MOH has also coordinated with international donors, including joint advocacy with ethnic leaders. International response has been mixed. Most countries have kept engagement informal, while The United States, European Union, and European Parliament have moved closer, recognising the CRPH and NUG as legitimate representatives, and UN organisations have increasingly sought cooperation.
Despite this resilience, NUG health networks face severe constraints. The MOH has limited financial resources due to reduced funding from international donors. In addition, the supply of essential medicines is frequently disrupted because of the SAC’s strict control over medical supply to NUG-governed areas. Facilities in conflict zones are often underground, mobile, or improvised, leaving them vulnerable and limited in reach. Online services are hampered by inconsistent internet access, and workforce shortages persist due to limited clinical training opportunities and the continued killing and arrest of medical professionals.
Non-state Actors (NSAs)
NSAs, including local and international non-governmental organisations (NGOs), civil society organisations (CSOs), ethnic health organisations (EHOs), and private providers, play a significant role in healthcare delivery, particularly in fragile settings. Before the coup, the international community channelled technical and financial support largely, and NGOs supported PEN rollout, with slow but clearly directed progress, until the coup brought it to a halt.
The 2022 Organisation Registration Law has hindered humanitarian operations; hundreds of aid workers have been arrested, and the military restricts and monitors aid delivery. Donors have withdrawn funding to avoid subsidising the military government, suspending or reducing operations, worsened by USAID funding cuts affecting border area populations. Despite this, NSAs have demonstrated adaptive capacity by restoring parallel systems, using informal communication channels, maintaining buffer stocks, and adjusting supply chains and training models. Funding remains the primary constraint.
Patients favour private providers for accessibility, convenience, and the quality of communication and health education they offer. Some clinics serve low- and middle-income households through affordable consultations and free check-ups. However, the high cost of routine tests and specialist care deters some patients from recommended procedures, and access remains considerably low in rural or conflict-affected areas.
The Cost of Being Sick in a Broken State
As a Myanmar proverb goes, “an empty sack cannot stand upright“. Amid displacement and economic hardship, many are forced to prioritise food, shelter, and basic needs over healthcare, a trade-off that accelerates disease progression and undermines long-term wellbeing. Rising NCD costs impede poverty reduction, pushing out-of-pocket expenditure to 71.13%, and those already vulnerable get sicker sooner and die earlier than those in higher socioeconomic positions, creating a compounding cycle where illness deepens poverty and poverty worsens illness. The burden extends to caregivers, most often women and family members, who frequently reduce or leave paid work to provide care. For both patients and caregivers, chronic illness generates stress, anxiety, and depression, all largely unaddressed in a collapsing health system.
The Way Forward
Reforming PHC to integrate NCD prevention and management strengthens health system resilience, reduces costs, and optimises resources. A sustainable community-to-PHC referral system and regular follow-up are essential for medication adherence, and early detection of complications, as demonstrated by home visit programmes in Bhutan.
Community interventions that build health literacy encourage lifestyle changes, routine screening, and treatment adherence. Since most NCD risk factors are modifiable, raising awareness through print, broadcast, and online channels is crucial. Accurate risk perception motivates preventive behaviour, making public awareness a cost-effective entry point in resource-limited settings.
Sustained investment in manpower, supply chains, and technology is required. Uninterrupted medicine and equipment supply must precede PEN expansion. mHealth services, telemedicine, and digital platforms offer viable delivery options, and mobile-based CVD risk assessment tools proven feasible in rural India, could be adapted for Myanmar.
Capacity building for health facility staff should be included within PHC following WHO guidelines. Task-shifting to paramedics and community health workers is critical for high-risk identification, screening, and follow-up. Workforce allocation needs decentralisation to grant state and regional Health Directors greater authority over context-specific decisions. Effective NCD response requires coordinated action across public, private, and non-governmental sectors, spanning health, finance, education, agriculture, and transport.
Increased health spending must be implemented to reduce out-of-pocket expenditure. Aid should flow through multiple channels, prioritising local civil society actors in conflict-affected areas. Maintaining parallel funding streams has proven resilient when one channel fails, and flexibility remains central to effective humanitarian response.
Population-wide policy enforcement is necessary, covering smoking restrictions, health warnings on packaging, alcohol age and time restrictions, and taxation on alcohol, imported sugar, ultra-processed foods, and beverages. Regulating unhealthy food marketing and strengthening food labelling standards are equally critical for reducing modifiable risk factors at scale.
Monitoring NCD trends and risk factors guides policy priorities, making operational and implementation research a critical investment for evidence-based policymaking. Since NCD treatment gaps are deeply intertwined with socioeconomic, governance, and environmental crises, these recommendations can only yield meaningful results alongside progress toward peace and stable governance.
Conclusion
Myanmar’s polycrisis has systematically dismantled the conditions necessary for NCD care to function. Underfunding, attacks on healthcare infrastructure, workforce depletion, medicine shortages, and shrinking humanitarian access have pushed NCD patients further from care, deepening a cycle of poverty, inequality, and preventable suffering. Addressing this burden requires more than technical health interventions; it demands restored governance, sustained financing, community-centred care, cross-sectoral coordination, and a health system rebuilt on equity. Meaningful progress cannot be achieved without peace, yet Myanmar’s NCD patients cannot wait for perfect conditions. Therefore, all relevant stakeholders should take immediate action to address this issue.
Dr. Jeslyn is a Junior Research Fellow at the Sustainability Lab of the Shwetaungthagathu Reform Initiative Centre (SRIc). She holds a Master of Public Health and has experience in research analysis, remote healthcare services, and community outreach programs.
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