Mr. Tun Khine Oo, 36, lives in the outskirts of Yangon, Myanmar’s hectic but vibrant capital. An hour-long commute through the city’s car jammed streets takes him to the noodle factory where he worked as a bus driver to support his young son and wife for the last 6 years. Thanks to a steady income from the factory, combined with his wife’s earnings as a factory clerk, the small family have just enough to get by.

In 2015, his life changed forever when he was diagnosed with kidney failure. Unaware of the causes or treatment for his condition, he was completely in the dark about what options were available to him or how his life would be affected.

None of us can predict or plan for news like this. This is why the International Labour Organisation (ILO) works to promote and strengthen social health protection systems to ensure that such misfortunes do not tip people’s lives over the edge into poverty.

Following his diagnosis, Tun Khine Oo feared that this would be his fate. The doctors explained to him that his life would now depend on regular dialysis- a costly treatment involving the use of a machine to cleanse his blood.

Despite the high cost of the treatment, his family convinced him to give it a try, aware that this was his only option for survival. The problem was, they had no idea how they would be able to maintain payments for this life saving treatment while continuing to make ends meet.

Health costs prevent millions of people from seeking or getting the care they need. Protecting the right to health means protecting people from financial hardship.

For the father of one, his first few dialysis treatments risked financially crippling him and his family. However, just as his situation was starting to look hopeless, an unexpected development took place- Tun Khine Oo was connected with the Social Security Board (SSB).

Managed by Myanmar’s Ministry of Labour, Immigration and Population, and overseen by a tripartite board of employers, workers and government representatives, the SSB medical scheme provides health insurance to its members, covering outpatient and in-patient care, drugs, maternal care and transportation costs. The scheme is open to workers in regular employment in the formal sector who contribute 2% of their salary to the SSB.

Fortunately, Tun Khin Oo falls under this category. He was informed that, as an SSB member, he was entitled to financial support for his urgently needed dialysis treatment.

Four years on since his life changing diagnosis, Tun Khin Oo now travels to a SSB contracted hospital twice a week to receive dialysis. Costing between 450,000 and 500,000 kyat per month, the treatment amounts roughly to the sum of the bus driver and his wife’s monthly salaries combined.

While this would be an impossible financial burden for the family to bear alone, Tun Khin Oo explains that around half of these costs are now covered by the SSB. In addition, the medicines he needs are now available to him for free.

“I might not be alive today without the SSB scheme” he stresses.

Thanks to the scheme, combined with Tun Khin Oo and his wife’s monthly earnings and the provision of free lunch from their employers, the family are just about able to scrape by.

However, Tun Khin Oo expresses concerns for his family’s future. His 7-year-old son currently lives with his grandparents in the countryside, as they cannot afford to have him live with them in the city. Because of Tun Khin Oo’s illness, he is unable to save any money for the future. Their son’s education is therefore a great worry for him and his wife.

The bus driver also fears for the security of his job. Because of his health, he tires quickly and needs to take frequent breaks. Although he worked for the factory for six years now, he worries about what would happen if his employer ever decided to replace him.

“Because both [my wife and I] are working, we haven’t had to take out a loan yet. But if one of us stops, we will face a lot of difficulties,” he explains.

Despite these concerns for the future, Tun Khin Oo frequently expresses how fortunate he is to have been able to access support for his treatment, and he urges any workers in a position to do so to utilise their right to register as a member of the SSB.

‘I would like to encourage every worker to become a registered member of the Social Security Board like me’ he says with conviction.

Currently in Myanmar, about 1,400,000 employees (equal to around 2.5% of population) from about 34,000 establishments are covered by SSB health insurance, 2,000 of which are voluntarily registered. Free care is provided to members at SSB run facilities, which include 96 clinics, 3 Worker’s Hospitals, 58 enterprise clinics and mobile medical units. When treatments or services at SSB clinics are not available, as is the case for Tun Khin Oo’s dialysis, care is provided at a number of contracted private clinics and hospitals across the country.

Unfortunately, for the many workers in informal employment across the country, SSB membership is not an option. These workers either rely on the limited tax funded services available free of charge at public health facilities, or, as is often the case, they have to pay for private health care.

As a result of limited coverage and low Government spending on health, 74% of current health expenditures in Myanmar are comprised of out of pocket spending by households, which remains the dominant source of financing for healthcare (source: GHED, 2016).

While there is clearly still a long way to go before Universal Health Coverage is achieved in Myanmar, the country has come a long way in a short space of time, with reforms underway to ensure that situations like the one faced by Tun Khin Oo and his family do not lead to bankruptcy and poverty.

Under Myanmar’s Sustainable Development Plan 2018-2030, the National Health Plan 2017-2021 aims to strengthen the country’s health system and move towards universal health coverage by 2030 in a pro-poor fashion. The government hopes to achieve this by extending access to an essential package of health services to the entire population while increasing financial protection.

To ensure that this important goal is achieved, the ILO has been supporting the development of a more comprehensive and equitable social protection system in Myanmar through promoting effective implementation of the country’s Social Security Law 2012 and the establishment of nationally defined social protection floors.

As part of these efforts, the Grand Duchy of Luxembourg funded ILO project, “Support to the extension of Social Health Protection in South-East-Asia” has been providing technical expertise to Myanmar’s SSB medical scheme. A key objective of the project’s efforts in this area is to extend population coverage of the SSB medical scheme, expand and enhance services provided and strengthen financial protection for SSB members.

Tun Khine Oo’s story illustrates both the possibilities and current limitations of the scheme. Without access to the benefits of SSB membership, Tun Khin Oo and his family would not have been able to cope with the financial burden of his illness. At the same time, his precarious financial situation illuminates the remaining gaps that need to be addressed within Myanmar’s health care system.

As well as strengthening financial protection for current SSB members like Tun Khin Oo, it is crucial to expand coverage to those without access to formal employment. With ILO’s support, Myanmar is working towards a point at which such goals can be made a reality.