Gaps between rural and urban health in Myanmar

There is a clear and persistent gap between rural and urban health care, particularly in access to services, workforce availability, and quality of care.

Access to services – Rural communities face chronic shortages of health professionals, while urban areas have a much higher concentration of providers and specialists. Long travel distances, limited-service hours, and under-resourced health facilities lead the rural population to limited access to services.

Quality of care – Continuity of care is weaker in rural areas due to high workforce turnover, and limited access to specialist services affects diagnosis and treatment options that lead to poorer health outcomes.

I would like to promote the following action plan:

Local recruitment/ rural healthcare workforce pipelines: Recruiting health care workers from rural backgrounds to work for their communities

Telehealth and mobile clinics: To provide services to the rural population

Rural care networks: Rural clinics connected to regional hospitals via telehealth, shared staffing, and referral pathways.

In Myanmar, the gap between rural and urban healthcare is very large and persistent. Urban centers such as Yangon and Mandalay have more hospitals, specialist care and trained medical professionals, while rural areas—where about 70% of the population lives often lack basic health facilities, qualified staff and essential medical equipment.
In rural Myanmar, people frequently have to travel long distances (sometimes hours) to reach the nearest clinic or hospital, with poor roads and limited transportion. Many villages either have no health center at all or only a basic health post run by a health assistant or midwife, which cannot handle emergencies or specialized treatment.
This unequal distribution contributes to poorer health outcomes in rural areas. For example, rural maternal and child health indicators are worse than in urban settings, and rural residents are less likely to have access to skilled birth attendants or timely care. Meanwhile, the healthcare system overall remains underfunded, with low public spending, chronic shortages of doctors and nurses and heavy reliance on out‑of‑pocket payments that many rural families cannot afford.
The situation has been exacerbated by ongoing political instability and conflict, which has driven many health workers out of rural areas and disrupted services. According to recent reports, post‑coup conditions and restrictions on aid have severely weakened emergency response and access to care in some regions.
In line with what Dr. Ari Isman described in his TEDx talk, rural healthcare in Myanmar is fundamentally different from urban healthcare. It requires solutions tailored to local realities rather than simply copying urban systems. Telemedicine and mobile clinics have been introduced in some remote areas to connect villagers with doctors in cities and community health volunteers help provide basic preventive care and health education where doctors are scarce.
One idea to help close the gap could be a telehealth hub network linked with community health workers, where trained volunteers or midwives in rural townships can use mobile technology to consult specialists in urban hospitals. This could include simple diagnostic tools connected via smartphone and digital health records, helping to triage patients earlier and reduce unnecessary travel. Combining this with targeted transport support such as ambulance services for rural emergencies would further improve outcomes.
Overall, reducing the rural–urban health gap in Myanmar requires rethinking healthcare delivery for rural settings, investing in technology and workforce training and creating solutions that work within the country’s infrastructure and social context.

Of course, there are big differences between rural and urban health in Myanmar.
Access and quality of care are much better in urban areas where most health facilities, specialists, equipment, and trained professionals are located. In contrast, rural areas have far fewer facilities, long travel distances, poor transport, fewer skilled staff, and lower service quality.
This leads to delayed care, poorer health outcomes, and higher risk of complications especially in maternal and child health gaps.

Access: Most hospitals and specialists are in Yangon/Mandalay; rural villages often lack local clinics or have only basic centres with minimal staff and equipment.
Workforce: Doctors, nurses, and midwives tend to work in urban settings; rural areas suffer human resource shortages.
Quality: Even when rural residents reach care, quality (e.g., maternal/newborn services) is generally lower due to limited trained staff and supplies.
Costs & travel: Long journeys and travel costs delay care-seeking in rural communities.

Examples of Innovative Approaches
Community Health Workers (CHWs) & Auxiliary Midwives: Trained volunteers in rural areas support basic primary health services, health education, immunization support and manage common conditions where doctors are scarce.
Integrated Community Malaria Volunteer (ICMV): Projects training malaria volunteers to diagnose and treat malaria and other illnesses have increased access in hard-to-reach areas.
Ethnic and community-based health organizations: In underserved regions (especially conflict-affected areas), local health systems and organizations deliver essential care and build trust within communities.

Other Innovative Ideas to Close the Gaps
1. Expand and support ICMV — with training, supervision, supplies, and modest incentives
2. Mobile clinics and outreach teams that regularly visit remote villages
3. Telehealth for remote consultation and referral support
4. Incentives for rural retention of skilled staff (housing, allowances, career paths)
5. Stronger linkages between government, NGOs, and community support groups to coordinate services and resources

In Myanmar, there is a large gap between health care in urban and rural areas. People in cities usually have better access to hospitals, trained health workers, medical tests, and quality services. In contrast, rural and conflict-affected areas have limited access to care, shortages of health workers, weak referral systems, and lower quality services. Because of this, rural communities have worse health outcomes, especially for mothers and children, infectious diseases, and preventable illnesses.

Political instability and ongoing conflict have made the situation worse. Many skilled health workers have left, health services have been disrupted, and communities now depend more on NGOs, ethnic health organizations (EHOs), and community-based providers.

To improve the situation, Myanmar needs to move away from a hospital-focused system and invest more in prevention and community-based primary health care. Strengthening community health workers, sharing tasks among health staff, promoting healthy behaviors, detecting diseases early, using mobile clinics, and working closely with local and EHOs can improve access to care and fairness. It is also important to protect health workers, encourage them to stay in rural areas, and reduce financial barriers for patients.

Yes, the difference between rural and urban healthcare in Myanmar is something we can feel immediately not just see on paper. In the cities, even with all the challenges, people can still find a functioning hospital, a specialist, or at least a private clinic. There is electricity, diagnostic equipment, and a chance to be referred if something serious happens. But in rural and conflict affected areas, healthcare often means a single overburdened volunteer medic working out of a bamboo hut or a church, with only a stethoscope, a blood pressure cuff, and whatever medicines managed to reach the village that month.
Urban patients may wait in long lines, but rural patients wait in fear that there will be no trained provider, no medicine, no transport, and no way to survive complications. For diseases like tuberculosis, which require early diagnosis and continuous treatment, the difference between rural and urban access could literally be life and death.

Because of this reality, I’ve been thinking deeply about how to close this gap in ways that fit the conditions on the ground. One idea that I believe holds real promise is an AI powered mobile app for TB screening using digital chest X rays.

In many rural areas, TB is underdiagnosed not because people don’t seek help, but because there is no radiologist, sometimes not even a trained clinician who can confidently read a chest X ray. This delays diagnosis, spreads infection, and increases mortality.
But what if a rural health volunteer could take a chest X ray using a portable digital CXR machine, receive an instant AI generated TB risk score using offline mobile app with AI capability.

Here’s how it would work in practice:
1. Portable X ray arrives in the village either carried by a mobile health team or placed in a rural clinic with solar electricity.
2. The health worker takes a digital chest X ray.
3. The image is scanned with a mobile app and processed locally in mobile device without internet.
4. The AI model analyzes the CXR within seconds and flags:
TB likely, TB possible or TB unlikely
5. If the result suggests TB, the app automatically guides the health volunteer for the next steps.
6. This tool wouldn’t replace a doctor but it would multiply the ability of rural health workers and dramatically speed up detection.

In rural regions, especially those affected by conflict and displacement:
• Radiologists are almost nonexistent.
• TB rates are high, but health teams often identify cases only when symptoms become severe.
• Travel to towns for diagnosis is dangerous, expensive, and often impossible.
• Mobile networks may be unstable able to work offline without internet access for TB detection.
An AI based TB screening app would transform the first point of contact, giving rural communities access to a level of diagnostic support that previously only existed in major hospitals.

There is a clear gap between rural and urban healthcare in both access and quality of care in Myanmar. Urban cities have more medical professionals available, better healthcare equipment, diagnostic machines, in both private and public hospitals while many rural communities have limited health facilities, shortages of health workers, and long travel distances to reach even basic care. Some does not even go to hospitals or community clinics, and they just treated with traditional medicines. Moreover, as we discussed in Topic discussion 1, there are also healthcare professionals’ shortages occur due to many reasons.
To further close the gap, one effective idea would be to establish community-based telehealth hubs in rural villages. These hubs could be run by trained community health workers using simple digital tools to consult urban doctors, provide basic screening, and deliver health education in local languages. This approach combines technology with local trust and could significantly improve access and quality of care for rural populations. In addition, coordination with NGOs and international NGOs has played an important role in reaching hard-to-reach rural communities. These organizations often provide outreach services, mobile clinics, health education, disease prevention programmes, and support for essential services where government capacity is limited. Training local young people as community health assistants could help in terms of building trust, local employment, and improve sustainability.

Gaps between rural and urban health in Thailand
– Workforce imbalance: Major cities and urban areas have a higher concentration of doctors, including subspecialists, for which the ratio can be up to 10x different.

– Accessibility: Rural people rely on a three-level healthcare system where traveling to district hospitals for specialized treatment remains difficult due to distance and poor resources, while in urban areas, there are more options, such as private hospitals and clinics, highlighting more gaps in seeking treatment.

– Burnout: Rural doctors frequently work 80-100 hours per week, leading to burnout and high turnover, which decrease the quality of care.

Innovative action plan in Thailand
– Rural workforce scheme: There has been an effort to recruit the students from rural backgrounds to train them specifically for service in their own communities.

– Telehealth medicine: Digital platforms (esp. during COVID-19, apps like Mor Prompt) allow rural people to consult specialists via telemedicine and access personal digital health records. This includes linking referral networks as well.

– Mobile medical service: Using mobile clinics to bring specialized screenings and care directly to remote areas.

– Empowered community networks: We have established and strengthened village health volunteers as a bridge to screen and treat patients locally, including using mobile technology, reducing the workload in big hospitals.

Yes, there is a big difference in the access and quality of care between rural and urban setting. In the Philippines, one way to close this gap is through mobile health clinics. A mobile health clinic is a customized vehicle—often a van or bus—equipped with medical supplies and staffed by healthcare professionals. They allow healthcare providers to reach marginalized communities that lack access to traditional healthcare facilities.

Here are some examples of mobile health clinics operating in the Philippines:
Mobile Primary Care Facility (MPCF) Vehicles
– Mobile clinics of the Department of Health that provide essential medical assistance and healthcare services to geographically isolated and disadvantaged areas (GIDAs) or areas with underserved populations. It contains a standard set of equipment such as an x-ray machine, ultrasound, laboratory equipment, telemedicine kit, generator set, vehicle airbags, and an air conditioning unit.

KonsulTayo mobile clinic
– a project of the Department of Health and Philippine Business for Social Progress (PBSP), the largest business-led NGO for social development in the Philippines. These mobile clinics are part of PBSP’s Access TB Project, providing free chest x-ray, specimen collection and transportation, ECG, and other primary care services. Our town is one of the beneficiaries of this project. Several times a year, a KonsulTayo mobile clinic arrive at our municipality to provide free chest x-ray.

TrucKABATAAN
– a combination of the words, truck and “kabataan” which means youth in Filipino. It is a collaboration of several agencies, including the Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar, Korea International Cooperation Agency (KOICA), the Philippine Government, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO)
– This mobile clinic provides essential health services to adolescents, from sexual and reproductive health to maternal and child health services for adolescent parents.

KliniKalye
– this mobile health clinic is found in an urban area (Metro Manila). It provides free and accessible medical care to street children and their families.

Main Gaps
Limited access to quality health care services in rural and hard-to-reach areas
Shortage of healthcare professionals and facilities
Logistical challenges for referral process – it delays emergency referrals
Lower immunization and other public health services coverage – some children have never had an immunization because of living in conflict affected zones.
Low health awareness due to limited access to health education programs.
Higher mortality -especially maternal and child mortality are higher.

Innovations
Recruit and train local staff – community health workers and strengthen ethnic health organizations. (This will increase service utilization rate, due to community trust)
Hardship allowance and incentive programs for health workforce in rural areas.
Strengthen village tract health committee – regularly communicate through meetings for their concerns and make sure their health needs are prioritized. (One of our approaches is forming VTHC by including at least one representative from every target village and holding quarterly meetings with them. They can also assist in population and household surveys.)
Expand mobile health services and immunization outreach programs.
Develop telemedicine and digital health platforms.
Arrange safe working environment by improving and renovation of infrastructure, adequate supply of medicine and commodities.
Public-private partnership for referral purposes– the government linked with private hospital through strategic purchasing of services (local people can seek essential health care at a nearer hospital)
Most importantly, local empowerment is crucial to improve their ownership and to get sustainable results.

Yes, there is a big gap between rural and urban health care access and quality in Myanmar.

Urban areas usually have more hospitals, specialists, diagnostic tools, and trained staff. People can reach services faster and have more choices. In rural and conflict-affected areas, facilities are fewer, staff are limited, medicines are often out of stock, and travel is difficult and costly. Quality of care also varies because of limited training and supervision.

Some innovations are already helping. For example, mobile clinics, community health workers, and EHO/CBO service networks are bringing basic care closer to remote communities. Teleconsultation and simple digital health tools are also being used in some places to connect frontline workers with doctors and to support reporting and follow-up.

To close the gap, I think we should expand community-based care, support rural health workers with incentives and continuous training, and scale up telehealth and offline digital systems. Mobile outreach teams and shared supply systems can also help reach hard-to-access areas. Strengthening local organizations and referral links between rural and urban facilities is also very important.

Yes, The major gaps between rural and urban is quality health care and lack of pocket money to use in health care. Moreover, rural people has low awareness in health care seeking and late diagnosis. Then it ends with poor outcome like death or long term suffering. The idea to tailor these gap is tele-medicine. It can be operated like hotline call for mobile network coverage area. If internet is available, rural people may request the medical person via VDO call or voice message. In addition, Tele-medicine channel might work to deliver health message via social media or platform for health knowledge improvement.

1. Gaps in Access to Health Services in our country
In urban areas like Yangon, the community generally have access to tertiary level hospitals, 24-hour service, sophisticated diagnostic facilities, and pharmacies. In contrast, rural and remote areas—particularly in Chin, Rakhine, Kachin, and parts of Shan State mostly rely on rural health centers and health posts staffed by basic health staff. The only hospital level township is very far away from their residing villages. Geographic barriers and high transportation cost significantly delay emergency referrals, increasing preventable mortality and disability-adjusted life years (DALY).
2. Gaps in Quality of Care
Urban facilities typically have better infrastructure, improved availability of medicines and medical equipment. Rural facilities frequently face shortages of essential medicines, limited diagnostic capacity, absence of specialists and weak supply chain systems. Continuity of care and supervision is also weaker in remote settings, which affects service quality, especially for maternal and child health, non-communicable diseases (NCDs), and emergency care. Health professionals prefer to work in urban areas for better living standards, career development opportunities and security concerns, too.

Innovations and Efforts to Close the Gap
Currently the following are running in rural communities to cover the gap as much as possible.
1. Community Health Worker Programs: select and train the enthusiastic volunteers from their communities to give basic health care before transporting to the health posts
2. Mobile Clinics and Outreach Services
3. Telehealth and Digital Health (Limited but Emerging): m-supply software for pharmacy management, Viber bot for sharing health information and helpline number for emergency health care is now available but limited in some cases
4. Public–Private and NGO Partnerships: they are collaborating with ethnic health organizations and community-based organizations in conflict areas to extend service coverage.