Ariel Pablos-Mendez is the Assistant Administrator for Global Health
With an economy of more than $80 billion, growing at over 5 percent annually, Burma presents unique challenges and opportunities for development as it transitions to an open society. Inequality, ethnic strife and migrants in border areas, as well as authoritarian vestiges of the military regime and crony capitalism, are some of the challenges. While women are relatively empowered thanks to low fertility, Buddhism underpins a rich culture, and a socialist past left reportedly high levels of literacy and very low crime rates.
Under the leadership and vision of President U. Thein Sein, his partners in government, and an energized Parliament that notably includes Daw Aung San Suu Kyi, the reform agenda moves forward.
This month, Robert Clay joined me on a visit to Burma – the first of its sort for global health. We were generously hosted by ThuVan Dinh, our new health advisor in Rangoon, and Dr. Aye Aye Thwin, the health office chief from the regional mission in Thailand, with great support from USAID Mission Director Chris Milligan and U.S. Ambassador to Burma Derek Mitchell.
Health statistics are mostly unreliable – the result of poor health information systems and no census since the late 1980s. Add regions in conflict, and a central bureaucracy and peripheral culture that demanded positive reports, challenges seem aplenty. But at least in Rangoon and nearby townships, things look better than in many low-income countries and are ripe for smart development. Hope springs anew for a transformative era of peace, prosperity and development for a country that’s just emerging from isolation from the international community.
We met the Minister of Health and officials in other ministries in Naypyitaw, the brand new capital city as well as with several other governmental institutions in Rangoon and nearby townships, and partners (implementing NGOs, U.N. agencies, bilateral donors, private sector organizations, etc.) Our calling card was the integrated and joint priority of reducing child mortality by 30 percent in five years. And while maternal and child health, HIV/AIDS, TB and malaria are obvious targets for investment, there was a strong emphasis on the importance of strengthening health systems and stemming the growing problem of chronic diseases and injuries: of the approximately 500,000 annual deaths, 40 percent are due to chronic conditions and 30 percent to injuries according to estimates.
Pablos-Mendez talks with health workers in Burma. Photo credit: Leek Deng.
New commitments in health hold promise for the Burmese people. Soon, health officials plan to roll out the pentavalent vaccine – a combination of five vaccines in one: diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b (the bacteria that causes meningitis, pneumonia and otitis) for children in the country under the age of 1. Leadership has pledged to hire as many midwives as needed, and efforts are underway with Parliament to raise a meager health budget.
Add possibilities of new U.S. investment in Burma’s first Demographic Health Survey, a public private partnership to increase neonatal survival by offering evidence-based training and high quality affordable resuscitation devices to birth attendants to Help Babies Breath, and technical assistance on financing reform towards Universal Health Care (UHC), there is great momentum and transitions afoot.
Coming on the heels of President Obama’s addition of Burma to his Asia tour, I agree that this is an exciting time of transition not only for Burma’s health care system, but for the country as a whole. I also agree that this reform agenda will bring some remarkable improvements under the leadership of President U. Thein Sein. However, I think it is a little premature to predict the country’s health care system will make real progress until obstacles like the severe shortage of health care workers and inadequate health care facilities attempted to be remedied. In addition, I also think hope for the system is premature as Burmese Minister of Health Pe Thet Khin described more than 900 of the country’s medical facilities as being “compromised”.
No doubt Myanmar has one of the highest literacy rates in the Asia-Pacific region.
But sadly, decades of Marxist-socialist dictatorship had destroyed the private sector and turned the people into *educated illiterates*. Chronic unemployment added to the misery.
The poor state of the health information systems are partly to blame for the rising number of preventable diseases.
It’s not uncommon to see roadside vendors serving food with unwashed hands, thus spreading amoebic dysentery, hepatitis, among others.
I’ve met diabetics who had little or no knowledge how to cope with the life-threatening disease. And totally unaware that people with diabetes can live a normal life, provided . . .
More importantly international aid organisations, including USAID, should make compulsory the role of health information in the health delivery services.
Printed health literatures – handed out at mass gatherings such as schools, pagodas, churches and mosques and temples – would help individuals and communities to improve their health, by increasing their knowledge or influencing their attitudes.
Information, after all, is the only resource that grows rich when it is shared.
Lord Buddha said: Health is the greatest gift . . .
But, much work needs to be done before it becomes a true blessing.
– Burmese-born journalist
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