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Friday, May 11, 2012

Chance to improve public health in Myanmar


NEW YORK — In 1998, the publication Burma Debate included my article "The Health of Burma's Women and Children," which was a critical assessment of the health situation in the country. It was a groundbreaking article in that as soon as it was published I received a midnight call from UNICEF's representative in Myanmar warning of a possible backlash from the government. As things seem to be changing in Myanmar, I hope this article contributes positively to improvements in that punished country. — C.C.

The rapid changes now taking place in Myanmar (aka Burma) are creating the conditions for renewed support of the country's precarious public health system, the right way to improve the Burmese people's dismal health status. This could be one of the most helpful measures foreign governments and organizations can give to the Burmese people.

In recent years public spending on Burma's public health system has been less than 0.5 percent of the country's gross domestic product. In 2000, Myanmar ranked as the second worst country in overall health system performance, according to the World Health Organization (WHO). In addition, there were wide inequities between urban and rural areas, and health services failed to cover the most peripheral regions in the country.

In 2008, the U.N. Development Program's Human Development Index, which measures progress in terms of life expectancy, adjusted real income and educational achievement, ranked Myanmar 133 out of 177 countries.

New measures are badly needed by a population with a poor health status, reflected in tens of thousands of deaths from malaria, tuberculosis, AIDS, dysentery, cancer and respiratory infections. Every year, tens of thousands of Burmese travel to Thailand to seek medical care at the 120-bed Mae Tao Clinic, where services are free and nobody is turned away. Those reaching the clinic seek treatment for a host of diseases now common in Myanmar.

The best assessment of the health situation in the country has been provided by the WHO Country Cooperation Strategy, which presents the direction and priority areas for the organization's work.

Malaria remains the leading cause of mortality and morbidity in the country. What's worse is that a majority of malaria infections have developed a high resistance to anti-malaria drugs. In addition, Myanmar is also one of 22 countries with the highest burden of tuberculosis. Increasingly, TB patients are showing multidrug resistance to available treatment.

Although some progress has been made in the fight against HIV/AIDS, international sanctions have hampered efforts to curb its spread. A quarter of a million people are infected with HIV, according to U.N. statistics. But only a small percentage has access to anti-retroviral therapy. Among those most likely to contract the virus are intravenous drug users, sex workers and men who have sex with men.

Myanmar has one of the highest adult HIV prevalence rates, after Cambodia and Thailand. According to the Doctors Without Borders' report "Preventable Fate," 25,000 Burmese died of AIDS in 2007. These deaths could have been easily prevented with anti-retroviral therapy drugs and proper treatment.

Dengue and dengue hemorrhagic fever are now seasonal epidemics in some parts of the country, and leprosy, although no longer a serious public health problem in Myanmar, still needs more control activities and improvements in services.

Noncommunicable diseases such as diabetes mellitus, cardiovascular diseases (including hypertension) and cancers are increasingly becoming public health problems due to widespread risk factors in the population such as smoking. At the same time, malnutrition, including several micronutrient deficiencies, continues to be a serious health concern in Myanmar.

The under-resourced public health care system has had negative effects on access to health services. It is estimated that the government in Myanmar spends a smaller percent of its GDP on health care than any other country in the world, and international donor organizations give less to Myanmar, per capita, than to any other country except for India.

This year, however, the government has quadrupled its health budget and has addressed the lack of supplies and poor hospital conditions. At the same time, the government intends to improve doctors' education and increase technical exchange programs with other countries.

If political conditions continue to improve in the country, it will be an opportunity to re-assess the role of international aid.

To be effective, aid will have to be aligned with national programs and policies, be closely monitored and respond to the technical demands suggested by donor countries.

The Burmese people's better health will be the best reward for these actions.

Cesar Chelala is a winner of the Overseas Press Club of America award.


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