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By CESAR CHELALA, Friday, May 11, 2012 ...
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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