The best way of easing a health crisis in eastern Myanmar, where some basic indicators are comparable to those in Somalia, is to boost support for healthcare systems run by communities who in many cases spent decades at war with the central government.
This is one of the key recommendations of a survey of 6,620 households, conducted by members of the Health Information System Working Group (HISWG) – a network of medics and other health professionals. The survey found that preventable diseases such as diarrhoea, acute respiratory infections and malaria contributed to infant and child mortality rates that were more than double national trends.
Infant mortality rates per 1000 live births for Myanmar as a whole stood at 41. In Eastern Myanmar the figure was 94.2. Mortality rates for children under five years old were even starker - 141.9 in the east of the country compared to 52 per 1000 live births nationally.
The survey forms the basis of a new report titled The Long Road to Recovery, which highlights the critical role local ethnic minority organisations have long played – and must continue to play - in addressing basic health needs.
Build on what is working
Rather than replacing these systems with ones the central government, the report says: “It is crucial to formally recognize and increase international support, especially during this critical transition period, for the existing ethnic and community-based health organizations that have a unique ability to identify, understand, and fulfill the needs of vulnerable communities who have been marginalized for decades”.
Myanmar embarked on a process of political reform in 2010 and has agreed ceasefires with 14 of the 16 main armed ethnic that had been fighting the central government for decades.
The report says the local networks that sprung up in eastern Myanmar during the decades of ethnic conflict have been filling the gaps in government public health programs, regularly providing basic care to close to 500,000 people. Seventy percent of respondents said they had sought treatment at these local facilities over the previous year, whereas just eight percent used government facilities.
Cynthia Maung, director of the Mae Tao Clinic on the Myanmar-Thailand border and one of the authors of the report, said greater freedom of movement as a result of recent ceasefires, combined with dramatic increases in humanitarian aid to Myanmar as a whole should, over time, translate into to continued steady health improvements.
“These ceasefire agreements have meant that it is now possible to deliver health services to many areas that were previously inaccessible due to the ongoing conflict.”
Potential peace dividend
The report suggests some early trends are encouraging. For example, more than 70 percent of women in eastern Myanmar had assistance from a trained health professional during the birth of their latest child, and rates of malaria are falling in part because of the increasing use of nets.
Further improvements depend on peace in ethnic areas holding. But the fragility of Myanmar’s patchwork of ceasefires was made clear earlier this month when clashes erupted between the Myanmar Army and an armed group known as the Myanmar National Democratic Alliance Army (MNDAA) in the Kokang region of Shan state, near the Chinese border. Dozens of fighters on both sides have been killed in recent weeks and thousands of civilians have fled to other areas of Myanmar or across the border.
As well as the unpredictable long-term security situation, a shortage of competent health workers and unwillingness to work in remote areas with limited infrastructure has restricted central government services.
However, the government doesn’t officially recognise local ethnic health service providers and so many of them are not registered. This in turn makes it difficult for them to access government assistance or to collaborate with state health agencies.
The risks of ignoring local systems
Maung said there are signs this may slowly be changing with ethnic and community-based organisations in eastern Myanmar beginning preliminary talks with Ministry of Health officials.
“While it is still early and these discussions have yet to bear fruit,” she said, “we view future opportunities for coordination and cooperation as critical to improving health for the people of eastern Burma [Myanmar] who have been disenfranchised as a result of decades of conflict and militarization.”
Saw Eh Kalu Shwe Oo, head of the Karen Department of Health and Welfare, which represents the eastern ethnic minority of the same name, told IRIN that in addition to the lack of available government health services, people often preferred local providers from their own ethnic group who spoke their local language, and were more likely to be trusted.
As well as limiting the possibilities for durable improvements in public health, the report warns that solely providing aid to government health services “risks heightening mistrust among ethnic communities and jeopardizing prospects for an enduring peace in Burma.”