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The Time to Act is Now

Helping Improve the Burmese People’s Health

by Dr. CESAR CHELALA

Following recent events in Burma, Aung San Suu Kyi has asked that foreign governments take a more active role in increasing aid. This is the right time to support Burma’s precarious public health system as a way to improve the Burmese people’s dismal health status. This could be one of the most helpful measures the US and other governments and organizations can give the Burmese people.

Burma’s public health system has been underfunded for several years with public spending on health less than 0.5 percent of the country’s GDP. As a result, in 2000 Burma ranked as the second-worst country in the world in terms of “overall health system performance,” according to the World Health Organization (WHO).

There are wide inequities between urban and rural areas, and health services fail to cover the most peripheral regions in the country. In addition, although health care is nominally free, patients have to pay for medicines and treatment, even in hospitals and health clinics.

However, the government has recently quadrupled its health budget and has addressed 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.

This is a welcome change for a country that for decades has followed an isolationist policy. Such policy has turned the country into the second-poorest in the Asia-Pacific region. In 2011, the UNDP’s Human Development Index, which measures progress in terms of life expectancy, adjusted real income, and educational achievement, ranked Burma 149 out of 187 countries.

The 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 are looking for attention to a host of diseases now common in Burma.

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

Malaria continues to be the leading cause of mortality and morbidity in the country. What makes the situation even worse is that a majority of malaria infections are now highly resistant to anti-malaria drugs.

In addition, Burma is also one of 22 countries globally with the highest burden of tuberculosis (TB). Increasingly, TB patients are showing multi-drug resistance to available treatment.

Although some progress has been made in the fight against HIV/AIDS, international sanctions have hampered efforts to curb the spread of the infection. According to U.N. statistics, one quarter of a million people have been infected with HIV.

However, 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.

Burma has one of the highest adult HIV prevalence rates, following Cambodia and Thailand. According to a Doctors Without Borders’ report titled “Preventable Fate,” 25,000 Burmese died of AIDS in 2007. These deaths could have been easily prevented with anti-retroviral therapy (ART) drugs and proper treatment.

Dengue and dengue hemorrhagic fever (DHF) are now seasonal epidemics in some parts of the country, and leprosy, although no longer a serious public health problem in Burma, still needs more leprosy control activities and improved services aimed at those affected by the disease.

Non-communicable diseases (NCDs) such as diabetes mellitus, cardiovascular diseases (including hypertension), and cancers are increasingly becoming serious public health problems as a result of widespread risk factors, such as smoking, in the population. At the same time, malnutrition, including several micro nutrient deficiencies, continues to be a serious health concern in Burma.

The public health care system in the country is seriously under resourced, which has had a negative consequence in terms of access to and coverage of health services.

It is estimated that the government in Burma spends the smallest percentage of its GDP on health care than any other country in the world, and international donor organizations give less to Burma, per capita, than to any other country except India.

If political conditions improve in the country, it will be an opportunity to reassess 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 the donor countries. The Burmese people’s better health will be the best achievement of these actions.

Dr. César Chelala is an international public health consultant and a co-winner of an Overseas Press Club of America award.