As Myanmar
prepared to go to the polls, there was an unprecedented sense of hope for the
future. But taking the country out of poverty and raising the population’s
standard of living won’t be easy.
International health charity Merlin has been working in Myanmar since
2004 when we were asked to run a malaria control programme in Chin State. Over
the past nine years, the team has developed an excellent reputation among the
donor and international community and has a regular place at the table with the
Ministry of Health. There is a clear
sense that this year will provide a significant opportunity to shape the future
of health care in Myanmar, but that desire must be tempered by realism about
the challenges ahead.
Myanmar has some of the worst indicators for maternal and child health
in Asia. 70,000 children die every year from largely preventable diseases and
240 out of every 100,000 women in Myanmar die in childbirth, compared with 8.2
women in the UK. Among specific diseases, the leading causes of death and
illness in Myanmar are TB, malaria and HIV/AIDS.
Travelling back to Yangon from the Ayeyarwaddy Delta where I visited
the community health programme supported by Merlin, I was keenly aware of the level
of unmet needs. The current level of overseas development aid is amongst the
lowest in the world, while total government expenditure on health and education
combined has up until recently been only around 2 per cent of GDP.
Consequently, the major burden of health expenditure (92.5 per cent) is borne
by the people, who can ill afford the cost.
In this context, the natural disasters that Myanmar is prone to are
even more devastating. Less than one year after Merlin arrived we were called
on to launch an emergency response to the 2004 Boxing Day tsunami that swept
across the low-lying delta region. When Cyclone Nargis hit in 2008, taking the
lives of more than 140,000 people and affecting over two million, our network
of community health workers was greatly affected but we were well-placed to
undertake a large-scale emergency response.
Then most recently when Cyclone Giri hit Rakhine State in 2010, Merlin
worked hand in hand with villagers to improve water sources and ensure access
to safe water and sanitation for over 20,000 people.
In all these crises, the courage and participation of the communities
have been at the very root of their survival, but sadly it is a question of
when not if the next disaster hits and there is a real need to maintain a capacity
to respond as well as working hard to make Myanmar more resilient to the
challenges ahead.
Merlin’s programme in Laputta has clearly been successful in supporting
volunteers in the delta’s 651 river-accessed villages. Merlin trains, equips
and supports these volunteers to provide a package of free health care, as well
as paying transportation costs to the nearest hospital. One mother I spoke to
proudly held up her child and told me he would not have survived were it not
for the care and support of Merlin’s health workers.
In addition Merlin has strengthened the village health committees
(VHCs), empowering them to make their own decisions around health care. These
committees are now organised and can represent the health needs of different
groups.
In total, Merlin provides healthcare to 750,000 people in 1,100
villages through a network of 1,400 community health workers and this month has
expanded its health work into northern Shan State.
As I travelled around some of the townships in the Delta that are
supported by Merlin’s community based health workers, there was a clear sense
that 2012 will be a turning point, but in order for long-term change to happen
there must be a significant increase in funding to address the current gaps and
to build resilience to future disasters.
For our own team the sense of change is tangible and working with the
Ministry is increasingly open. There are, however, a wide range of
uncertainties and differences of opinions about the scale of donor money likely
to follow. When might things become more certain? ‘Impossible to tell’ was a
recurrent theme. This time last year it would have been inconceivable to have
predicted the level of change that has occurred and no one can predict what the
coming years will bring.
Merlin – UK
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