A large-scale survey among ethnic minority communities in eastern Burma released on Thursday found that health care in the conflict-affected region has somewhat improved after ceasefires were signed in recent years, although it remains beset by serious health care challenges.
This situation, researchers said, is best addressed by further progress towards peace in Burma and by increasing government and international support for decentralized, ethnic health care organizations already working in the region.
The 64-page report by the Health Information System Working Group (HISWG), a network of field-based organizations working in eastern Burma, surveyed 6,620 households in 64 townships that are home to some 450,000 people, mostly ethnic Shan, Karen, Mon, and Karenni minorities. The surveyed areas included ethnic rebel-controlled and government-controlled areas, as well as mixed administration zones.
The survey’s main findings included “decreased rates of malaria and maternal malnutrition, and improved patterns of breastfeeding” in recent years, a press release by HISWG said, adding that the survey “also reveals that infant and child mortality rates in eastern Burma remain higher than the country’s official figures, and are similar to other conflict-affected countries such as Somalia.”
Infant mortality in eastern Burma was 94.2 per 1,000 live births in 2013, as compared to 41 for Burma as a whole in 2012, according Unicef figures cited in the report. Preventable diseases diarrhea, malaria and acute respiratory infections were the leading cause of death among all age groups and accounted for 15.6 percent, 14.8 percent and 11.8 percent, respectively, of all deaths among children under the age of five, the survey found.
The survey found that 10 percent of the population had access to government-operated health facilities, while 84 percent of patients, in particular pregnant women, rely on ethnic organization’s medial teams and field workers.
HISWG said its ethnic and community-based organizations had “developed their own primary health care service structures, outside the central government health system, through a network of rural clinics and mobile medical teams” to help hard-to-reach communities during past decades of ethnic conflict in eastern Burma and were therefore best placed to improve access to health care.
“To establish a good and effective health care system in the ethnic regions, it is very necessary that the government reduces its centralized policy as much as they can. They should mandate ethnic health organizations and workers in managing health programs in ethnic regions,” Dr. Cynthia Maung, founder of Thai-Burma border-based Mae Tao Clinic and lead author of the report, told The Irrawaddy.
“It is necessary to balance the involvement of locally-trained ethnic workers in job recruitment. The government should also promote the role of ethnic health workers in managing funding, writing health policy, planning and administration of ethnic regions,” she said.
Dr. Maung said ethnic health care workers communicate better with local communities and have gained their trust, and should therefore be empowered by both government policy and international donor support.
The international community has reengaged with Burma’s government after its transition from military to nominally-civilian rule in recent years and donors have sought to align funding with central government priorities, leading to concerns among ethnic aid and medical organizations that their role is being overlooked after decades of receiving international support.
Dr. Maung said a lack of security, ongoing conflict and displacement of people, and difficulties in transportation through militarized areas have hindered ethnic communities seeking access to health care services. Progress towards establishing a nationwide ceasefire and a subsequent peace agreement is therefore key to improving the health care situation in eastern Burma, she said.
Ethnic Karen rebels groups operating in eastern Burma have generally had stable ceasefires with the government in recent years, although a nationwide ceasefire process hit deadlock in September last year.