Myanmar's Health System on Life Support

Doctors Without Borders (DWB) says that 120,000 HIV-positive Myanmar residents meet World Health Organization (WHO) criteria for antiretroviral (ARV) treatment, but only one-third are receiving the drugs.

During the nearly half-a-century of military rule that officially ended last year, Myanmar's governing junta spent heavily on armed forces and had one of Southeast Asia's largest armies. But it spent just $12 per capita on public health in 2009, according to WHO. And only $1 of that amount came from the government; the rest came from non-governmental organizations (NGOs) and patients. That low figure was matched only by the war-torn Democratic Republic of Congo.

Now newly diagnosed HIV patients at a Yangon clinic are being told to return for treatment when they are sicker, as ARVs are being given only to those in advanced stages of illness. Medications to fight TB and malaria also are in short supply.

In response, more patients are turning to NGOs. After the junta banned them from public hospitals, NGOs ran what amounted to a parallel health service. Now they are calling for closer cooperation with the government. "We need to start thinking about a long-term health system where we can all work together," said Peter Paul de Groote, DWB's head of mission.

Reformist President Thein Sein said he has quadrupled the nation's health care budget for 2012-13. Mike Toole, adviser to the 3MDG Fund, a consortium of international donors to Myanmar, said this "is a good start, but it's coming from a very low base." Even given "massive investment," he said, "it would probably take at least 20 years, and possibly 30, to catch up with Thailand."

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