Myanmar: new opportunities to transform the health system
I recently spent a week in Myanmar. I went there to run an advocacy workshop for our team in Yangon and help them develop a plan for influencing national policies on health and nutrition.
Save the Children has been running programmes in Myanmar since 1995 but advocacy is a relatively new area of work Advocacy is a key part of the way that we aim to realise children’s rights. However in Myanmar, the ability of NGOs like Save the Children to engage in policy making discussions was restricted until very recently.
Opportunities born from a disaster
For decades, Myanmar was a closed country with few opportunities for civil society. In 2008, Cyclone Nargis hit and claimed thousands of lives in the southern Delta area.
Because the government was unable to respond to the natural disaster on its own, space was created for civil society to support the emergency response and engage in greater dialogue with policymakers.
Elections in 2010 and the creation of a new constitution have since led to further political shifts.
With the rapid pace of change, Myanmar is now at a critical juncture regarding the reform of key policies relating to children’s health and nutrition.
During our workshop, we explored how Save the Children in Myanmar can build on its programming experiences and use advocacy to ensure that the government meets the needs of all children.
Why urgent action is needed on child survival
Child mortality rates in Myanmar are the highest in the region. In 2010, 56,000 children died before their fifth birthday – almost half in their first month of life – from largely preventable causes.
Malnutrition is a huge problem with more than one-third of children stunted and one-quarter underweight.
The weak public health system seriously undermines children’s rights to health and survival.
Inadequate funding for health is the main underlying challenge. The government spends less than 2% of GDP on health, one of the lowest rates in the world. This works out as around US$2 per person – hardly enough to meet even the most basic needs.
This low level of investment means that there is not enough money to train and hire enough skilled health workers. It also means that 81% of all spending on health in Myanmar comes straight out of people’s pockets. A combination of official charges, unofficial fees and the opportunity costs of seeking health care deter people from using the services that they need or push them further into poverty.
Advocating for universal health coverage
These challenges illustrate why the Government of Myanmar needs to accelerate efforts to improve children’s health and nutrition.
There are positive signs that health is being prioritised, with promises to increase the health budget and to achieve universal health coverage.
But as in many countries, advocacy will be required to help turn these promises into reality, especially for the poorest and most marginalised children.
It was a great privilege for me to be involved in the development of our first advocacy strategy for child survival at a time when there are opportunities for genuine transformations within the health system.
As we begin to put our new plans into action over the next months and years, I hope that there will be lots of positive stories to share.