Decentralizing Methodology for Burma/Myanmar:

1. Decentralizing Methodology for Burma/Myanmar: Establishing and Empowering Localized Community Health Care

2. MDGs Health Focuses: • reducing child mortality rates • improving maternal health • combating HIV/AIDS, malaria, and other diseases

3. Important Population Health Figures (Myanmar) • 53.4 millions of population • about 70 percent of the population reside in rural areas • majority of the population is living with an income as low as 379.6 per person (UN data, 2009) • government expenditure on health is less than 3 percent of GDP (CIA) • 18,725 doctors, 1,870 dental surgeons, 19,922 nurses, 162 dental nurses, 1,771 health assistants, 2,908 lady health visitors, 16,699 midwives, 529 public health supervisors grade (1), 1,359 public health supervisors grade (2) and 889 traditional medical practitioners (reporting health personnel 2005-06, WHO) • There are less than 200 private commercial health care services and thousands of GP clinics nationwide (Yangon/ Mandalay Directory 2012) • The current nutrition status shows that protein energy malnutrition among under-five children was 32 percent (MDG, Myanmar, 2005)

4. WHO’s report on Health System of Burma/Myanmar • Inefficient hospital management and administration at different levels • Delayed development of modern curative facilities and services compared to advances in medical science • Insufficient drugs and equipment • Shortage of manpower and technology • Weakness in proper referral system • Weakness in hospital wasted management system • Weakness in radiation protection system • Weakness in proper drug storage system, and • Weakness in proper medical recording and information system • Section: 6.5. Prevention, control and management of common diseases and injuries

5. Country’s Health Care System: State • Centralized & Privatized ideally for commercial purpose with exception • State is controlling public health care • State corrupted its own health policy and laws, and organized state-owned selectively privatized ‘for-profit’ health care • Every medical & health related research undergoes with Dept. of Med. Research (DMR) @MOH • DMR works for commercial entity (such as foreign medicine dealers & distributors) • All the foreign health assistance and funds undergoes through government • Structure is costly and highly bureaucratic; • i.e. majority of budget goes to office expenditures • MOHA is managing not-for-profit public health care groups instead of MOH • Public complaints takes ages to reach decision makers • Policy implementation, monitoring is ineffective • Corruption occurs at almost every level • Not-for-profit INGOs & CBOs are not in a position to work freely nationwide even though they are registered with MOH

6. Country’s Health Care System: State continue… • Policies, ethical norms becomes myth rather than reality • State ‘s policies ensures the free health care for all citizens in state-owned citizens • State does not provide efficient infrastructure nor HRs (MDs, Nurses, etc) necessary for public health care • State’s policies encourages the R & D in medical and public health sectors • State put tight control and strict regulations over all the medical & public health related researches, and have fewer experts in the field • State is supposed to be providing all the basic medicinal supplies, drugs and facilities to its own health care institution (MPF) • State cannot supply all the medicines, drugs and facilities needed by its institutions, and taxed highly only import of medicines and health care products • State undermines the privatization and commercialization of public health ‘in principles’ • State and its conglomerates are operating private health care centers and hospital at special privileges

7. Country’s Health Care System: Community (not-for-profit) • Decentralized & localized • Volunteer groups are running mobile with their realistic plan and human resources regardless of jotting down handsome policies on papers • CBOs are running in ‘individual’ or ‘small group’ voluntary basis organized locally • Small scale but effective • Meeting and getting in touch with their serving community • Reduce office expenditure • Making decisions independently • Finding and tackling issue on the ground, and no long reporting procedure is needed • Self-disciplining of participants and peer pressure ensure the ethics among CBOs’ participants

8. Country’s Health Care System: Community (not-for-profit) continue…. • Getting fewer and being threatened • Donors or funding organizations go to either government or ‘handsome’ non-profit health entity; donors or funding organizations are focusing on good ‘reports’ rather than good ‘results’ • Experts have limited time commitments towards non-profits jobs due to their living • Junior social health workers need to develop their expertise • Public health research activities by CBOs are discouraged by State • Health equipments, Medicines and drugs are getting more expensive due to State’s taxation • Long-term operation makes CBOs exhausted (in labor and finance)

9. Country’s Health Care System • What would we do about it? • Change; decentralize • Empower; CBOs • Enrich; health care professionals • Develop; public health research • Advocate; State to increase public health budget • Network; SEA

10. Are we settled? Please share and advise!