Myanmar’s long military rule has brought severe neglect to the health sector. But since 2013, the 3MDG fund has helped to save lives through contributions in areas including maternal and child healthcare. Parallel to this, more long-term work is being done to build up functioning health systems. Sida is one of the fund's seven donors.
After decades of military rule, Myanmar's health sector is suffering from significant problems. Minimal resources have been invested in health, national coordination is poor, the lack of trained doctors and personnel is manifest and capacity is low. This has resulted in people lacking access to even basic healthcare – especially in rural areas. Women are particularly vulnerable - maternal mortality in Myanmar is among the highest in Asia.
Since 2013 Sida, together with six other donors, has been supporting Myanmar's health sector through the 3MDG fund, managed by the UN agency, UNOPS. The fund has markedly improved access to healthcare in a number of remote areas of the country. The focus is maternal and child healthcare and communicable diseases (HIV, tuberculosis and malaria), all as a part of building up the country's own health system.
"This is the best way to as coordinated as possible support a government that we cannot work with directly.* Donors working together makes it possible to coordinate the work, run activities on a larger scale, find pragmatic solutions and reach more people. It is also better for the Government that we donors speak with one voice," says Tomas Lundström, programme officer for the support to the fund from the embassy in Myanmar.
Focus on maternal and child healthcare
The majority of the health fund is maternal and child healthcare, with 4.5 million people being reached since 3MDG started in January 2013. This includes 123,000 women delivered by trained healthcare personnel. 128,000 women have received maternal care during and after pregnancy.
"We know that training and knowledge can markedly reduce the risks associated with childbirth. That's nothing new. In the event of complications, the women can be referred. If we're talking about saving lives, this makes a big difference," says Tomas Lundström.
The challenge has been to reach the women. Among other things, 3MDG has ensured that mobile midwife teams and volunteers in villages have received basic training and that midwives have received further training.
"3MDG's support to national midwifery training is also very important, both now and for the future," says Tomas Lundström.
One of those trained is Daw Ling Gei Pai, who is a midwife at the health centre in Nga Shawng. The course in Basic Emergency Obstetric and Newborn Care taught her how to identify and deal with bleeding associated with childbirth. Daw Ling Gei Pai recalls when she shortly thereafter visited the village Chawk Yo and met a pale mother with low blood pressure. With her new knowledge she was able to intervene quickly and stop the bleeding within half an hour.
"I was so happy to be able to help the woman using what I'd learned. The opportunities to practise on mannequins during the course made an enormous difference in this emergency situation. I knew straight away what I should do.
HIV, tuberculosis and malaria are among the most common causes of disease and death in Myanmar. Particularly problematic are resistant forms of malaria and TB. 3MDG has therefore particularly focused on these diseases, especially among particularly vulnerable groups and in remote parts of the country. Through 3MDG, 1.7 million malaria tests have been carried out since January 2013, and 125,000 people have received treatment against the disease.
Important building of health systems
These results have a direct significance for the health and lives of poor people. At the same time, it is also important to work at a structural level to help new systems to be built up and to improve the Government's conditions for itself being able to provide citizens with qualitative healthcare.
"If the systems are not built up at the national level, there will be no results in the long term. The goal of all development cooperation is to enable the Government to take over and do what we do. Here in Myanmar, the conditions are particularly difficult since there has been a military dictatorship for so long. But today, the Government is an active part of the fund, and we have close cooperation with the Ministry of Health," says Tomas Lundström.
In cooperation with the Government, 3MDG also contributes to the building of health clinics and the development of systems for delivering medicines and training medical personnel. Wai Yee Khine, who is working to strengthen the country's health system at 3MDG, takes a positive view of the Government's increasingly active role.
"One key result is that during autumn 2016 we have been able to support the Ministry of Health's work to produce a five-year health plan. This is the first time this has happened in four or five decades. All the key stakeholders have participated in developing the plan, including the health organisations of various ethnic groups.
Tomas Lundström hopes that better national health systems might ultimately contribute to a more equivalent healthcare in Myanmar.
"Now it is incredibly unfair. In one village you can lie dying, while in another place you're in luck because just there they happen to have some form of support.