Political Instability in Border Areas Since Myanmar’s independence from the United Kingdom in 1948

Political Instability in Border Areas
Since Myanmar’s independence from the United Kingdom in 1948, the country has experienced numerous ethnic conflicts. Various small militia groups and ethnic armed organizations operate and control parts of the country, primarily in remote a border areas today. Furthermore, religiously fueled violence between the Buddhist majority and Muslim minority has forced hundreds of thousands of Rohingya refugees to Bangladesh. Our proposed interventions will target the populations most affected by malaria in Myanmar, which are those living in the regions bordering Thailand and Bangladesh. Anticipated risks associated with program implementation in areas of political instability include inaccessibility to distribution centers which would disturb supply chain, and the potential of government push-back for working with ethnic minorities.
Inadequate Health Care Workforce
According to the Ministry of Health and Sport, in 2014 Myanmar operated 988 hospitals and 1,684 rural health centers which included 348 maternal and child health centers. Additionally, Myanmar has 13,000 doctors, 30,000 nurses, 22,000 midwives and 11,000 CHWs operational nationwide. This represents 0.195 CHWs per 10,000 persons reported by the World Bank, a severe shortage in a country with low number of doctors and nurses. Auxiliary CHWs can play a vital role in service delivery, particularly in ethnic minority and rural border regions, however, they are often required to perform beyond their basic training.
Weak Health System Infrastructure
Since Myanmar’s democratic transition in 2011, the country’s health system has advanced, however further improvements are required. Addressing inequalities in access to health services across the country and bridging gaps in service delivery between urban and rural areas and for minority ethnic groups should be prioritized. Furthermore, the 2008 military drafted constitution enshrines a central or national level control (as opposed to state or subnational control), over health expenditure. Unfortunately, the centralization of the health systems in Myanmar increases these disparities in services against rural areas.
Additionally, Myanmar currently allocates a mere 3.65 percent of its total budget on health care. This is an extreme low by global and regional standards, and as a result, out-of-pocket (OOP) spending by households is the main source of financing for health. Because of the variations in socio-economic status, especially for ethnic minorities, OOP spending causes further disparities in the health services received between urban and rural communities.
Weak Monitoring and Evaluation Systems
Strong monitoring and evaluation systems are required for any successful health intervention. However, although Myanmar has a National Health Management Information System, it struggles particularly in the areas of malaria. At the time of this proposal, the national epidemiological data on malaria in Myanmar were incomplete which poses challenges in planning, implementation, and monitoring since targets could be difficult to identify. There is concern of underreporting of malaria cases and death in the border regions of Myanmar. Adequate training in M;E could improve the quality of data.