Centralization A Major Cause of Burma’s Healthcare Woes, Ethnic Health Providers Say

Khoon Phillip – The Director of Civil Health and Development Network – CHDN.

By KANTARAWADDY TIMES

As the coronavirus pandemic takes hold in Burma, ethnic health organizations are on the front lines of providing healthcare to vulnerable, conflict-affected populations.

The Karenni Civil Health and Development Network (CHDN) is one such health network, comprised of medics from ethnic health departments who provide care to locals in remote areas of Karenni State where government health services are not provided.

Even where available, these government services are often distrusted by villagers due to language and cultural barriers, the lack of basic medical supplies and local staff, and decades of civil war waged in these areas by the Burmese state.

Kantarawaddy Times recently spoke with CHDN director Khun Philip about the health sector in Karenni State, the National League for Democracy (NLD) government’s health policies, and ethnic health organizations’ advocacy for and practice of a federal health system.

Your organization is providing healthcare to local people in remote areas and implementing what has been described as a federal health system. Can you explain what this system is?

The federal health system is one where the ethnic state has full authority to manage the health system of their state. It’s not controlled by the central government. What I understand is that people can fully cooperate within a federal health system.

What difficulties do people in ethnic states face when a federal health system is not practiced?

There is no federal health system in ethnic states because there is too much control from the central government. The decisions made by [Burma’s] central government do not really fit with the needs of the ethnic regions. For example, if there is an outbreak of a disease then staff at the lower level have to report this outbreak to the various upper levels. Then they have to wait for orders from these upper levels [before they can take action]. These staff are trained by the central government. At the ground level, these staff do not understand our ethnic languages, or the customs and culture of the ethnic people. The centralized power means that the decisions of the central government do not fit with regional needs, and this has a negative impact. Therefore, there are many difficulties on the ground level.

Please describe the current government’s health policy.

This government has a health policy—they already drew it up. Even though the policy is good, in practice, the policy cannot be implemented. For instance, the NLD government drew up a National Health Plan (NHP). At the ground level, their staff do not understand the NHP very well, so they cannot fully implement it. I think the government has drawn up a good policy, but there are no voices from the local people included in the policy. In addition to that, the lower-level staff do not understand the NHP, so they cannot adhere to the policy. It’s like the policy just stays on paper.

What do you think needs to be added to the government’s health policy?

They need implementation. I think they also need monitoring and evaluation to measure whether a project is successful or has failed. I think every government staff needs to understand the government’s policy and implement the guidelines. There are no government medical clinics in remote areas, or there is a clinic but often there is no nurse or medic on staff.

How would a federal health system address this?

They should consider not only the population but also the regional situation. For example, where there are populated, crowded areas in towns or cities, there are many clinics. In remote areas there are less people, so the government doesn’t consider setting up clinics there. On the other hand, village-to-village communication is really difficult in remote areas. So it’s like the government has ignored the healthcare needs of local people in mountainous areas. That’s why these local people cannot access the government’s healthcare system.

There are clinics in some areas, but no nurse on staff. Is this also because of centralization?

[The government] only builds buildings, but they do not provide medical staff, medicines, and medical equipment. If a local villager is sick, even if there is a nurse in the clinic, there might be no medicine or medical equipment, and the nurse can do nothing. Local people need not only a building, but also a nurse, medicine and medical equipment. As I told you, if the nurse cannot speak the local language, then there will be a communication problem between the villagers and the nurse. The nurse will not be able to stay in the area for long if he or she cannot speak the local language and does not understand the local culture… Clinics in remote areas don’t function well. It’s not only because of one cause. There are many different causes.

Is there a connection between healthcare in remote areas and the current peace process?

I think it is connected to the current peace process. What I understand is that every person has the right to access the healthcare system. This is a human right. [Protection of] human rights is very much dependent on political and peace processes. Our people cannot go to the hospital because of armed conflict in our area. This makes it connected to the peace process. If peace is restored in our country, healthcare will be implemented well, and include the training of medical staff and the building of medical clinics in remote areas. Even though we have a good health policy, we cannot implement the policy if there is no peace restored in our country. That’s why peace is so important.

How many villages do your backpack medics go to in order to provide medical treatment in Karenni State?

There are two forms of medical treatment. The first is that we set up permanent clinics and provide medical treatment to local people [from that clinic]. Another way is that our backpack medics travel to remote areas and provide medical treatment to local people in that area. Currently, we have 26 permanent clinics. We have 54 backpack medical teams. Our project area is in nine townships, including seven townships in Kayah [Karenni] State, Pekhon Township in southern Shan State and Thandaung Gyi area in the Karen region as well as the Pinlaung area. We can cover more than 1,000 villages.

How do you cooperate between different organizations in the health sector?

First, we cooperated to work with the government’s health department after 2012. For example, we cooperated in providing preventive vaccinations and maternal healthcare. If we could not cure a seriously ill patient, then we transferred them to the government’s hospital. Second, we have cooperation between the health organizations of ethnic people. For example, we built a network with the Shan, Karen, Mon, Chin, and so on. We have a regular meeting every three months. We discuss health policy. We also discuss the preparation of a health system in a future federal Union after centralization has decreased. We discuss what kinds of things we will put in the future federal Union, what we are going to focus on in the health system in the future. We have written research papers. Regarding federalism, we have discussed and negotiated it a lot amongst ourselves. We have drafted agreements.

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