The intersection of politics and healthcare is a messy one. It is not straightforward, like the uncompromising multi-lane highways of Naypyidaw. It is a tangle of emotional, financial, and judicial paths; of competing priorities, historic resentments and ideological justifications. It is all about the management of a behemoth of competing administrative, fiscal and clinical interests. Politically, it’s a minefield; just look at Obamacare, or the controversial so-called ’privatisation’ of the British NHS. At its core though, we all want to enjoy decent health, both for ourselves and our peers. A healthy taxpayer such as myself, who might have visited their GP once or twice over the course of decades, does not resent the democratic pooling of resources for the greater good of a healthier, more able society. I - we - hold our healthcare services dear; and so we should. But that doesn’t mean we shouldn’t reform them and constantly push ahead with developing policies that essentially have one simple aim: better care for more beneficiaries. That, after all, should be the goal of any government’s healthcare manifesto.
Demographic change is the main driver for healthcare reform in Europe and the US. Most of us will live longer, managing ever-complex healthcare needs and chronic illness with costly pharmaceuticals, thus increasing the ‘burden’ on the state’s coffers. Heading off long-term policy impacts is a luxury of governments with money to spend and expertise to harness. But what about a country like Myanmar? Healthcare expenditure as a percentage of GDP is still relatively low, lagging at 2.7%. (Compare this with the region’s star pupil, Vietnam, at 6%.) Even if Myanmar’s health ministry were better funded, the country would not have enough medical professionals to deliver policies. The number of doctors, nurses and midwives increased by one fifth between 2006 and 2011, boosting the total from 1.27 to 1.49 per 1,000. According to the WHO, however, that is still “far below” the global standard of 2.28. How can a shoddy healthcare infrastructure absorb huge amounts of aid effectively? The depletion of professionals where they are needed most is as problematic as anywhere: young professionals avoid working in the state sector due to low salaries, and those who do join are immediately posted to rural areas at an entry-level salary of less than US$200 per month. Curiously this mirrors the ‘brain drain’ we see in any rural community across the globe. And it raises much more abstract, and difficult, questions about the motivating factors of clinical professionals, the morality of healthcare, and the role of free-market ideology in healthcare. But it would be dangerous to draw parallels to the west. Just as our recent foreign interventions have failed militarily and diplomatically as a result of the reckless imposition of alien ideals on traditional cultures, so too would it be wrong to try and impose our western ideals of healthcare delivery on Myanmar. What is the ideal, anyway?
The fact that the Myanmar government, pre-election, announced plans – developed with the input of INGOs - to increase the healthcare budget with an annual growth rate of 6% until 2020, is a good start. But it’s not enough. Depending on the precise make-up of Myanmar’s new government, the National League for Democracy must acknowledge the need to develop the country’s health sector, and in doing so recognise the role that small NGOs and INGOs, like The Angus McDonald Trust, have to play. Aung San Suu Kyi’s party has the potential to draw incredibly exciting plans on a blank canvas, winning more hearts and minds in the process. And in an ideal world Myanmar’s dizzying diversity of ethnicities and landscapes can and should be exploited to develop healthcare solutions that last, as well as aiding the peace process. Joint immunisation drives and other so-called convergence projects could bind neighbouring states; health-workers deployed by central government could collaborate with counterparts, sharing knowledge and expertise; healthcare reform could be a dividend of an ongoing peace deal. And some way ought to be found to de-politicise it.
But I’m afraid that this all sounds far too starry-eyed, if not downright far-fetched. Let us not ignore the tragedy of the Rohingyas, the inter-communal violence that drives bloody wedges through communities, the sinister advance of Buddhist extremism, which is seeping further south. Arguably, policies around education and conflict resolution should come higher up the list of priorities than healthcare. Ignore it, however, at your peril. Rakhine State proves that healthcare and politics are inextricable: here, the choking off of healthcare funds was used as a repressive political tool, hitting citizens where it hurt hardest. Experts disagree over how it can recover; but all agree that is has been set back by years, if not decades. Resentments have built up around the varying degrees of care that communities just metres apart receive, and this would blow apart my theory that healthcare can be a tool that adapts to the different needs of its beneficiaries. Instead, healthcare as a means to exploit inequalities seems to be the prevailing practice.
These are all issues to reflect upon as we enter a new year, and Myanmar enters a new chapter in its political history, with reverberations to be felt by 52 million people. Constitutional questions aside – and the big elephant in the room is whether the military will relinquish power, or rather to what (if any) extent – the incoming administration has ample political capital to spend, and the eyes of the world are watching to see how the monarch-like Daw Suu will mould a new Myanmar. We watch and wait, and here at the Trust we hope that our work can continue unabated in uncertain times. A happy new year to you all!