By Jacob Thomases

This year marks the end of the 15-year window given to complete the Millennium Development Goals (MDGs), a set of eight challenges given to the developing world by the United Nations in 2000. Expect an extra level of scrutiny and additional donor dollars paid to Southeast Asia’s developing countries as the United Nations and the global development community take their final measurements of the success of the MDGs. It is an opportunity for Myanmar, which has been under a spotlight because of the presence there of drug-resistant malaria, to receive international help in fulfilling the sixth MDG: combating communicable diseases.

HIV/AIDS fatalities are relatively high, with 18,000 deaths annually in an infected population of less than 200,000, primarily due to lack of patient access to antiretroviral treatment. Thailand, which has more than twice as many people suffering from HIV/AIDS, has a mortality rate about half that of Myanmar’s.

Myanmar’s tuberculosis prevalence – 489 per 100,000 people – is three times the global average. Nine thousand cases of multi-drug resistant tuberculosis (MDR-TB) are estimated each year in Myanmar. The country has only two laboratories capable of testing for it and therefore must export some suspected cases to Thailand for testing, which is a very slow process. There is also a lengthy treatment process for MDR-TB, which is 100 times more expensive than treatment for normal cases of tuberculosis and comes with more side effects. As a result, only about 800 such treatments have ever been undertaken in Myanmar.

Myanmar has the highest rate of malaria infection in the world, and 1,000 people die from the disease every year. Particularly troubling is the growing presence of malaria strains resistant to artemisinin, the most effective remedy for the disease. A recent study by The Lancet Infectious Diseases journal found that 40 percent of malaria parasites taken from samples across Myanmar had the genetic mutation linked to artemisinin resistance. Chloroquine and sulphadoxine-pyrimethamine, which were the primary malarial treatments before the discovery of artemisinin, were rendered useless by drug-resistant mutations that began in Southeast Asia and spread around the world.

Health outcomes are almost universally worse in the country’s border states, where the Ministry of Health has little presence. These areas tend to have poor transportation networks for patients to access medical care. Health information, clinics, and pharmaceuticals are also in short supply. Those living in Shan and Kayin (Karen) states often travel across the border to Thailand for primary care.

Healthcare is technically provided in full by the government, but the reality is that Myanmar’s citizens pay 80 percent of costs out of pocket. The government allocates far too small a portion of its annual budget to healthcare to make a dent in the country’s problems. Spending has encouragingly quadrupled since the 2011 reform process began, but is still just 2 percent of gross domestic product (GDP) – less than half of what neighbors China, India, and Thailand spend. State doctors are underpaid and often have to set up private practices on the side to pay their bills. There are also not enough trained nurses and other health care workers to perform tasks like administering medicine, managing data collection, etc. Public healthcare spending must reach 4-5 percent of GDP if the government wants to significantly combat its communicable disease problem. If the military’s influence recedes from government, it is not unreasonable to hope that the country’s outsized defense spending might give way to other priorities.

The challenges facing Myanmar’s healthcare system, and foreign partners eager to assist, are significant. Members of CSIS’s Global Health Policy Center and Sumitro Chair for Southeast Asia Studies have explored these challenges in more depth, and offered recommendations to meet them, in Myanmar: Regressed, Stalled, or Moving Forward? and Rehabilitating Health in the Myanmar Transition.

Mr. Jacob Thomases is a researcher with the Sumitro Chair for Southeast Asia Studies at CSIS.