I first set foot in Myanmar in 2012. It was a special assignment, I was part of a delegation, led by the General Manager of the Global Fund to Fight AIDS, Tuberculosis (TB) and malaria, on an official visit to the country.
We met the health minister, partners, the national health programs officials, civil society groups and the lady herself. At that time she was a Parliamentarian, based in Naypyidaw, the capital city. I recalled seating in the car heading towards the capital from Yangon; it was raining cats and dogs since morning, I was not sure if the driver could properly see the road. Flying was not logistically possible that day. Needless to say, during the entire 325km bumpy ride, I was wide alert.
At Naypyidaw, we faced another challenge – locating the residence of Daw Aung San Suu Kyi, the Rose Cottage. Telecommunications were very limited, let alone the use of any GPS. Myanmar only started to liberalise communications services in 2013. Thanks to our experienced drivers, we managed to find the Rose Cottage, a simple single storey house among a few similar looking houses. We had to wait for our turn, the group before us had apparently overshot their meeting time allocation.
After a few minutes, we were greeted by Daw Aung San Suu Kyi and her aide. We sat at a simple rectangular table and were served tea. Our head of delegation spoke about our programmes in Myanmar and the important role of parliamentarians in policy development, and how the Global Fund supports the work of civil society in Myanmar. She was very receptive and supportive of the initiatives but also emphasised on the rule of law. She was not the warmest person I have ever met I must say, but she exuded confidence. This type of visit continues each time a senior official visits Myanmar. In a way it is to maintain and strengthen relationship, in another way to exchange views on the health landscape, and in another subtle way to get a feel of the political situation in the country.
On the political front, I was often asked about the situation of Rakhine. I was also often asked about the ethnic minority controlled areas in the country. I will not go into details but suffice to point that it was not easy to work on a portfolio of grants in a country where situations were constantly evolving sometimes at a rapid pace and approaches on programmes needed to be adapted according to the situation while ensuring the targets or end results were not compromised.
Apart form navigating political sensitivities, the international development and humanitarian actors had to deal with Myanmar’s proneness to natural disasters; the largest being the Nargis. Myanmar, is also a country that bears high disease burden, for example it is one of the 30 high TB and multi drug resistant TB burden countries in the world. Despite it all, Myanmar made remarkable achievements in reducing the HIV, TB and malaria burden in the country. On fighting malaria, a decade ago Myanmar had more than 1 million malaria cases every year; as of 2019 this number dropped to 108,000, and a significant decline in malaria-related deaths from 1,707 in 2005 to only 30 at the end of 2017. Death related to TB saw a 78% reduction from 2000 to 2019. For HIV, a total of 184,544 people were on antiretroviral therapy compared to 40,128 in 2011. Further information can be found here and here.
Part of the success is attributed to the willingness and openness to dialogue between Myanmar and the international community. This was especially relevant to the Global Fund because of its “dark” history in Myanmar – it abruptly withdrew its support to the country in 2005. It took five years to persuade the government of Myanmar to re-engage with the Global Fund. In 2011, after much efforts on “reconciliation”, the Global Fund resumed activities in Myanmar. Even so there would still be occasional awkward encounters when a senior official would bring up the topic on the 2005 termination.
I cannot write about the tremendous progress of the Global Fund in Myanmar with the support of international partners without highlighting the dedication of its people. Those who have experience in large donor funding would know how burdensome it is – the amount of rigour, complexity and the demand required from grantees, from funding application to implementation, monitoring and closing of the programmes. Two observations I witnessed in my eight years working on Myanmar programmes – the Myanmarese are very organised and are never late for appointments. Perhaps it is to do with the long years under the military administration. Myanmarese are very proud people. They take pride in the achievements gained in the health front and want to sustain them, examples include the increasing domestic financing in health and the government taking over the handling of HIV treatment in the country in 2019.
Recent developments have been ugly in Myanmar. The international community have rightly condemned the military coup. The United States have imposed sanctions on the military. But it has also maintained support for healthcare, civil society groups and areas directly benefitting the people of Myanmar. This is a positive signal, from a health perspective; it was absolutely needed as the gains achieved since the country started its democratic path is enormous. Reversing these gains is not an option.
Lest we forget during the democratization process and when Daw Aung San Suu Kyi led the country, Myanmar was still under strong military influence. Throughout my career at the Global Fund, I have witnessed at least three health ministers, one being a former major general who was appointed as minister in 2015.
The world should consider that since the opening of the country to democratisation, many lessons have been learnt especially on navigating the country’s political labyrinth. Perhaps instead of looking deep and far for solutions to the current situation, if not already done. it might do good for the international community to take on the lessons over the past decade in dealing with the current Myanmar. For all is not lost.