Although Burma’s government increased spending on health care in 2013, the rise brought healthcare spending to 3.9 percent of the country’s total budget. While the increase is promising, Burma remains one of the world’s lowest countries in terms of total money allocated to health care. In comparison, the country’s spending on the military remains high, representing 20.1% of the country’s total budget. A recent Reuter’s report noted that Burma is the only developing country in Southeast Asia where spending on the military is higher than combined spending on healthcare and education.

According to a study conducted by the Lancet, Burma has some of the worst health indicators in the world. Life expectancy is 56 years, 40% of all Burmese children under the age of 5 are moderately stunted, and Burma has more than 50% of all malaria-related deaths in Southeast Asia. This is in part due to poor diagnosis and treatment, but also to the widespread prevalence of counterfeit anti-malarial medication.

Although the majority of Burma’s population lives in rural areas, most health services continue to be concentrated in larger towns and cities. For example, according to a 2012 annual report published by the Myanmar Ministry of Health, rural health centers have only increased from 1,337 to 1,565 since 1988. Patients claim many of these centers lack basic supplies, medication, and equipment. Patients with complex medical conditions frequently travel great distances within Burma, often to a larger city like Rangoon, in the hope of finding treatment that is unaffordable or unavailable in their village or town. There are few Burmese hospitals that are able to provide treatment for complex cases, and even at those facilities in Rangoon that do offer care, treatment continues to be cost-prohibitive.

Even with increased investment in the health care sector, Burma faces a long list of challenges when it comes to improving health care in the country. One key challenge will be ensuring designated funds reach intended recipients. Widespread corruption can mean that the government’s increased spending on the healthcare system may disappear before it reaches its intended target. According to the World Bank, Burma ranks in the lowest percentile when it comes to government effectiveness, regulatory quality, and control of corruption—all key factors when it comes to ensuring that the government’s increased spending on health care reaches intended targets.

At the other end of the spectrum, patients are frequently expected to make under-the-table payments as a means to ensure they receive quality care. Burmese patients seeking care on the Thai-Burma border report that bribery is a common and a widely accepted aspect of getting health care in Burma. In addition to the up-front costs of doctor visits, medication, and supplies, patients report having to pay for everything from extra blankets to using the toilet. Families also say that if they want to ensure their loved one receives quality care from hospital staff, they must be prepared to pay extra. Those that are not prepared to pay bribes can expect longer wait times, poor quality care, and some patients report that hospital staff may simply ignore them altogether.

Another key challenge for rebuilding Burma’s healthcare system is the lack of reliable health indicators. In previous years, constraints on health activities in Burma made data collection difficult and presented challenges for accurately assessing and responding to the most challenging health issues in the country. The lack of reliable data is likely to change as more health and humanitarian organizations start working within the country. However, it is important that the government also plays a role in contributing to reliable, consistent, and long-term data collection and analysis that can help inform the country’s priorities in healthcare delivery and investment.

Because Burma faces a long road in rebuilding its ailing healthcare system, a strategic and measured approach must be employed. In addition to continuing to increase spending, the government must take steps to address the needs of resource-starved rural health clinics and hospitals. Additionally, tackling corruption will be essential to ensure that increased spending on healthcare reaches its intended target. Without better monitoring and oversight at the local level, there are few guarantees that funds allocated to healthcare will be used as intended and in the most efficient and effective way possible. Finally, it is essential to have a better understanding of the challenges facing the country. Better data collection and reporting is necessary to get an accurate picture of rates of disease, current healthcare outcomes, and the true resource constraints facing local clinics and hospitals. While there is a long list of challenges facing the country’s healthcare system, attempting to address these issues are important first steps in the right direction.

On the Thai-Burma border, the Burma Children Medical Fund (BCMF) helps to coordinate treatment for Burmese patients with a variety of complex medical conditions. In particular, BCMF serves a large number of patients with heart disease; the majority of these patients came to Thailand in search of treatment after they ran out of options in Burma. Many patients report first seeking treatment at their local clinic or hospital where they received an inaccurate diagnosis and were sent home with TB medication or nothing more than a multivitamin. For those patients that do receive an accurate diagnosis, they are typically referred to a larger hospital in Rangoon as local hospitals and clinics do not have the capacity to treat cardiac patients. A common story is one where patients and their families sell precious belongings or borrow money from a local money lender in order to make the trip to Rangoon, only to find out that the only viable treatment is surgery and that the costs of that surgery are more than they can hope to earn in a lifetime. Out of options and hope, they return back home in debt and without treatment. A few patients may hear about the Mae Tao Clinic operating on the Thai-Burma border from a friend or neighbor. They make the trip to Thailand in a last-ditch effort to get treatment that remains out of reach in Burma. After arriving at Mae Tao Clinic, patients with complex conditions such as cardiac disease are referred to BCMF staff who coordinate and fund their surgery in Chiang Mai.

*Samantha Carter has worked as an auditor for the US Accountability Office and now works for BCMF as a management and program analyst and Naw Htoo Htoo is a program officer with BCMF.

This op-ed first appeared in The Bangkok Post on 24 June 2013