From the PATH office in Yangon, located in a modern seven-story condo building, I look down on a busy thoroughfare choked with buses and cars, and across a skyline of apartment rooftops increasingly dotted with cellular antennas and satellite dishes. But we can also see a simple outdoor vegetable market where I often stop, like many locals, to buy fresh dinner ingredients.
As I visit my favorite seller, who sits on a stool under an umbrella behind a profusion of leafy herbs, fresh tomatoes, and ripe mangos, I participate in a daily market ritual that has changed very little in several generations. And as I head home from the office, I can see the enormous golden Shewdagon Pagoda, a 344-foot-tall Buddhist temple visible from everywhere in the city, connecting this culture to a religious tradition that dates back millennia. This is Myanmar: rapid change and modernization mixed with deep, ancient traditions.
Living in Myanmar during this period has been an enormous privilege. Since 2011, social and economic reforms—from the abolition of the censorship board to the opening up of the telecom market to competition―have ushered in new rights and opportunities. But deep challenges remain, not the least of which is an outdated, under-resourced health care system.
Myanmar spends just 2 percent of GDP on health care, one of the lowest rates in the world. While the elite fly to Bangkok for top notch care, everyone else here makes do with poorly equipped hospitals, rudimentary clinics, or the village midwife. Doctors, who earn very little, often demand stiff out-of-pocket fees for their services.
Since the country first opened up, international development agencies have been coming to Myanmar’s aid—strengthening health care delivery systems and fighting back against infectious diseases like HIV, malaria, and tuberculosis. With many organizations now on the scene, I am often asked to describe what is unique about PATH and what we have to offer.
Public-private solutions, technology, and innovation are the words that come to mind first. PATH is well-suited to work in Myanmar because we specialize in building collaborative, locally appropriate solutions that are designed to be self- or government-sustained long after donor funding trends have moved in another direction.
Our work here is an extension of the deep expertise we have delivered on the ground in Southeast Asia for 35 years. Initially, we are focused on these three areas:
Nutrition is a major challenge in Myanmar. Nearly 40 percent of children under five are stunted. Deficiencies in vitamins and minerals have lifelong consequences on health, productivity, and mental development.
PATH’s flagship project in Myanmar is improving nutrition through rice fortification. In Myanmar rice is a staple food, and our unique approach does not require people to change their eating habits. Working with local commercial partners we’re producing vitamin- and mineral-packed fortified rice kernels that are then blended with regular rice. By working with local partners to manufacture, market, and distribute the rice we are creating a self-sustaining market for a highly nutritious food.
2. Reproductive health and family planning
Women in Myanmar are struggling to gain control over their sexual and reproductive health and rights. It is estimated than nearly a quarter of women of childbearing age have an unmet need for contraception, locally referred to as birth-spacing. This results in unintended pregnancies, with many ending in unsafe abortion. Myanmar women traditionally give birth at home with a midwife, but for poor women in remote villages too often there is no skilled birth attendant, and newborns and infants die at an alarming rate.
PATH is working on a number of fronts to make life better for women and girls here. The first step is family planning: we are advising government officials on an approach to strategically target public resources, while creating a market for birth control pills, condoms, and other products that some can afford to pay for out of pocket.
Next is essential newborn care—training health care workers in effective strategies to save compromised infants in the first minutes and hours of life.
And finally, we are protecting women against cervical cancer—a disease which is killing women unnecessarily because they don’t have access to screening. By introducing screening and treatment methods that are viable in low-resource environments, we are saving lives.
Women’s ability to stay healthy, keep their children healthy, and control the size of their families will be central to Myanmar’s development. PATH is committed to this work.
PATH is eager to bring our vaccine and immunization expertise to Myanmar. In recent years, Myanmar’s immunization program has been steadily improving, with coverage rates reported to be 85 percent. But in a complex environment like Myanmar, there are significant systemic barriers, particularly in 70 townships that are physically and socioeconomically hard to reach.
We’re mobilizing resources to assist the Myanmar government with these challenges and to support them in the introduction of new vaccines to protect against diseases such as Japanese encephalitis, a deadly brain infection spread by mosquitos.
In a hospital here in Yangon, I recently visited the only pediatric neurology unit in the country—a place where desperate parents from remote parts of the country bring their impaired children. While their symptoms can be managed, there is no cure. PATH has supported other countries in Southeast Asia to introduce the Japanese encephalitis vaccine, I hope we can soon do the same here.
My time in Myanmar has left me deeply appreciative of the warmth and grit of a people who have endured a long and troubled history. Their language has no word for “no” and their standard greeting is “Have you eaten breakfast?” Our work at PATH gives me a window into their struggles and the magical difference a little innovation can make. As Myanmar heads into a new era, I hope together we can ensure that everyone in this country has a chance to eat breakfast every day, stay healthy, and live their best life.
- Ingrid McDonald was formerly a program adviser for the Mekong Regional Program at PATH.