You can read the full proposal here: 2013 BPHWT Proposal
Burma is a very ethnically diverse country with dozens of indigenous ethnic groups. After independence in 1948, marginalized ethnic groups began to take up arms in the country’s border regions in pursuit of increased autonomy. In addition to long-running instability in these areas, a military coup in 1962 led by General Ne Win marked the start of almost six decades of military rule. The subsequent military regimes, holding power in Burma, have been widely considered to be among the world’s most oppressive governments due to the denial of democratic freedoms; the widespread and systematic perpetration of human rights abuses against its own people; and the persecution of its ethnic minority groups. Despite recent internationally heralded “reforms” undertaken by President Thein Sein’s government, these changes have not yet manifested into substantial sustainable change on the ground.
The seventeen-year old ceasefire between the government of Burma and the Kachin Independence Organization was broken in 2011 and has driven the displacement of over 70,000 internally displaced persons (IDPs) and refugees to the China-Burma border. Even as intense fighting continues in Kachin State, the government of Burma has pursued preliminary ceasefire and peace agreements since the end of
2011 with various ethnic groups in Chin, Arakan, Mon, Karen, Karenni and Shan States. Incidences of armed conflict have decreased significantly since the signing of these initial peace agreements, but fighting has continued in some ceasefire areas, particularly in Shan State. The government of Burma has prioritized development over political dialogue and inclusion, with the lull in fighting prompting incidences of land confiscation to increase exponentially in the ethnic resource-rich regions. Burma Army and their allied armed groups have been forcibly displacing civilians from their homes and confiscating land from villagers at a rapid rate for development projects and/or military camps, while providing the villagers with little or no compensation. The bulk of the development projects are resource extractive projects (i.e., hydropower dams, logging, mining, etc) and are proceeding often without the consultation of local community members and without valid environmental, health and social impact assessments, which is causing legitimate concern among community members that these projects will negatively affect them over the long-term.
In the conflict and current ceasefire areas, the Burma Army (Tatmadaw) and its allied armed forces continue to routinely commit widespread human rights violations against ethnic civilians. These widely documented abuses include forced labor, confiscation and destruction of food supplies, arbitrary taxation, torture, land confiscation, rape, and extrajudicial execution. These ongoing abuses demonstrate that the peace talks have not significantly improved the situation on the ground and that in order to achieve a meaningful, durable peace, the Burma government must be committed to resolving the underlying political and socioeconomic issues driving conflict in the ethnic border regions. The BPHWT recognizes the fragile nature of the peace process and how previous peace agreements have broken down; consequently, BP health workers will continue to take security precautions while traveling and providing health services until a genuine political dialogue and change occur.
(ii) The General Health Situation in Burma
Public health is another casualty of decades of military rule and ethnic oppression. Burma’s current rulers have not deviated from the negligent socioeconomic policies of the past and continue to chronically disregard basic essential social services. Despite almost $20 billion of approved foreign direct investments in 2011, which is more than the
previous two decades combined1, the regime spends around $17 per capita in 2010 on health, amongst the lowest in the world. According to the United Nations Development
Program’s development index, Burma spent less than 2% of total GDP in 2010 on health, leaving Burma in the 149th position in the United Nation’s Development Program’s Human Development Report for 20113. Burma is thus lagging far behind the UN’s Millennium Development Goals (MDGs).
Today, Burma’s health indicators for child, infant, and maternal mortality rank amongst the worst in Asia. Burma’s infant mortality rate was estimated by UNICEF at 50 per 1,000 live births in 2010, with an under-five mortality rate of 66 in the same year4.
These figures also suffer highly unfavorable comparisons with the recorded infant and child mortality rates of Thailand for 2009 at 11 and 13 respectively5.
The main causes of morbidity and mortality in the country are overwhelmingly preventable from disease entities such as malaria, malnutrition, diarrhea, acute respiratory illnesses, tuberculosis, and HIV/AIDS. Burma continues to register the greatest number of malaria deaths and the highest malaria fatality rate of any country in Southeast Asia.
The Health of Internally Displaced Persons:
While the health indicators of Burma’s population rank amongst the poorest globally, the health of IDPs within Burma is even more serious cause for concern. Health indicators for the rural ethnic populations in eastern and southeastern areas are demonstrably worse than Burma’s national rates. IDPs face harsh living conditions in the jungle: their means of survival are a constant challenge. In addition to dealing with the burden of protracted conflict and the high frequency with which they are forcibly displaced, access to state healthcare systems is either extremely limited or non-existent. This situation has resulted in mortality rates which are comparable with some of the world’s most volatile countries at war as shown in the following table:
Eastern Burma’s demographics are characterized by high birth rates, high death rates, and the significant absence of men under the age of 45. These patterns are more comparable to recent war zones, such as Sierra Leone, than to Burma’s national demographics.
In 2010, BPHWT published a report entitled Diagnosis Critical, which demonstrates that a chronic health emergency exists in Eastern Burma. The survey-based report, covering 21 townships and 6,372 households in both ceasefire and non-ceasefire areas, brings to light a legacy of longstanding, official disinvestment in health coupled with protracted civil war and the abuse of civilians. The data showed that among the rural Eastern Burma population, child mortality rates are twice as high as the national average. Furthermore, 60% of deaths in children under the age of 5 are caused by preventable and treatable diseases (for example, acute respiratory infection, malaria, and diarrhea). Infectious diseases are the primary cause of death for both children and adults, with malaria accounting for almost half of all deaths. Moderate to severe malnutrition is also prevalent within IDP populations, at levels consistent with those found in Africa. 41.2% of children under five are acutely malnourished. A water and sanitation survey conducted by the BPHWT indicated that more than 56% rarely or never boil their water and that access to and use of latrines are low.
The estimated Maternal Mortality Rate within the IDP population ranks amongst the highest in the world. One in twelve women in Eastern Burma is at risk of death as a result of pregnancy or childbirth, a rate three times higher than the national average. Since most causes of maternal death are preventable within a functioning health system, this is strongly indicative of the lack of reproductive health-related care and services.
In a survey conducted in 2010 across the States and Divisions in which the BPHWT medics operate, 88% of births were shown to take place at home instead of in a hospital or clinic, usually only with the assistance of a traditional birth assistant (TBA). In unstable environments, it is not uncommon for internally displaced women to deliver their baby in the jungles located deep inside Burma, while hiding from the Burma army patrols. Overall, only 4% of IDP women had access to emergency obstetric care. Many also lack awareness of the dangers of pregnancy complications and how to avoid them. For example, the survey showed that only 41.1% received any iron supplements during their previous pregnancy.
Back Pack Health Worker Team
The BPHWT was established in 1998 by Karenni, Mon and Karen health workers to provide healthcare to IDPs, living along the eastern border of Burma, affected by many decades of civil war. In 2012, the BPHWT provided primary healthcare in 20 field areas with 95 teams to a target population of over 200,000 people. There are currently over 1,500 health workers, living and working in Burma, connected with the BPHWT consisting of 331 medics, 780 TBAs and 403 village health volunteers (VHVs).
As depicted in the Organizational Structure, the BPHWT is governed by the Leading Committee which is elected every three years by the BPHWT members. The Leading Committee is comprised of 13 members who serve a three year term. The Leading Committee appoints an Executive Board of 10 members. This Executive Board is required to meet monthly and make decisions on current issues and planned activities of the BPHWT. The BPHWT has a range of documents that guide the leadership, management, healthcare delivery, health information systems, and human resources of the organization. Full copies of any of these documents are available upon request.
The BPHWT Constitution: The Constitution provides the framework for the operation of the BPHWT through thirteen articles that define: the organization’s name, vision, mission statement, organizational identification, symbol, goals, objectives, policies and principles, actions and implementation, monitoring and evaluation, membership, election of the Leading Committee, amendments to t h e Constitution and organizational restructuring, employment of consultants, and job descriptions for positions.
Vision: The vision of the Back Pack Health Worker Team is that of a healthy society in Burma through a primary healthcare approach, targeting the various ethnic nationalities and communities in the border areas and remote interior regions of Burma.
Mission: The Back Pack Health Worker Team is organized to equip people with the skills and abilities necessary to manage and address their own healthcare problems, while working towards the long-term sustainable development of a primary healthcare infrastructure inBurma.
Goal: The goal of the Back Pack Health Worker Team is to reduce morbidity and mortality, and minimize disability by enabling and empowering the community through primary healthcare.
Financial Management and Accountability: The BPHWT has written financial policies and procedures guiding the Leading Committee, Executive Board, p r o g r a m coordinators, and field staff about financial management and accountability; the production of annual financial reports; and the requirement for an annual, independent audit. These documents establish the financial records to be kept; the management of bank accounts; the procedures for cash withdrawals, deposits transfers, receipts, disbursements and general administration funds; and liquidation of cash assets. There are also regulations for payments for board, lodging, travel and honorariums for services rendered.
Service System: Since 1998, the Back Pack Health Worker Team has been working towards developing an accessible, community-based, primary healthcare service system within the BPHWT field areas based on the health access indicators.