Thursday, May 5, 2016

Myanmar - MSF requests price cut for pneumonia vaccine

Aid organisation Médecins Sans Frontières is demanding that drug companies cut the cost of pneumonia vaccines for poor children worldwide, a move that could greatly affect Myanmar.

MSF has presented a petition with nearly 400,000 signatures to pharmaceutical giants Pfizer and GlaxoSmithKline asking that they drop the vaccine cost to US$5 per child in all developing countries and for humanitarian organisations.

Pneumonia is the leading cause of vaccine-preventable deaths in Myanmar. Recent UNICEF data shows pneumonia accounted for 16 percent of under-five deaths in 2015, with 7516 losing their lives because of the disease.

Myanmar is due to introduce a new pneumococcal vaccine for pneumonia in the coming months. The $20 million project, co-financed by the government and the Global Alliance for Vaccines and Immunisation (GAVI), is slated to run from 2016 to 2020.

A spokesperson for GAVI said they will be purchasing these vaccines from GSK, with each course costing around $9. But if MSF’s cost-slashing request is successful, savings could amount to around $10 million.

Dr Greg Elder, medical coordinator at MSF’s Access Campaign said, “After combined sales of more than $30 billion for the pneumonia vaccine alone, we think it’s pretty safe to say that Pfizer and GSK can afford to lower the price.”

Dr Andrea Incerti of MSF Myanmar said that the pneumonia vaccine, even at the lowest global price, is still “much more expensive” than almost any other vaccine.

“There are many tragedies that cost children’s lives that we can’t do anything about, but today no child should be dying of a vaccine preventable disease like pneumonia,” Dr Incerti said.

Lowering vaccine costs is a move supported by multiple health actors that operate in Myanmar including many NGOs and United Nations agencies.

“Lowering vaccine costs is crucial to increase access … [It] will enable the most marginalised and vulnerable children to be protected from vaccine-preventable diseases, thus reducing deaths among children under-five,” said Maharajan Muthu, Maternal and Child Health Specialist at UNICEF Myanmar.

But drug companies disagree with the suggested ease of lowering the fee. In a statement, drug company GSK said at current production “we are able to just cover our costs and maintain our ability to supply the vaccine to these countries in the long-term”.

The organisation said it was committed to “looking at ways to reduce production costs”.

MSF estimates that pneumonia kills almost 1 million children around the world annually.

Last year, 193 governments at the World Health Assembly unanimously passed a resolution demanding more affordable vaccines and increased transparency around vaccine prices.

Several countries indicated at the event that they are not able to introduce the pneumonia vaccine because of its high price.

By Nick Baker

Friday, April 29, 2016

Myanmar - Malaria Control among neglected populations along the China-Myanmar Border

Infectious Diseases of Poverty has published an article investigating the risk of malaria on the China-Myanmar border and how this has changed over the years. Jian-wei Xu explains more about the work in this blog.

As a malaria control staff member in Yunnan Province of China, I have been working on the China-Myanmar border for 27 years. I’ve heard many stories about malaria, experienced many malaria situations, and joined many intervention activities.

Understanding the high death rates

In November 2003, more than 100 deaths occurred in Kokang, Shan Special Region in Myanmar. At the time, local people and the authorities didn’t know the cause of these deaths. Chinese investigators suspected Acute Respiratory Syndrome (SARS) or plague to be the main cause of these deaths.

Eventually, experts from Yunnan Institute of Parasitic Diseases (YIPD) confirmed it was malaria. For 13 days, between November 7 and November 19, 1392 new cases of malaria and 125 deaths were detected across 30 villages in Kokang, Myanmar.

Intensive efforts with international and domestic financial support to control malaria have dramatically reduced malaria burden on China-Myanmar border over the past decade.

Especially with support from the 6th and 10th rounds of GFATM malaria control projects, and cooperation with Myanmar and Health Poverty Action (HPA), malaria control interventions was able to conduct in five special regions of Myanmar from 2007 to 2013.

Malaria prevalence

As a result of the interventions of GFATM projects, parasite prevalence rate had decreased from 13.6% in March 2008 to 1.5% in November 2013 in the five special regions of Myanmar. Annual parasite incidence had reduced from 19.6 per 10, 000 person-years in 2006 to 0.9 per 10, 000 person-years in 2013 across 19 Chinese counties.

In the Shan Special Region II (locally called Wa State) of Myanmar, our annual indicator survey for evaluation did not detect any malaria parasites in November 2013.

On June 19, 2014, HPA reported a P. falciparum malaria outbreak in a private Rubber Plantation, located close to the border. At the time when the outbreak was reported, there were 122 inhabitants, in 24 households of which 14 families were of the Lahu ethnic minority who emigrated from Lancang County, China in 2004.

There were ten families of the Wa ethnic minority who emigrated from other villages of the Shan Special region of Myanmar in 2005. We realized that our GFATM projects did not cover the special community when we arrived at the outbreak site.

What does our research suggest?

Our investigation results show that imported P. falciparum from Salween River Valley caused the outbreak and that children were at higher risk of malaria infection during the outbreak.

Seeking inappropriate treatment from a private healer who just administered a single artemether injection for treatment of malaria and lack of protection of bed nets were the causes of the outbreak.

The majority of the China-Myanmar border is just a political border where immigration control is only available at those important border crossing points. Illegal immigrants, internally displaced people, refugees and ethnic minorities exist along the mountainous and forested border. However they have limited access to the public health service.

Inappropriate diagnoses and treatments with sub-therapeutic-dosage and/or mono-therapies still exist in the private sector along the international border.

We cannot deny that inappropriate treatments in the private sector have helped to save lives, however, they contribute to maintain malaria transmission and are thus harmful to patient prognosis, public health and also a cause of drug resistance.

In this situation, our malaria control and elimination programs should give special attention to these neglected populations. In order to increase coverage and service of public health facilities, and to strengthen cooperation with private sectors for proper malaria case management, malaria control along China-Myanmar border needs further multilateral collaboration.

Tuesday, April 26, 2016

Myanmar - Danish Ambassador discusses joint Myanmar-Denmark worker health and safety programme

Denmark has a proven track-record of successfully combining economic growth, high employment and social security and so it is fitting that there government is pursuing an initiative help Myanmar with its efforts to improve workplace health and safety.

On April 21, U Thein Swe, Union Minister of Labour, Immigration and Population of the Republic of the Union of Myanmar welcomed Mr. Peter Lysholt Hansen, the Ambassador of Denmark to Myanmar, in order to discuss future cooperation on labour market issues.

Following the meeting, the Union Minister and the Danish Ambassador announced that Myanmar and Denmark will cooperate on an initiative aimed at ensuring safe and healthy work places and improved social dialogue in Myanmar.

In the following interview with Mizzima, the Danish Ambassador explains the importance of the programme and why his government is involved.

Please could you tell us about the initiative being pursued by the Danish government to work with Myanmar to help improve the safety and health of workers in their workplace? How long has this been running and what are the objectives?

The overall goal of the new initiative is to contribute to the development of safer and healthier working conditions and improvement of social dialogue in Myanmar through the strengthening of labour market institutions.

More specifically, the Danish support consists of capacity building activities in two areas. The first of these is the area of occupational safety and health where experts from the Danish Working Environment Agency (which is the Danish government institution responsible for occupational safety and health in Denmark) will be providing advice and technical training on occupational safety and health to the staff at the Factories and General Labour Laws Inspection Department (FGLLID, department under the Ministry of Labour, Immigration and Population).

Basically, this is about the workers of Myanmar being able to go to work without getting sick, injured – or even dying.

The second area of focus will be capacity building of representatives of the social partners in Myanmar (workers’ and employers’ organizations). This training is planned to be carried out by representatives from Danish workers’ and employers’ organisations (peer-to-peer training).

Generally the activities are scheduled to be launched around the beginning of September. However, two weeks of pilot trainings for staff at the FGLLID have already been carried out in September and October of 2015.

What do you see as the challenges to improving workplace safety and health in Myanmar?

The good news is that there is a strong commitment and eagerness to improve the situation amongst the relevant Myanmar authorities. At the same time, workers are increasingly getting aware of their right to safe and healthy working conditions, and employers are starting to realize that good working conditions can both  increase productivity, as well as that it might be a prerequisite for securing orders from large international companies, e.g. in the garment industry.

It is also helpful that the number of inspectors at the FGLLID has increased, and that a new draft law on Occupational Safety and Health is awaiting parliamentary scrutiny. It goes without saying that the situation will not change overnight, but against this background there really is reason to be optimistic.

What is the message your embassy is receiving from Myanmar's new government on this issue?

It is very positive. I met with U Thein Swe, Minister of Labour, Immigration and Population on 21 April. From this meeting it was very clear that the government prioritizes improving the situation of the workers in Myanmar and reforming the labour market in order to foster sustainable economic growth, which will be crucial in facilitating Myanmar’s reintegration into the World economy.

Are the existing workplace laws adequate? Are there plans to change the laws?

As I stated earlier, it is extremely positive that there is strong commitment to labour market reform, because the task that lies ahead is considerable. Positive changes have taken place in the legal framework within recent years. However, attention has to be paid to whether these legal changes bring about the desired results in practice or not, and further legal reforms are necessary too. While legal reforms are a prerequisite for a modern and well-functioning system of labour market governance, it’s no quick fix, though. The capacity of the institutions responsible for implementing and enforcing the new laws will have to be increased too.

In the same vein, it will be equally important to ensure that the legislative process is undertaken in a consultative manner and to further build the capacity of labour market actors so that they are capable of engaging effectively in social dialogue, which is in its very early stages in Myanmar. This is the rationale behind the Danish support.

Concrete steps have already been taken in planning further legislative reform. On November 14, 2015, together with Myanmar, Denmark, the United States, Japan, and the ILO launched the Initiative to Promote Fundamental Labour Rights and Practices in Myanmar, which is intended to help modernize Myanmar’s labour legislation, improve compliance with international labour standards, and foster a robust dialogue between the government, business, labour and civil society.

Is there anything else you would like to add?

The importance of well-functioning social dialogue – understood as negotiation, consultation or simply an exchange of information and views between representatives of employers, workers and governments – really should not be underestimated.

Take the Danish example. Denmark has a proven track-record of successfully combining economic growth, high employment and social security. This success is frequently attributed in large part to the particular institutional setup of Danish labour market governance – which is characterized by a strong cooperative spirit amongst the government, trade unions and the employers’ organizations.

The Danish system was established as far back as in 1899 when a major industrial dispute ended. The dispute ended only as the social partners recognised each other and made an agreement about the rules on the labour market. A revised version of this agreement is still valid today.

Sunday, April 24, 2016

Myanmar - Increasing anti-venom production to prevent snakebite fatalities across Myanmar

Snake bites are well-known medical emergencies in many parts of the world, especially in rural areas.

The incidence of snake bite mortality is particularly high in South-East Asia, home to many different venomous snakes, and farmers, rural workers and children are often the most at risk. In 2009, snake bites were included in WHO’s list of neglected tropical diseases, recognising how snake bites represent a common occupational hazard and result in thousands of deaths and chronic physical handicap cases every year.

Much is now known about the species of venomous snakes responsible for these bites and the clinical effects of their venom in humans. In Myanmar, the most common venomous snakes are the Russell’s viper (Daboia siamensis) – responsible for almost 90% of bites in the country, the Monocellate cobra (Naja kaouthia) and the Banded krait (Bungarus fasciatus), which are widespread throughout the nation.

In 1999, the Ministry of Health initiated a programme for the management and prevention of snake bites, with technical support from WHO especially in terms of capacity building. Fellowships are provided to both staff members of the MoH and of the Myanmar Pharmaceutical Factory to conduct research in different institutions of the South East Asia region and receive training on the production of anti-snake venom and the clinical management of snake bites. In-country training is also provided to health personnel, especially in high risk townships where the occurrence of snake bites is most frequent.

The Anti Snake-Venom Production Centre of the Ministry of Industry in Yangon is one of the high-technology facilities that have benefitted from the collaboration with external partners, in particular Australian, Brazilian (Instituto Butanta, Sao Paulo, Brazil) and Thailand (Thai Red Cross) institutions” . The Production centre is responsible for the nationwide production of anti-venom, and is now able to cover for the country’s needs thanks to increased investments and the implementation of new technologies.

Thanks to improvements in all steps of the production process – from ensuring better health and survival rates of horses and sheep, from which the anti-venom anti-bodies are extracted, to using new purification methods to improve the quality of the product – the Production Centre has been able to increase production of specific anti-venom vials (anti-viper and anti-cobra the two most common forms of snake bites) from around 30,000 in 2007-08 to 80,000 vials in 2015-16”.

The production of anti-venom is essential to ensure that the consequences of snake-bites can be mitigated: around 8 vials are needed to treat a single bite, and there is a limited time span (only 3-4 hours after the bite) within which the anti-venom can be fully effective. The time limitations for treatment call for an increased dissemination of anti-venom across the country, in particular in Rural and Sub-rural health centres, where most cases are likely to be reported. In order to tackle the difficulties of storing the anti-venom vials and prolonging their shelf life, the Ministry of Industry and the MPF Anti Snake -Venom Production Centre has implemented a new technology for producing anti-venom, which will allow the lyophilisation of the product to ensure its durability and prolonging its effectiveness even in more difficult storage conditions.

WHO remains committed to supporting the Ministry of Health and the Ministry of Industry in improving the production and dissemination of anti-venom across the country, to ensure that this important public health threat for Myanmar can be effectively managed and controlled.

Myanmar - Myanmar Authorities Checking Chickens For Bird flu Spread

The Myanmar authorities are taking measures in Mandalay region in a bid to prevent spread of bird flu which broke out in Monywa, northwestern Sagaing region earlier this month by checking regional main border gates, according to an official of the Department of Livestock Breeding Friday

The authorities are checking the delivery of chickens through Ayeyawaddy bridge (Yadanarbon ) linking Mandalay and Sagaing and Yadanar Theinga bridge linking Shwe Bo township and Singu township.

Farming zones in the region have worked to prevent spread of bird flu.

At present, chicken prices in the market stand high due to increasing deaths of chicken amid the high temperature in summer.

According to the Ministry of Health, bird flu occurred in 47 poultry farms owned by 29 breeders in Monywa and 23, 226 chickens were culled earlier this month. Enditem

Monday, December 30, 2013

Myanmar - Myanmar’s ‘Big Sister’ Leads in HIV Fight

An organization formed by sex workers for sex workers is making strides in reducing the rate of infections.

Myanmar may have grabbed the world’s eye by opening its borders and ushering in a foreign investment surge, but one story has slipped quietly under the radar. The country has also significantly reduced the rate of HIV infections in its sex worker population from its previous high of 40 percent in females 2005, according to Population Services International (PSI) down to less than 10 percent today.

“Myanmar allowed sex worker-run programs to organize and scale up over the last eight years using an empowerment-based model, rather than a coercive testing model like the 100 percent condom programs in Thailand and Cambodia. The success of the program in reducing HIV rates so dramatically shows investing in sex worker-run programming works,” Andrew Hunter, program and policy manager of the Asia Pacific Network of Sex Workers (APNSW), told The Diplomat.

Myanmar’s HIV epidemic paralleled Cambodia’s, which peaked at over 42 percent for brothel-based workers and 18 percent for entertainment workers a decade ago, according to the National Center for HIV/AIDS, Dermatology, STD (NCHADS), but its peer-led outreach did so with far less media attention and international NGO fanfare.

Not Smothered by INGOs

Melissa Hope Ditmore, one of the foremost researchers on worker-led initiatives in the sex industry, documented a case study of Targeted Outreach Program (TOP), the largest HIV prevention program in Myanmar initiated by PSI. The project has been unique for reaching up to 55 percent of female sex workers and 70 percent of MSM out of the country’s estimated 60,000 sex workers. From NYC, Ditmore told The Diplomat “TOP was very successful working against HIV and STIs. We know that community-lead initiatives are the most effective.”

Kay Thi Win started working in 2004 with TOP in peer education after being approached by them while employed as a sex worker. It was a job she came to from economic hardship after her father died in 1998, while she was studying at high school. Win’s mother could not support the family and they lost their home. In 2000, a friend introduced her to sex work as a way to support her family. Initially she told them she was working at a factory near the Thai border, but now they know about her work and support her. According to Raks Thai, an NGO that helps migrant workers, reports that migrants from Myanmar comprise the largest groups of all migrants in Thailand due to limited work options, but Win preferred to stay in the country.

She learned about the HIV epidemic sweeping the country from TOP and how to use condoms for protection. Win told The Diplomat from a conference on HIV in Bangkok that by 2012 the rate of HIV had declined to just 7.1 for sex workers. Though no longer working for TOP, she still refers sex workers to the project for health services.

Win now heads the AIDS Myanmar Association (AMA). AMA is Burmese for “big sister.”  Win says that AMA is the only 100 percent sex worker-led organization in the country. “AMA does health education, referral health services for HIV, and STI counseling and treatment. [There is] sexual and reproductive health treatment, also for our members who are getting sick,” said Win.

Ditmore explained “Sex workers have since started a project that they direct, rather than being a subsidiary of another project. I expect that if AMA continues its work, which is lead by sex workers, that it will have great success and boost the reach of existing services to which they refer others.”

AMA’s work has also caught the eye of the Association of Women’s Rights in Development (AWID), the “only international feminist membership organization.” Win was invited to speak to AWID in the beginning of 2012 and surprised the organization by saying that sex workers do not see themselves as victims in need of rescue but are rather the empowered one in the financial transaction. She now sits on AWID’s board as the first sex worker to do so in its history.

Staying Safe in Sex Work

The feminist group awarded AMA a grant for teaching financial skills to sex workers. “We believe that sex workers earn a lot of income but do not know to how to save their money,” Win explained. “AMA advocates with bank staff and managers to provide training for sex workers [on the] banking system and information about bank savings.” Win adds, “Many of sex workers do not have a National Identity card,” which she says is needed to open a savings account.

Win thinks women working in entertainment clubs like beer gardens and karaoke clubs (KTV) make “around $100 to $200 money per month from drinking and pocket money (tips), with the salary.” Though no exact data is reported, a large number of people live on $2 or less a day in Myanmar (49 percent of Cambodians do so), so this is a large sum of money.

“The first job is to be an entertainer and they are paid about $30 a month, then they can be a sex worker. We also have ‘beer girls’ [beer sellers]. They sell beer in a bar, but they don’t have to drink beer. They are paid about $70 a month, but if they sell more beer, they get a percentage of that. A ‘bar girl’ [a term used to describe women who provide company to men visiting the bar] gets a salary of around $50 to $80 a month.” Bar girls and beer sellers are also common in Cambodia.

“We also have karaoke and night club workers. If a sex worker gets a drink at the club, she gets a percentage of the drink. If the client gets a session at karaoke, he will often drink with her and she can [get a percentage} of that as well. Massage workers don’t drink.”

Win notes that the clients are mostly locals. “There are far fewer foreign men.” Of the foreigners, most are Asian businessmen. “Sometimes local customers give more [money] than foreigners.”

 “We have condoms in brothels, massage places and KTV, but some of the KTV and massage owners or managers do not want us to take them but we try to keep them with girls and do advocacy toward that.”  Win says that “unofficially” condoms are used as evidence by police to arrest sex workers but they are not used to prosecute them in court.

Street-based workers comprise the majority of AMA’s members at about 70 percent. Win says rather than being the “poorer option,” some choose this over club work, preferring to be more independent. “In Myanmar sex workers from different cities and ethnicities, but [there are more] Burmese. We have a significant number of male, transgender sex workers and bisexuals.”

AMA is also supported by Myanmar Health and Development Consortium (MHDC) through a grant from UNFPA. The UNFPA and UNDP are working with AMA on a report on violence against sex workers. Dr. Hla Hla Aye, UNFPA Assistant Representative, Myanmar Country Office explained in an email to The Diplomat: “The decline of the HIV epidemic in Myanmar is due to the coordinated efforts of all stakeholders and national leadership with support from the UN and other actors together with community empowerment…however, the prevalence is still high in IDU [injecting drug users], SWs, and key affected populations still face the risk of stigma and discrimination, but to a much lesser degree compared to ten years back.”

U.N. affiliate Global Commission on HIV and the Law recommended in their report HIV and the Law that sex work be decriminalized to improve the global HIV response, an initiative that APNSW, the regional sex worker network wholly supports.

Tracey Tully, Advocacy & Communications Officer for APNSW, told The Diplomat “We argue in favor of full decriminalization of sex work, because sex workers have the right to work with other people. Sex workers have the right to work with cleaners, receptionists, administrative staff, security personnel, drivers and sex workers have the right to work for establishments, to have bosses. To put it simply: ‘If my boss is criminalized, I cannot use condoms.’  Any form of criminalization will have a detrimental effect on sex workers’ ability to negotiate safe sex and on community’s ability to respond effectively to the HIV epidemic.”

Antiretroviral Therapy Drugs (ARV) in Myanmar

Access to treatment for HIV positive people in Myanmar is a major problem, especially for people in rural areas. It affects not only sex workers but also migrants living in Thailand.

 “We would say that access to Antiretroviral Therapy drugs (ARV) is still a challenge for Myanmar however, a decentralization program for ARV has been initiated to overcome access problems,” noted Dr. Hla Hla Aye of the UNFPA.

AMA is proactive here as well, providing ARV to its members and a place (an apartment) for them to stay in Yangon while getting medicine “because people need to stay a minimum of two weeks to a month,” said Win.

While AMA has found a way to help its members, HIV positive migrants face treatment obstacles. Brahm Press of Raks Thai Foundation told The Diplomat they are highly mobile group and separated from their networks at home, so tend to seek out sexual companionship. Though a survey identified the use of sex workers’ services without condoms as a path of transmission for Burmese fishermen, Press clarified that these tend to be “sweetheart” relationships. Because of the perceived level of intimacy, condoms were not used. “Serial monogamy without condoms has been identified as a path of HIV infection.”

Unlike Myanmar, Thailand has national health insurance with access to ARV, but migrants may not necessarily be able afford it. Press said “Just recently the Thai government announced a change in the general health insurance for migrants. They raised the price to 2,200 baht a year, plus another 600 for the health examination, annually. This new rate includes ART and, supposedly, all migrants, regardless of documentation status can subscribe. The catch is, the government estimates they need 300,000 migrants to enroll to break even. There is inconsistent implementation of the policy with a number of hospitals not announcing the new policy; and at some locations, migrants living with HIV who bought health insurance prior to the announcement of the new policy were told that they still need to buy ARV out of pocket and cannot buy into the new insurance until their old one expires. With a lack of access to ART, some are advised to return to Myanmar, which has access problems itself.”

Press explained that even though migrants may find treatment at home, eventually they will want to return. “[Migrants] come from rural areas and there are still not enough jobs in their home countries. So, even if they do go home to start treatment, they will most likely return to Thailand once they are strong, to continue working. And that raises other concerns about adherence.”

Though solutions are being worked on for those needing ARV treatment in Myanmar and Thailand, the means to economically support oneself while on treatment appears to be another obstacle in resolving Myanmar’s HIV situation.

Ditmore reported that programs like TOP prioritize hiring sex workers who are HIV positive for peer education, but limited job openings will likely be an issue for sex workers – who often also come from rural areas – at least until Myanmar’s economy becomes stronger.

Michelle Tolson

Sunday, March 17, 2013

Myanmar – Healthcare

In March, I will be heading into Myanmar as part of a syndicated research project with the objective of profiling the country’s healthcare infrastructure. 

We will be evaluating distribution channels for pharmaceuticals, medical devices and diagnostics.  Included in our analysis will be profiles of the existing distribution companies who currently have the footprint in country to effectively and efficiently access Myanmar’s healthcare system.  We will also be profiling regulatory issues in general, as well as those specific to healthcare.

Once among the most reclusive nations in the world, Myanmar (also known to many as Burma) has begun a series of political reforms that are designed to attract foreign investment into the country.    With a population the US government estimates at approximately 55 million, Myanmar is the 24th most populous country in the world and the second largest country in Southeast Asia in terms of landmass.  Despite its plentiful natural resources such as natural gas and timber, Myanmar is the poorest country in Southeast Asia.  The country’s poverty stands in stark contrast to its relative wealth from only 50 years ago when, at the beginning of the military junta’s rule, Myanmar was the wealthiest country in Asia.

Much of the hopes foreign investors have today for Myanmar are based on a recollection of what Myanmar once was, and hopes the foundations for a prosperous country can still be found. In addition, for many multinational companies (MNCs), Myanmar further adds to the commercial opportunities in the region.  Many MNCs believe they will be able to pivot from their operations in Thailand (65.9 million people) to serve Cambodia (14.5 million), Laos (6.4 million) and Vietnam (87.8 million) and now, the possibility of Myanmar as well.  Viewing the combination of these five countries together and crafting distribution strategies tailored to the almost 230 million consumers in the region constitute an important and compelling business opportunity.

For Myanmar to become a viable emerging economy where MNCs and private investors can confidently deploy resources, the recent attempts at democratization of the country’s political system and liberalization of its economy must continue.  Neither is certain.  The country’s recent political reforms took place against a backdrop of long-standing grievances by its people regarding political and economic issues.  At a very basic level, the new government’s pledge to triple the country’s GDP in five years is a reflection of the political reality that further turmoil is likely unless the economy can find its footing.  This admittedly audacious goal may be within reach providing Myanmar is able to pivot government economic development away from central planning and military spending towards free markets and investments in education and healthcare specifically.

Political reforms have certainly created latitude for the new government to act even in the face of a similar crisis; however, the final note potential investors should keep front of mind is that Myanmar’s reforms are still reversible.  While the release of 700 political prisoners, the accommodation of certain limited but substantial democratic reforms, and the relaxation of basic freedoms are encouraging, Myanmar has a long way to go.  Nobel Peace Prize winner Aung San Suu Kyi pointed this out earlier in 2012 when she noted, “”Ultimate power still rests with the army so until we have the army solidly behind the process of democratisation we cannot say that we have got to a point where there will be no danger of a U-turn. Many people are beginning to say that the democratisation process here is irreversible. It’s not so. We must wait until after the elections to find out whether or not there have been real changes. And depending on these changes, there should be suitable changes in policy.”

The Myanmar government of today led by Thein Sein has retained many of the same military officers who previously constituted the junta.  While it is not surprising these former military officers now have positions in the new government, their resistance to key democratic reforms and their willingness to allow foreign companies to compete with previously protected domestic companies will be key to monitor.  In the same way, most of the established businesses that had found a way to survive and prosper under Myanmar’s repressive political and economic system for the last several decades are likely losers in the midst of a broad opening of the country’s economy to outside investment.  President Thein Sein’s proposed changes to the State-Owned Economic Enterprises Law (SEE Law) resulted in significant pushback from the established businesses, largely a reflection of these fears.

Regardless of these cautionary notes, Myanmar has already been successful drawing FDI. Some of the early in-bound investment has come from Chinese and Thai investors in low-wage, high labor-content industries eager to take advantage of these factors.  Other more promising areas that have driven FDI thus far have been oil and gas exploration (in particular natural gas, of which Myanmar is estimated to have the world’s 10th largest reserves of), mining and forestry.  Cumulatively, China has close to US$14 billion of investments in Myanmar, followed by Thailand (US$9.6 billion) and then third Hong Kong (US$6.3 billion). Most of these investments have gone to secure oil and gas resources as well as mining and some agricultural land.  Myanmar’s potential as a regional agricultural exporter is significant; China already is looking to source feed crops from Myanmar. Thus far, Myanmar’s FDI patterns are noticeably different than those of what are commonly referred to as the Asian Tigers.

As other resource-rich countries globally have illustrated, simply having access to bountiful natural resources does not guarantee a wise use of tax revenue and national wealth accrued as resources are extracted and exported.  Those hopeful about Myanmar’s future believe the country has the capability to develop political leaders capable of rooting out corruption and ensuring FDI and tax revenues flow towards the nation’s economic development.  One of the primary beneficiaries of such a positive approach would be the further development of Myanmar’s healthcare system.  However, the danger does exist that Myanmar’s FDI may be misdirected.  Some analysts believe the comparison between Myanmar and other regional economies is, at least thus far, an un-earned comparison.  Jared Bissinger, an academic researcher on Myanmar’s FDI policies recently wrote, “While there’s also some interest in telecoms and banking, it’s the extractive industries that are Burma’s main draw for potential investors.  The Asian Tigers, by contrast, were mostly resource-poor and relied on export-oriented manufacturing to develop.  Their foreign direct investment (FDI) was mostly in manufacturing, not resources.  They also developed in a much different international environment, one with far fewer competitive exporting countries.  They sold their wares mostly to the high-consuming countries of the West, the same countries that are now grappling with the lingering effects of the global financial crisis.”

Over the course of the next month, our blog will be introducing more details about the challenges specific to healthcare FDI into Myanmar with an eye on how to best capture the opportunity represented in the country’s recent opening to foreign investment and expertise.  We will be discussing structural issues related to basic infrastructure (power, water, road, rail, etc.) as well as very specific questions such as how to get the necessary government approvals for new drugs to be brought into the country.  Ultimately, the research completed as part of this project will be summarized in a market research report that will be available for purchase.