Medical staff take a swab sample from a woman to test for the Covid-19 novel coronavirus at a clinic in Insein, Yangon on September 21, 2020. Photo: AFP/ Ye Aung Thu

CHIANG MAI – As Covid-19 infections and pandemic deaths skyrocket in Myanmar, the legacy of decades of mismanagement of the country’s health sector has come into glaring view.  

On October 29, Myanmar recorded a total of 50,503 confirmed cases and 1,199 deaths, up from 10,734 cases and 226 deaths a month ago. But that’s likely only the tip of the Covid-19 iceberg considering there are no nationwide health services for testing and treating patients.

Tests have been conducted mainly in urban centers as much of the country lacks even basic health facilities.

With a population of 53.6 million according to the latest census, that makes Myanmar among the hardest hit nations on a per capita basis in Southeast Asia, trailing only Indonesia, the Philippines and Singapore.

The situation is at a tipping point with patients unable to get adequate care due to a lack of medicines and equipment. Temporary hospitals for Covid-19 patients are now being established in football stadiums and other open spaces due to overflowing hospitals. 

Complaints have been aired in the media about poor conditions and questionable health practices, including instances where patients who have tested positive for Covid-19 being forced to share rooms with those who have not.

According to UNOCHA, the rapid rise in Covid-19 cases and subsequent prevention and control measures continue to limit the ability of humanitarian actors to reach displaced and other people in need of assistance in Rakhine, Chin, Shan, Kayin, and Kachin states.

Volunteers lower into a grave the body of a person suspected of dying from the Covid-19 coronavirus at a cemetery, in Yangon on October 26, 2020. Photo: AFP/ Ye Aung Thu

Other sources tell of untested, returning migrant workers being housed in schools, monasteries and government offices. Many of the new centers are being run by unpaid volunteers who get nothing more than food and a place to stay.

They often lack protective suits and necessary equipment and medicines to treat the patients and in many instances have to transport the bodies of the deceased to their homes.

Infections may have slowed down somewhat over the past week in the commercial capital Yangon, but they are now on the rise in Rakhine state, Bago, Mandalay and Ayeyarwady regions.

And this is likely only the beginning of an upward trend that the country’s even normally poorly equipped hospitals and clinics are in no position to handle.

By comparison, neighboring and more developed Thailand has only 3,759 cases and 59 deaths, which explains why the Thais have tried to seal its 2,100-kilometer border with Myanmar and even deployed troops to prevent people from crossing the porous frontier.

Myanmar’s exploding Covid crisis points to decades of policy failure and mismanagement. Myanmar once had one of Asia’s best health service systems, which until the early 1960s was the envy of many of its neighbors.

At the time, medical students sat for the same exams as those in the United Kingdom, then a paragon of modern medicine. In the 1950s, Myanmar’s then-civilian government designed a plan called pyidawtha, or Happy Land, which aimed to develop the country into an industrialized welfare state with proper health services.

It covered a wide range of areas from infrastructure, the construction of light industry and agricultural development to health, education and democratization of local institutions. While some skeptics feared it would lead to some kind of socialism, it was merely the introduction of the kind of mixed economy usually associated with Scandinavian welfare states.

Military-appointed members of parliament wear face masks amid fears about the spread of the Covid-19 novel coronavirus while attending a session in Naypyidaw on March 4, 2020. Photo: AFP/Thet Aung

Then came the 1962 military takeover and the introduction of what then was called “the Burmese Way to Socialism.” Everything was nationalized or, rather, handed over to about twenty state corporations run by the military.

Under decades of military rule and mismanagement, Myanmar spent the lion’s share of the national budget on the armed forces to fight insurgencies, pay soldiers and officers, build defense industries and procure weapons from abroad, including from China, Russia, Ukraine, Singapore and Israel. 

According to official records, the size of the armed forces’ combined three services increased from 199,581 men at the time of the 1988 pro-democracy uprising to reportedly 500,000 today. Myanmar’s indigenous arms industry was also expanded from a handful of firms before 1988 to more than 20 today.

That all meant progressively less spending on health care as the country was in a perpetual state of civil war with unaccountable military rule. A World Health Organization (WHO) report from 2000 ranked Myanmar’s health system to be the worst in the world.

The situation has not improved much since. By 2008, less than US$1 per capita was spent on health, meaning Myanmar still ranked among the lowest worldwide in nearly every health care funding category. 

All this was supposed to change when a military-rigged general election in 2010 introduced a form of quasi-civilian rule under president Thein Sein, a retired army general who formed a cabinet made up of other ex-military officers and a few civilians.

Promises were made to improve living conditions and bring more transparency to governmental affairs, including over the national budget.

Myanmar’s Army Chief Min Aung Hlaing salutes during the 73rd anniversary of the Martyrs’ Day ceremony in Yangon on July 19, 2020. Photo: AFP/Ye Aung Thu

Yet the Asian Development Bank wrote in a 2012 report that “Myanmar is the only developing Asian country with a defense budget that is greater than the education and health budgets combined.”

While the government substantially increased spending on social sectors, the ADB report said “education and health spending may still account for less than 2.0% of GDP based on its FY2012/13 budget.”

In the budget enacted in 2015, $12 was spent per capita on health, still abysmally low but an improvement on previous years. 

The formation of a more genuinely civilian government led by the National League for Democracy (NLD) in 2016 raised hopes of health care improvements. Indeed, a new pledge was made to move toward a universal health care system, which is reflected in the National Health Plan 2017-2021.

But that ambition was before Covid-19. As a direct result of decades of neglect and inept policies under military rule, ill-equipped government hospitals across the country are now overloaded with Covid-19 cases amid an emerging health catastrophe.