ODA Burma 1988-2005

ODA Burma 1988-2005

Click on the following link for chart showing Overseas Development Assistance (ODA) to Burma from 1988-2005. The chart shows aid from the following:

1) All Donors
2) Development Assistance Committee (DAC) Countries (Rich Western Countries + Japan)
3) Japan

http://docs.google.com/Presentation?id=ddpzz666_15hfqrfthk

Constitutional sophistry

"As it is, some of the commentaries on the Constitution are not well founded. Thus it is widely held that Daw Aung San Suu Kyi is debarred from office because of her former marriage to a British citizen, Michael Aris, but in fact she is technically debarred from the Presidency only because her two sons are not Burmese citizens, while this nationality barrier does not in fact apply to nomination as a candidate for election or as a Minister. If she is also debarred from the Presidency because she is not “well acquainted” with military affairs, one might dare to ask whether military nominations would be allowed because knowledge by the military of political and economic affairs has been demonstrably deficient ever since 1962. There are however
political grounds on which she could be debarred from representative or ministerial
office, for example as a result of her declared support for Western sanctions policies."

Derek Tonkin, "Burmese Perspectives" (http://networkmyanmar.org/images//bp%206%20june%202008.pdf

The above is an example of the logic-chopping that has been employed by the pro-engagement lobby with regard to the sham Constitution recently affirmed in Burma's sham referendum. The claim that the Constitution is not designed to prevent Suu Kyi following a Mandelaesque path to the Presidency, that technically, legally (whatever that means in Burma) she could still end up as Head of State is used as a tool to paint regime opponents as misinformed and, more usually, purveyors of deliberate anti-regime misinformation (the terms 'anti-regime' and 'misinformation' being virtually synonymous among sections of the pro-engagement cheer squad). As usual, this piece of sophistry in fact reveals itself to be the product of either ineptitude or deliberate dissembling. The Constitution as it currently stands

(http://www.amnestyusa.org/all-countries/myanmar-burma/page.do?id=1011205&n1=3&n2=30&n3=955

clearly does prevent Suu Kyi from attaining not only the Presidency but any other Executive Post; this however, despite the strategic focus upon it of Tonkin et al, is not the main point of concern. The Constitution effectively disenfranchises all existing opposition forces in toto, and whittles the possible space for future political organisation to virtually zero.

The qualifications for the Presidency are set out in Chapter II of the Constitution. They are as follows:

Qualifications of the President and Vice-Presidents

(4) (a) The President of the Union shall be loyal to the Union and the citizenry,

(b) The President of the Union must be a citizen of Myanmar who was, and both of whose parents were, born in the territory under the jurisdiction of the State, belonging to the nationality of Myanmar,

(c) The elected President of the Union shall be a person who has fully attained the age of 45.

(d) The President of the Union shall be well acquainted with affairs of State such as political, administrative, economic and military affairs,

(e) The President of the Union shall be a person who has been residing continuously in the country for at least 20 years up to the time of the election,

(f) The President of the Union himself, parents, spouse, children and their spouses shall not owe allegiance to a foreign power, shall not be subject of a foreign power or citizen of a foreign country. They shall not be persons entitled to the rights and privileges of a subject or citizen of a foreign country,

(g) The President of the Union shall possess specific qualifications required of the President in addition to qualifications required to stand for election to the Hluttaw.

(h) The Vice-Presidents shall possess qualifications required of the President.

With regard to Suu Kyi's eligibility, she clearly meets conditions b), c), and e). Come 2010, condition a) my be used to disqualify her (grounds with which Derek Tonkin concurs - after all, she supports sanctions) as may the military requirement in condition d). Condition f) clearly puts her out of the running due to the nationality of her sons (and their spouses - surely a patently bizarre Constitutional requirement?). It is condition g) that presents the real barrier, and the fundamentally anti-democratic heart of the new Constitution.

Eligibility for election to the Pyithu Hluttaw and Amyotha Hluttaw (the two National representative assemblies) is defined by a common set of requirements (apart from age, which is at least 25 for the former and at least 30 for the latter - condition a) below). They are:

32. In connection with prescribing of the qualifications of the Pyithu Hluttaw representatives,

– Persons who possess the following qualifications have the right to stand for election as Pyithu Hluttaw representatives:

[a]

(b) being a citizen born of parents both of whom are also citizens;

(c) having settled in the Union of Myanmar for at least 10 consecutive years up to the

time of being elected Pyithu Hluttaw representative; Exception—‘The period of staying abroad with the permission of the government shall be deemed to have settled in the Union.

(d) possessing qualifications prescribed in the election law.

Condition d) is sufficiently vague to allow for considerable future manipulation, but more importantly there is a list of circumstances which preclude an individual from standing for election. These are:

33. In connection with those who have no right to stand for election as Pyithu Hluttaw representatives,

The following persons shall not have the right to stand for election as Pyithu Hluttaw representatives:

(a) person serving prison term, having been convicted by the court concerned for having committed an offence;

(b) person still within the period the authorities have prescribed that he or she has no right to be elected as Pyithu Hluttaw representative for having been punished for a commitment of offence that makes him or her lose qualifications required of a Pyithu Hluttaw representative before or after the State Constitution comes into force;

(c) persons adjudged to be of unsound mind as provided for in the relevant law;

(d) person who has not yet been cleared from being declared destitute;

(e) person owing allegiance to a foreign government, or a subject of a foreign government or a citizen of a foreign country;

(f) person who is entitled to rights and privileges of a subject of a foreign government, or a citizen of a foreign country;

(g) person who obtains and makes use or member of an organization that obtains and makes use of money, land, housing, building, vehicle, property etc. directly or indirectly from a foreign country’s government, or religious organization or other organizations;

(h) person who commits or abets or member of an organization that commits or abets acts of inciting, making speeches or issuing declarations to vote or not to vote misusing religion for political purpose;

(i) members of a religious order;

(j) civil service personnel;

proviso: The expression shall not apply to Tatmadaw member Hluttaw representatives.

(k) person who obtains and makes use or member of an organization that obtains and makes use of State funds, land, housing, buildings, vehicles or property directly or indirectly;

proviso: (1) The expression ‘State funds’ does not apply to pension or allowances officially granted by the State for services rendered for the benefit of the State.

(2) The expression ‘land, housing, buildings, vehicles and property belonging to the State’ does not apply to State-owned land, housing, buildings and apartments, other buildings and apartments, State-owned air-craft, trains, vessels and motorcars and property etc. which have been permitted by the State to be used under an existing law or as required by duty or leased from the State on payment;

(l) person still within the period the authorities have prescribed that he or she has no right to be elected as Pyithu Hluttaw representative for commission of an unlawful act or for failure to act in conformity under the election law making him or her lose qualifications required of a Pyithu Hluttaw representative before or after the State Constitution comes into force.

Several of these conditions are fairly standard (e.g. c), d), e), f), j), k)) but some are striking in their implications. Condition h) would appear to render anyone who has been involved in political activity ineligible to stand for parliament, and indeed would appear to make political activity in the traditional sense impossible - the very activity of politicking would prevent achievement of the desired end! [the clumsy drafting re misuse of religion is a post-September 2007 addition that is absent from the Detailed Principles document circulated earlier] .Condition g) tightens the noose on the NLD and other anti-regime groups, but also appears to disenfranchise those individuals in receipt of aid, post-Nargis. That presents an acute dilemma for the pro-engagement forces: the act of engagement may well directly hamper the development of democracy by disenfranchising the engagees! Conditions b) and l) complete the barrier by permitting discretionary (and retrospective) action to disenfranchise individuals.

Given that Suu Kyi would have to meet these criteria as well as the specific requirements for the Presidency, it is clear that she could not be eligible to be Head of State. But nor could any NLD member or any political activist aspire even to be a member of the National assemblies (which adds a further block on Suu Kyi re the Presidency as the President is chosen from among 3 Vice Presidents who are in turn chosen by each Hluttaw and the Tatmadaw representatives). But the problem is much more fundamental, as those eligible for the State and Region Hluttaws must meet the same criteria, as must nominees for the positions of Union Ministers, Attorney and Deputy Attorney-General, Auditor and Deputy Auditor-General, Chairman and members of the Union Civil Service Board and Justices of the Supreme Court. Furthermore, the requirements are replicated for all of these functions at the State/Region level.

In other words, those active in political activity will be locked out of political power at every significant level. The 25% quota for the Tatmadaw is nothing in terms of a block to democracy compared to this wholesale exclusion. The idea that this Constitution represents in any way a step forward on a road to democratisation is a fantasy in the minds of some and a lie issued from the mouths (and pens) of others.

Natural Gas Exports and the Missing Money

Burma’s emergence as a major regional supplier of natural gas should proved considerable revenue for any the government to spend on much needed infrastructure, health care and education. Rising gas prices and increasing output volumes have caused Burma’s gas exports to soar in the last few years, dramatically improving the country’s balance of payments and the size of its foreign currency reserves.

Burma’s Gas Exports, Earnings and International Reserves

Year	Gas Export Volumes (million cubic metres)	Gas Price ($US per million Btu)1	Balance of Payments ($US m)	Reserves ($USm)
2003-04	5,664.4	4.98	541	781
2004-05	9,501.1	7.43	929	873
2005-06	9,138.5	7.31	1,547	1,026
2006-07	13,028.3	8.45	2,226	2,039
2007-08	10,326.8*	9.41	2,355**	3,307**

* ie, April–November 2007. Source: MCSO (2008), IMF (2007, 2008).

** Projection

Burma’s gas exports come courtesy of its possession of large, and exploitable, fields of natural gas offshore in the Gulf of Martaban and in the Bay of Bengal. Cumulatively, these fields have confirmed recoverable reserves of around 540 billion cubic metres – enough, at present prices and production volumes, to bring in annually around $US2 billion for the next 30 to 40 years.² Two of the fields, the so-called ‘Yadana’ fields off Mouttama, and the ‘Yetagun’ fields off Burma’s Tenasserim (Tanintharyi) Division, came on stream in 1988 and 2000 respectively, and it these that are the overwhelming source of Burma’s current gas deliveries. The primary customer of the output from the Yadana and Yetagun fields is Thailand which, as a consequence, now runs a substantial trade deficit with Burma (of just over $US2 billion in 2006/07).

Over the next few years, however, the export of gas from Yadana and Yetagun will be joined by that from new fields off Burma’s coast in the Bay of Bengal. These fields, the most lucrative of which are collectively known as the ‘Shwe’ (‘gold’) fields, have roughly the same gas reserves present (an estimated 200–240 million cubic metres) as collectively present at Yadana and Yetagun.³ The Shwe fields were explored and developed by a consortium that comprised Myanmar Oil and Gas Enterprise (MOGE), together with South Korea’s Daewoo Corporation, the Korean Gas Corporation, the Gas Authority of India Limited, and India’s Oil and Natural Gas Corporation.

The ultimate customer of the gas actually delivered from Burma’s Shwe fields, however, will be China, which in 2007 ‘won’ a fiercely contested bidding war against India and South Korea. This result provoked consternation in South Korea and India at the time, not least because China’s reported bid was below that of India’s offer.⁴ China’s Yunnan Province will be the recipient of the gas, courtesy of a 2,400km pipeline that will come ashore near the port of Sittwe (via a facility at nearby Ramree Island), and run more or less the length of Burma into Yunnan Province. With little in the way of labour or environmental considerations to get in the way, construction of the Shwe pipeline can be completed relatively quickly (two to three years). As matters currently stand, however, a delay seems likely in the project, with a senior Yunnan official recently stating with respect to the pipeline that ‘whether, when and how to build it are yet to be decided’ (emphasis added).⁵ In the light of this, it is now likely that the first Shwe gas (and its revenue) will not flow until at least 2011/12.

Burma’s ‘Missing Billion’

Whatever the latest delays, the gas earnings discussed above should be transforming Burma’s fiscal circumstances – allowing for the spending on basic infrastructure, health and education the country so desperately needs.

However, under current arrangements, the foreign exchange revenues Burma is accumulating via its exports of natural gas are making next to no impact on the country’s fiscal accounts. The reason for this is simple – Burma’s gas earnings are being recorded in its state finances at their ‘official’ (exchange rate) kyat value. This official exchange rate of the kyat (at around 6 kyat:$US1) over-values the currency by around 150–200 times its market value (currently about 1,000 kyat:$US1). This dualism in Burma’s exchange rate imposes other great costs on Burma’s economy, but critical here is that the use of the official exchange rate to convert the country’s gas earnings into kyat dramatically underplays their true (potential) contribution to state finances. Recorded at the official rate, Burma’s gas earnings for 2006/07 of $US1.25 billion translated into 7.5 billion kyat, or a mere 0.6 per cent of budget receipts.⁶ By dramatic contrast, if the same US dollar earnings were recorded at the market exchange rate (at that time around 1,200 kyat:$US1) their contribution of 1,500 billion kyat would more than double total state receipts, and more or less eliminate the country’s fiscal deficit. That this is not done is yet another revealing episode of the chronic macroeconomic mismanagement that inflicts Burma, as well as the SPDC’s priorities.

So where do Burma’s generals hide the ‘missing’ billion or so kyat they keep away from the state’s official finances? No-one but they know for sure, but the gas revenues do show up in the statistics for Burma’s foreign reserves provided by the Myanmar Central Statistical Organisation (MCSO) to the IMF. An inspection of the vaults of the Myanmar Foreign Trade Bank for the money might be a good place to start however – as also might the accounts of some accommodating if unscrupulous banks offshore. From these refuges the SPDC can (and does) spend as they might whim – on the new capital of Naypyidaw, on the nuclear reactor that is being purchased from Russia, on the extraordinary ‘physic nut’ bio-fuel campaign, and so on. In any case, the generals can rest assure that the money they expropriate is safe from prying eyes, and safe from the peoples for whose lives it might make a difference.

1 Prices are a composite of those applying to the delivery of natural gas to a number of countries and regions. Gas export prices are typically quoted in ‘British Thermal Units’ (Btu’s), a measure that accounts for both volume and energy intensity. Though there are other complications that must be taken into account in particular contexts, one Btu is equivalent to approximately 28 million cubic metres of gas.

2 British Petroleum, BP Statistical Review of World Energy, June 2007- www.bp.com/statisticalreview/

3 Estimates of the size of the Shwe fields vary, but those here refer to confirmed gas reserves according to British Petroleum’s BP Statistical Review of World Energy, op.cit.

4 Anupama Airy, ‘Myanmar Prefers China as Gas Buyer’, Financial Express, May 29, 2007, - wwww.financialexpress.com

5 The official was Bai Enpai, Secretary of the Yunnan Provincial Committee of the Chinese Communist Party. The statement, which was made on March 8, 2008 caused widespread astonishment given the conventional wisdom that the pipeline was a ‘done deal’. Bai Enpai’s comments were reported by China’s Xinhua News Agency, <www.xinhuanet.com/english/>.

6 Calculations derived from data in IMF (2007, p.9).

Not Financing Health and Aid for the Reconstruction of 'Hospitals' and 'Clinics'

In response to the destruction the regime has called for more than $US10.7 billion for reconstruction, of which $US42.52 million is for the reconstruction of the 110 hospitals and 288 rural health clinics destroyed or damaged. Burma, despite being a very poor country has an enormous amount of government provided hospitals and health clinics. In fact prior to the cyclone there were 839 hospitals, 1473 rural health clinics, 86 primary and secondary health centres, 348 maternal and child health centers, 14 traditional medicine hospitals and 237 traditional medicine clinics. This is quite remarkable, especially since the government spends considerably less than the other ASEAN governments on healthcare on a per capita basis. The regime in 2006 spent only nine cents per person, which compares with the government of Laos that managed to spend $US1.91. If expenditure on social security is not excluded then the Laos government would have spent around $US15, compared with Burma’s $US0.15.

ASEAN GOVERNMENT EXPENDITURE ON HEALTH 2006
	% Government Health Expenditure Financed by Aid	Government Expenditure without Aid/ Total Health Expenditure (%)	Per Capita Government Expenditure without Aid & Social Security Expenditure $US
Burma	82.03	3.0	0.09
Cambodia	41.30	15.3	4.59
Indonesia	2.24	49.29	12.54
Laos	41.3	21.04	1.91
Malaysia	0.0	45.2	114.33
Philippines	5.46	37.44	12.01
Singapore	0.0	45.2	288.72
Thailand	0.0	64.4	63.71
Vietnam	6.33	30.32	8.17

In total the regime in 2006 spent only $US4.6 million dollars on healthcare, which means that if nothing was spent on administration, officialdom and all the revenue was distributed (an unlikely scenario) then each government hospital and clinic in the country received from the ‘government’ on average about $US1,500. This includes the salaries of any doctors, nurses and all other staff. This paltry sum might go someway towards explaining the near absence of beds, sheets, clothes, medical equipment and drugs within the government hospitals and clinics. Burma might have lots of hospitals and clinics, but there is nothing in most of them.

This paltry allocation of resources to a system that is nearly all empty buildings is from a ‘government’ that earns around $US100m each month in revenue from its gas sales to Thailand. Theoretically, the regime could increase the country’s aggregate expenditure on healthcare by nearly 50 percent, if it bothered to allocate to healthcare, only one month of the revenue its receives from gas sales. Mind you the revenue does not end up in the government’s budget. Instead, the money from gas sales disappears into the private bank accounts of the generals or is wasted on totalitarian extravagances such as the building of a new capital city, purchasing nuclear reactors (for medical research) and weaponry for an army whose enemy is its population.

Moreover, the people of Burma can not afford to use the large number of buildings that constitute the health infrastructure of Burma with the lowest per capita expenditure on healthcare, at $US4, of the ASEAN countries. The people of Laos have the second lowest per capita expenditure on healthcare, though it much higher than the people of Burma, at around $US22. Burma’s per capita expenditure compares even more poorly with Cambodia, Indonesia and the Philippines, whose per capita expenditure on healthcare are around $US30, $US34 and $US45, respectively.

TOTAL EXPENDITURE ON HEALTH 2006
	Per Capita Expenditure $US
Burma	$US4
Cambodia	$US30
Indonesia	$US34
Laos	$US22
Malaysia	$US255
Philippines	$US45
Singapore	$US1035
Thailand	$US113
Vietnam	$US46

Source: www.who.int/nha/en/

Giving the regime money to build new hospitals and clinics, even if they were to be built is simply a waste of resources. There are already too many empty hospitals and clinics. More buildings are not needed. Rather the people of Burma need a health system that is properly financed and administered. Presently the country has neither, and simply throwing resources at the regime to erect more empty hospitals and clinics will only contribute to a mentality that sees infrastructure building as equivalent to the provision of healthcare.

.

Than Shwe giving more useless advice, this time to the doctors

GENERALS AS THE AXE HANDLES OF

THE NEO-COLONALISTS:

Revisiting the Financing Health in Burma

Burma comes last again in a game that most in the country don’t want to play. A re-examination of the financing of healthcare shows that Burma has the lowest per capita expenditure on healthcare in ASEAN at only $US4. This means that a country with an estimated population of 55 million spends in aggregate around $US220 million each year on healthcare. This very low expenditure is coupled with a ‘government’ that only bothers to spend around nine cents a year on the health of each person in the country. This is from a ‘government’ that earns around $US100m each month in revenue from its gas sales to Thailand. Theoretically, the ‘government’ could increase the country’s aggregate expenditure on healthcare by nearly 50 percent if it allocated only month of this revenue to health. The expenditure on healthcare in Burma is primarily very low because the country is so poor due to economic mismanagement, and because the government is utterly negligent, utilizing the apparatus of the state to further private returns, rather than enhancing the public good. In spite of its xenophobic, nationalist, self-sufficiency rhetoric, its healthcare system (if that’s what it can be called) is propped-up by foreign funds. Burma’s public healthcare system is more reliant on foreign funds than any other country in ASEAN. The situation regarding the financing of health in Burma is not only appalling in absolute terms, but on all reasonable measures is behind all the other ASEAN countries.

Lowest Per Capita Expenditure on Health

The people of Burma have by far the lowest per capita expenditure on health of the ASEAN grouping, at a very low $US4 according to WHO’s national health accounts.¹ The WHO in its 2006 World Health Report seemingly provides quite a different picture of per capita expenditure, reported as being between $US134 and $US394 between 1999 and 2003. This is because the regime’s kyat figures were converted into $US at the official exchange of K6/$US, rather than the market exchange rate. When these figures are adjusted at the market exchange rate, per capita expenditure is around $US1-2.30, somewhat similar to figures reported elsewhere.²

The very low per capita expenditure in Burma compares with Laos, whose per capita expenditure is the second lowest of the ASEAN countries, at around $US22 per capita. Burma’s per capita expenditure compares even more poorly with Cambodia, Indonesia and the Philippines, whose per capita expenditure on healthcare are around $US30, $US34 and $US45, respectively.

TOTAL EXPENDITURE ON HEALTH 2006
	Per Capita Expenditure $US	Expenditure % GDP
Burma	$US4	2.3%
Cambodia	$US30	6.0%
Indonesia	$US34	2.2%
Laos	$US22	3.6%
Malaysia	$US255	4.3%
Philippines	$US45	3.3%
Singapore	$US1035	3.4%
Thailand	$US113	3.5%
Vietnam	$US46	6.6%

Source: www.who.int/nha/en/

Burma’s low per capita expenditure is reflected in a related figure – the percentage of GDP expended on health. Burma allocates around 2.3 percent of its GDP to healthcare. This is similar to the percentage of GDP allocated in Indonesia, except in Indonesia per capita expenditure is $US34, compared with Burma’s $US4. This illustrates the relationship between economic performance and health expenditure. It is Burma’s very poor economic record that is mostly to blame for the countries appalling low per capita healthcare expenditure.

PRIVATE EXPENDITURE ON HEALTH 2006 (%)
	Private Exp/Total Health Expenditure	NGO Exp/Private Health Expenditure	Local Private Exp/Total Health Expenditure
Burma	83.2	0.20	83.198
Cambodia	73.9	15.61	73.78
Indonesia	49.6	2.30	48.454
Laos	79.2	5.95	74.486
Malaysia	54.8	0.067 (0.52)3	54.797
Philippines	60.4	1.94	60.388
Singapore	66.4	0.00	66.4
Thailand	35.6	0.88 (1.22)	35.596
Vietnam	67.6	0.27	67.597

Source: www.who.int/nha/en/

The Philippines is the runner-up with 3.3 percent of GDP allocated to healthcare, though per capita expenditure on health is much larger at $US45, again due to better economic performance. And the Philippines is hardly an economic success story. Laos, Thailand, Malaysia, and Singapore allocate between 3 and 4 percent of GDP to healthcare, though the per capita expenditure varies greatly between $US22 and $US994. Both Cambodia and Vietnam allocate a greater proportion of their GDP to health, at around 6 percent each.

Not all private health expenditure comes from local sources, as some proportion is provided by NGOs that obtain their funds outside the country. Most of this expenditure is foreign aid is channeled through NGOs, typically to bypass the local government. Cambodia with NGOs providing 16 percent of private expenditure on healthcare is the only country where NGOs contribute a significant percentage to a healthcare system in ASEAN. In Laos, NGOs provide nearly 6 percent of private health expenditure. NGOs provide even a smaller proportion of private healthcare expenditure in the Philippines and Indonesia at around 2 percent. Surprisingly given the rhetoric of those supporting aid to Burma, most (recorded) aid funds are not channeled via NGOs, recorded as only 0.2 percent of private healthcare expenditure, a similar proportion as that provided in Thailand and Vietnam. In fact, as discussed below most aid funds are channeled via the regime.

Importance of Private Expenditure on Healthcare

The very poor economic policies of the regime are prime reason for the low per capita expenditure on healthcare in Burma. Healthcare for most people in most countries is substantially funded by private expenditure, whether through private health insurance or by simply purchasing healthcare when the need arises. This means that the GDP/capita is an important determinant of the amount that individuals and families can spend on their own health. Since, the economy in Burma is so moribund people on average can only afford to spend around $US3.32 each on healthcare. The ineptitude of the regime in terms of economic management is responsible for such a dismal figure.

Not only is the amount spent on healthcare very small in Burma, but people in Burma have to provide the highest percentage of their healthcare from their own pockets, with personal private expenditure in 2006 accounting for nearly 83.4 percent of total health expenditure. This compares with Laos and Cambodia, where personal private expenditure accounted for around 74% of total health expenditure. Third place went to Vietnam with individuals and families providing around 67 percent of the country’s expenditure of healthcare. Whereas, people in Indonesia only provide around 48 percent of healthcare expenditure; whilst in Thailand only 35 percent of expenditure came directly from personal expenditure.⁴ Note that Cambodians, Laotians, Indonesians, Thais and Vietnamese not only provide a smaller proportion of the funds for their healthcare, but are also able to spend significantly more than their Burmese counterparts.

As the institutional framework in Burma is so poor, private health insurance does not exist. Cambodia is the only other ASEAN country sharing the stage with Burma in this regard. Private health insurance, though typically only available to the wealthy and middle class in poor countries is nevertheless an important component of private health expenditure, as it provides a safety net, especially when the state is remiss. Of those countries with private health insurance Vietnam and Indonesia have the lowest proportion of private health expenditure covered by private insurance at 3 and 5 percent, respectively. Private health insurance in the Philippines and Laos accounts for 10 percent of private expenditure on health. Malaysia and Thailand with better institutional structures have created a system where private health insurance accounts for 14 percent of private expenditure on health. Hence, even the middle class (as small as it is) in Burma have to fund all their expenditure on healthcare out of their pocket, when any emergency arises.

SPDC Spends Nothing on Healthcare

Burma’s state managed healthcare system contributes around 17 percent of the country’s total health expenditure, which is a smaller percentage than any of the other countries in ASEAN. Even the Laos and Cambodian state managed healthcare systems contribute more, providing around 21 and 26 percent of the country’s healthcare expenditure, respectively. This spending is even much less than the other poor countries in ASEAN with the governments of Vietnam, Philippines and Indonesia contributing 32, 40 and 50 percent, respectively.

However, these figures do not reflect the state’s contribution to their own healthcare system, as they include aid funds (or loans) channeled via the state. In the case of Burma, aid provides 82 percent of the regime’s expenditure on healthcare, which mean that the ‘government’ provides only 3.0 percent of the country’s healthcare expenditure. The proportion of funds provided by foreign donors to the state’s health system is considerably higher than that provided to any other of the governments in ASEAN. Foreign donors only provide the state managed healthcare system in Cambodian and Laos with 40 percent of their expenditure, whilst the Philippines and the Vietnamese public healthcare systems receive only 5 percent of their funds from foreign donors.

GOVERNMENT EXPENDITURE ON HEALTH 2006
	Total Govt. Health Exp/Total Health Expend (%)	% Govt. Health Exp Financed by Aid	Govt. Exp Minus Aid/ Total Health Exp (%)
Burma	16.77	82.03	3.0
Cambodia	26.1	41.30	15.3
Indonesia	50.4	2.24	49.29
Laos	20.8	41.3	21.04
Malaysia	45.2	0.0	45.2
Philippines	39.6	5.46	37.44
Singapore	45.2	0.0	45.2
Thailand	64.4	0.0	64.4
Vietnam	32.4	6.33	30.32

Source: www.who.int/nha

The lack of healthcare expenditure by the state again differentiates Burma from the other ASEAN countries, as all the other governments contribute some funds to providing healthcare for their citizens. The winning place is accorded to a ‘government’, (not an appropriate term for SPDC) that has the money to spend on healthcare and other services, accumulating around $US100m each month from the sales of the country’s gas reserves.

GOVERNMENT EXPENDITURE ON HEALTH 2006
	% Govt. Health Exp to Social Security	Govt. Exp Minus Aid & Social Security/ Total Health Exp (%)	Per Capita Govt Exp. Minus Aid & Social Security Exp $US
Burma	8.88	2.2	$US 0.09
Cambodia	0.00	15.3	$US 4.59
Indonesia	21.57	36.87	$US 12.54
Laos	23.65	0.087	$US 1.91
Malaysia	0.84	44.84	$US 114.33
Philippines	28.72	26.69	$US 12.01
Singapore	17.11	27.9	$US 288.72
Thailand	12.44	56.38	$US 63.71
Vietnam	63.47	17.75	$US 8.17

Source: www.who.int/nha

Some of the governments in ASEAN allocate a sizeable proportion of their healthcare expenditure to social security, typically to public servants and war veterans.⁵ As this expenditure is typically centred on a small proportion of the population these funds are also deducted from each government’s expenditure on healthcare in order to provide a better understanding of the size of the expenditure on the majority of the population.⁶ In this regard, Burma’s regime allocates less than 10 percent of government health expenditure to social security, a smaller proportion than other governments in ASEAN. The highest proportion of government health expenditure allocated to social security, at nearly 65 percent is in Vietnam, most of which is allocated to veterans of the North Vietnamese army. Other governments in ASEAN, including Laos, Indonesia and the Philippines allocate 20 or more percent of their healthcare budgets to the privileged in the public service.⁷

Once aid funds and government expenditure on social security have been removed from each government’s healthcare budget, the actual amounts provided by the governments in ASEAN for health care can be calculated. This again illustrates the paucity of funds allocated by the regime to healthcare, with the state only providing around 9 cents each year for each person in the country. Even the Laos government with its considerably higher proportion of expenditure allocated to social security managed to spend another $US1.90 on each of the country’s citizens in 2006. Cambodia, which does not have to support the healthcare of its public servants managed to spend double that of the Laos government at around $US4.50 and conversely, Vietnam that does spend a sizeable proportion of its healthcare budget on war veterans still to managed to spend an additional $US8 on each member of its population. All the other governments in ASEAN managed to spend considerably more on each of their citizens.

There is yet another factor to be considered with regard to these figures, as they include expenditure not only by the Ministry of Health, but also other ministries including expenditure on health provided for the armed forces, prisons, schools and universities (WHO 2006:160). Some of the countries in ASEAN, notably Thailand, Laos, Vietnam, the Philippines, Cambodia and Indonesia spend a considerable proportion of their health budget outside of the Ministry of Health, but unfortunately WHO’s national health accounts do not specify the ministries, which control this expenditure. The allocation of this expenditure is worthy of further analysis, but outside the parameters here. WHO’s national health accounts indicate that most of Burma’s government’s healthcare expenditure is located in the Ministry of Health, but as with the other countries in ASEAN the proportion spent on the military is unknown.

Begging for Healthcare

The health expenditure of all the countries in ASEAN except for Thailand, Malaysia and Singapore are partially funded by foreign aid and loans. The largest proportion of health expenditure funded by aid is in Cambodia, Laos and Burma. In 2006, aid funding contributed 22 percent of total expenditure within the Cambodian health care system; whilst in Laos aid funding was 14 percent. Burma not quite the winner here as in 2006, aid provided around 14 percent of total health expenditure. This does however mean that foreign donors are contributing substantially more to the healthcare of Burma’s population than its own government. This is the government that prides itself on self-reliance and fosters xenophobia, but refuses to allocate resources to the health of its own people. Instead the regime relies on funds from the despised foreigner, so it can spend on its ludicrous fascist style new capital and other absurdities including a nuclear reactor. Showing they share the same refined aesthetic sense as another of the world’s tumors, the government of North Korea. If the regime believed its own nationalist rhetoric, why does it allow foreigners to prop-up healthcare expenditure, even though it has the resources to support its own system.

TOTAL AID/TOTAL HEALTH EXPENDITURE (%)
	2000	2001	2002	2003	2004	2005	2006
Burma	1.1	6.15	6.88	6.1	11.2	10.9	13.9
Cambodia	9.4	18.65	19.43	28.4	26.7	25.7	22.3
Indonesia	10.8	4.44	3.30	3.5	3.0	4.6	2.3
Laos	30.3	12.63	15.00	20.00	10.3	11.3	14.1
Philippines	3.5	3.7	2.8	3.8	4.0	5.1	3.3
Vietnam	2.7	2.8	3.5	2.6	1.9	2.0	2.2

Source: www.who.int/nha

Expenditure on Immunization

All the governments of ASEAN provide at least some funds for basic immunization programs, except for the ‘governments’ of Burma and Laos (WHO 2005). All the funding for the program in Burma is provided by foreign donors, notably the government of Japan and the Western democracies. The immunization program in Burma is overseen by UNICEF, but implemented by the Myanmar Maternal Child and Welfare Association (MMCWA), a fascist style mass organisation controlled by the wives of the senior generals. This is their special contribution to the country, using the resources of taxpayers from foreign countries, whilst pretending to being loyal daughters of the nation.

% EXPENDITURE PROVIDED BY GOVERNMENT IMMUNIZATION PROGRAM 2003
Burma	0
Cambodia	7
Indonesia	90
Laos	0
Malaysia	100
Philippines	3
Singapore	100
Thailand	100
Vietnam	55

Source: World Health Report (2005)

The Philippines also shows an unimpressive commitment to their country’s immunization program contributing only 3 percent of total expenditure. Even the Cambodian government has managed to provide 7 percent of the funds for its country’s basic immunization program. All these governments compare to Vietnam’s that provides 55 percent of the funds for its young population to be vaccinated. Thailand, Burma’s old enemy having implemented rational economic policies can afford and chooses to allocate enough resources, such that it does not have to depend on the largesse of foreigners to protect its young population.

We do not begrudge the people of Burma our assistance. We do however, object to a ‘government’ that steals the revenue from gas sales, which rightly should be allocated to the state’s budget where it can be used to improve the situation for ordinary Burmese. We also object, to the irrational, wooly-headed, muddled economic policy making of a regime that has stifled economic growth. The ridiculous lame-brained policy making of the regime has impoverished the country meaning that on average Burmese people can only spend around $US3.32 each on their own healthcare. We also object to the deceit of a regime that pretends that it has taken responsibility for immunizing the young of the country. Healthcare and immunization programs should not be the plaything of the over-adorned wives of the generals (via the Myanmar Maternal and Child Welfare Association), most of whom, as with their husbands have little expertise in anything, except lauding themselves over the population. All in all the regime and its hypocritical nationalist rhetoric and lame-brained economic policies are objectionable.

Ministry of Health (Burma) Health Statistics – www.moh.mm/

World Health Organisation National Health Accounts – www.who.int/nha

World Health Organisation (WHO) (2003) Guide to Producing National Health Accounts with Special Applications for Low-income and Middle-income Countries, World Health Organisation.

World Health Organisation (WHO) (2005) World Health Report 2005: Making Every Mother and Child Count, World Health Organisation, Geneva.

World Health Organisation (WHO) (2006) World Health Report 2006: Working Together for Health, World Health Organisation, Geneva.

1 www.who.int/nha/en/

2 This was done simply, by assuming that the market exchange rate in 1999 was on average K800/$US and the market exchange rate in 2003 was on average K1,000/$US. The original figure was simply multiplied by the official exchange rate (K6/$US) and adjusted for the average market exchange rate.

3 The figures in brackets for Malaysia and Thailand include local funds provided to NGOs to supplement the healthcare of others within their country.

4 The proportion of private healthcare expenditure has dropped significantly in the last 10 year particularly with the introduction of under Thaksin of the 30 baht health card scheme, which has its own financing problems.

5 Strictly these should not be included in government expenditure, but many of the ASEAN countries do so.

6 Of course the proportion covered under these schemes no doubt varies, but any analysis in this regard is outside the scope of this note.

7 It is not clear from the data whether this expenditure covers healthcare payments for those in the military.