Search

 

Cablegate: Embassy Rangoon

VZCZCXRO5252
OO RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB RUEHPOD
DE RUEHGO #0308/01 1231032
ZNR UUUUU ZZH
O 021032Z MAY 08 ZDK TO ALL
FM AMEMBASSY RANGOON
TO RUEHC/SECSTATE WASHDC 7462
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHZN/EST COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 1836
RUEHBY/AMEMBASSY CANBERRA 1104
RUEHKA/AMEMBASSY DHAKA 4844
RUEHLO/AMEMBASSY LONDON 2022
RUEHNE/AMEMBASSY NEW DELHI 4651
RUEHUL/AMEMBASSY SEOUL 8192
RUEHTC/AMEMBASSY THE HAGUE 0676
RUEHKO/AMEMBASSY TOKYO 5754
RUEHRO/AMEMBASSY ROME 0160
RUEHFR/AMEMBASSY PARIS 0579
RUEHCN/AMCONSUL CHENGDU 1438
RUEHCHI/AMCONSUL CHIANG MAI 1540
RUEHCI/AMCONSUL KOLKATA 0296
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHPH/CDC ATLANTA GA
RUCLRFA/USDA WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUCNDT/USMISSION USUN NEW YORK 1506
RUEKJCS/SECDEF WASHDC
RUEHBS/USEU BRUSSELS
RUEKJCS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 06 RANGOON 000308

SIPDIS

SENSITIVE

SIPDIS

DEPT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD
DEPT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ASTEWART;
OES/IHA/DSINGER AND NCOMELLA
DEPT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
CDC ATLANTA FOR COGH SDOWELL and NCID/IB AMOEN
USDA FOR OSEC AND APHIS
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM
DOD FOR OSD/ISA/AP FOR LEW STERN
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE
ROME FOR FAO
BANGKOK FOR REO OFFICE, USAID/RDMA HEALTH OFFICE - JMACARTHUR,
CBOWES
PACOM FOR FPA

E.O. 12958:N/A
TAGS: ECON TBIO EAID SOCI PGOV AMED BM
SUBJ: 3D FUND ANNUAL REVIEW SHOWS POSITIVE RESULTS, IDENTIFIES
CHALLENGES

REF: A) RANGOON 096 B) 07 RANGOON 744 C) RANGOON 278 D) RANGOON

279 E) 07 RANGOON 634

RANGOON 00000308 001.6 OF 006


1. (SBU) Summary. The 3 Diseases Fund (3DF), the largest single
health donor in Burma, recently completed its first year in
operation. During the first annual review meeting, April 1-2,
donors, implementing partners, and GOB officials highlighted how the
3DF's assistance addressed Burma's health concerns in the areas of
HIV/AIDS, malaria, and tuberculosis, as well as identified
challenges to the prevention and provision of services for these
diseases. First year successes included: expansion of national
programs for all three diseases, increased number of NGOs providing
anti-retroviral treatments (ART) for HIV/AIDS patients, improved
coordination between implementing partners and township level health
officers, expansion of the public-private treatment for TB, and
provision and treatment of more than 100,000 long-lasting bed nets,
among others. In addition to expounding the success of 3DF
programs, donors and implementing partners also identified future
challenges that must be overcome to ensure successful development of
Burma's health programs. The 3DF will examine its current funding
priorities to determine whether it should reallocate funds from
HIV/AIDS programs to TB and malaria; implementing partners will
improve data collection and collaboration with the Ministry of
Health (MOH) and NGOs; MOH will work with 3DF to prevent multi-drug
resistant strains of TB and malaria from spreading. 3DF partners
urged other donors to provide more humanitarian assistance to Burma,
noting that funding gaps in the national programs may pose regional
problems as Burma's disease incidence crosses its borders. End
Summary.

Promoting Health Under the 3D Fund
----------------------------------

2. (SBU) A consortium of six donors - Australia, the European
Commission, the Netherlands, Norway, Sweden, and the United Kingdom
- established the Three Diseases Fund (3DF) in 2006 to reduce the
burden of morbidity and mortality for HIV/AIDS, malaria, and
tuberculosis (TB) in Burma and to cover the gap left by the pull out
of the Global Fund in 2005 (Ref A). To date, donors have pledged
$104 million over five years to assist national health programs at
the township level, and have disbursed more than $23 million to 26
implementing partners during the first year. According to Mark
Canning, British Ambassador and 3D Fund Board Chair, the 3D Fund's
implementing partners, which include UN organizations, international
NGOs, and local NGOS, use the funds to support 38 different projects
in more than 300 townships throughout Burma.

3. (SBU) The 3DF plans to expand its program in 2008 by giving

RANGOON 00000308 002.4 OF 006


small grants, up to $100,000, to local NGOs for small scale health
projects, 3DF Manager Mikko Lainejoki announced during the annual
review. The 3DF had planned to launch its small grants program by
March 2008, but faced difficulties identifying local partners and
establishing fund flow mechanisms, and determining how best to
monitor and evaluate the activities (to be reported septel).
Lainejoki told the Fund Board that the 3DF has resolved these issues
and will provide up to $1 million in small grants to local NGOs by
July.

Combating HIV/AIDS
------------------

4. (SBU) The 3DF, working closely with implementing partners, the
Ministry of Health (MOH), and the National HIV/AIDS Program (NAP),
have made progress in addressing HIV/AIDS in Burma, NAP Program
Manager Dr. Min Thwe explained. The number of HIV/AIDS cases in
Burma has dropped during the past three years, MOH officials
emphasized. According to MOH studies, while the number of most at
risk populations increased, the overall prevalence rate was 0.67
percent in 2007, showing a leveling off of new HIV/AIDS cases. In
2005, UN figures showed an HIV/AIDS prevalence rate of 1.3 percent
of the general population (Ref B). While the prevalence rate
decreased from 2005 levels, UN officials noted that it was due
primarily to the use of a new formula to determine prevalence, and
only secondarily to the increasing number of HIV positive patients'
deaths.

5. (SBU) In 2007, the NAP established and implemented its
operational plan, determined priority townships in Burma for ART
treatment, and mapped vulnerable populations. The NAP also provided
more than 30 million condoms free-of-charge in 2007. According to
the Ministry of Health, the GOB's highest priority is to reduce
HIV-related risk and vulnerability among targeted populations, such
as female sex workers and their male clients, men who have sex with
men, drug users, and families of HIV/AIDS patients. In 2008, the
NAP, which has a limited budget of approximately $250,000, plans to
expand its treatment program, allocating 60 percent of its budget
for ARTs and care and support. Because the national HIV/AIDS
prevalence rate is less than 1 percent, the NAP will gradually
reduce its budget for awareness raising, instead relying on NGOs to
conduct educational outreach and behavior change programs. In 2008,
the NAP hopes to improve coordination with the 3DF implementing
partners to reduce the spread of HIV/AIDS, including collaboration
on HIV/AIDS data collection, further cooperation on monitoring and
evaluation, and expanding treatment for PLHAs.

6. (SBU) While the NAP is active in more than 100 townships around

RANGOON 00000308 003.4 OF 006


Burma, the majority of HIV/AIDS treatment and prevention activities
are conducted by NGOs, most of which receive support from the 3D
Fund, PSI Deputy Director Habibur Rahmen explained. Ten 3DF
partners work on HIV/AIDS activities in 93 townships. While their
activities vary, most conduct home-based care; provide
socio-economic, psycho-social, and nutritional support to people
living with HIV/AIDS (PLHAs); and give medical support, including
ARTs. Currently, 10,882 people receive ARTs, which accounts for
less than 20 percent of Burma's HIV positive population.
MSF-Holland Country Director Frank Smithuis commented that while
ARTs are expensive, the cost of providing care with ARTs and without
is the same. Those HIV/AIDS patients who do not receive ARTs often
need food support and treatment for other diseases, which costs more
than providing ARTs, he explained. He expressed concern that more
NGOs and donors were not doing enough to help the Burmese people,
letting politics get in the way of providing humanitarian assistance
to the truly needy. He encouraged donors and NGOs to increase
funding for Burma, noting that NGOs have successfully worked in
Burma with small budgets, particularly in the health sector.

Lauding the National TB Program
-------------------------------

7. (SBU) Tuberculosis (TB) is a major public health concern in
Burma and the WHO classifies Burma as one of 22 TB high-burden
countries in the world. While the true prevalence of TB in Burma
remains unknown, the WHO estimates that more than 40 percent of
Burma's population is infected with TB (Refs C and D). The National
TB Program (NTP) plans to conduct a prevalence study in 2008, if
funds permit, to determine the true disease burden, NTP Manager Dr.
Win Maung told the Fund Board. Despite not knowing the true
incident rate, the MOH and WHO claim that the NTP has achieved WHO
TB targets, detecting 86 percent of new TB cases and successfully
treating 85 percent of cases. NGOs questioned the validity of these
numbers, arguing that without knowing the true burden of the
disease, it was impossible to know whether the NTP has detected 86
percent of the cases, Dr. Nyo Nyo Mint of PSI stated.

8. (SBU) In 2007, the 3DF, working through the WHO, successfully
strengthened the NTP's capacity at the township level, WHO TB
Officer Dr. Hans Kluge explained. The NTP, the strongest of the
GOB's national programs, will focus on improving its treatment of TB
cases in 2008, particularly of multi-drug resistant TB (MDR-TB) and
HIV-TB co-infection cases. Due to funding gaps, the NTP continues
to rely on the private sector to assist with TB detection,
surveillance, and treatment. The 3DF, which funds 10 partners for
TB, has successfully conducted community outreach activities in more
than 141 townships and supported the Public-Private Mix (PPM) DOTS

RANGOON 00000308 004.4 OF 006


program, which encourages coordination between the NTP and private
clinics for the treatment of TB. 3DF officials lauded the PPM
program, noting that PSI and Myanmar Medical Association (MMA)
clinics detected more than 10,000 new TB cases in 2007. PSI
detected 95 percent of these new cases, and provides TB treatment to
more than 10 percent of Burma's TB cases. During the meeting, PSI
officials pointed out that because the 3DF did not extend TB funding
to PSI past March 31, 2008, (it provided the funding to MMA instead)
PSI might to have to halt its TB services in 2009. Some
participants questioned whether the 3DF and NTP would be able to
successfully treat TB nationwide if PSI stopped its TB program.

Malaria
-------

9. (SBU) Malaria continues to be a significant health problem in
Burma, with more than 650,000 cases reported in 2006. 285 of
Burma's 324 townships are high-risk malaria areas, with 29 percent
of the population living in malaria-risk areas, WHO Malaria Officer
Dr. Leonard Ortega declared. However, the GOB allocates
approximately $150,000 for malaria programs each year, 95 percent of
which is spent on salaries and operational costs (Ref E). Despite
the high prevalence of malaria, both morbidity and mortality rates
for malaria have decreased during the past five years, now at 9.6 of
1000 people and 2.9 of 100,000 people respectively. The National
Malaria Program (NMP) expects to reduce both morbidity and mortality
rates to 6.0 and 2.5 by 2010, NMP Manager Dr. Than Win explained.

10. (SBU) 3DF partners acknowledge that Burma's malaria incidence
may be up to three times MOH figures, and informed the Fund Board
that the best way to reduce the number of malaria cases was to
increase educational awareness and provide long-lasting treated bed
nets to families in need. Only five percent of Burma's population
own and use bed nets, most of which are untreated, Birke Herzbroch
of Malteser explained. To successfully combat malaria, 3DF partners
and the NMP must provide more than 4 million bed nets as quickly as
possible. 3DF partners in 2007 provided more than 36,000 bed nets
to vulnerable populations and treated more than 57,000 bed nets with
long-lasting insecticide. Partners also established 14 mobile
clinics to treat malaria, trained more than 362 health care
providers, and procured malaria drugs for private and NMP clinics.
In 2008, the National Malaria Program and 3DF partners plan to
distribute additional bed nets, procure more than 2.4 million
chloroquine tablets to treat malaria, and increase the number of
outreach programs.

Identifying Future Challenges
-----------------------------

RANGOON 00000308 005.4 OF 006

11. (SBU) In addition to highlighting the positive steps taken by
the 3DF, Board Members, MOH Officials, implementing partners, and
donors identified challenges that both the 3DF and GOB must overcome
to successfully promote health programs and services while reducing
the burden of disease in Burma.

--Funding Gaps: The 3DF is the largest donor in Burma's health
sector, providing $23 million this year, substantially more than the
GOB gives to national programs and NGOs. However, 3DF funding alone
is not enough, Board members and donors emphasized, highlighting
funding gaps for all three national programs. Some of the gaps
include lack of funding for drug treatment protocols for HIV/AIDS,
TB, and malaria; no assistance for coordination of information
gathering and analysis; and less funding for monitoring and
evaluation of programs. Not only should other donors provide more
humanitarian assistance to help Burma's needy, but the GOB should
substantially increase the amount going to health programs, Board
members declared. The high rate of HIV/AIDS, TB, and malaria
prevalence in Burma is not just Burma's problem, they noted. As
more Burmese flee the country, looking for jobs or an escape from
persecution, they bring their diseases with them, making regional
outbreaks of MDR-TB and malaria likely.

--Reviewing Funding Priorities: 3DF members noted that the current
3DF budget is split 60-20-20 between HIV/AIDS, TB, and malaria. Due
to the lower prevalence rate of HIV/AIDS and the higher rates of TB
and malaria infections, some NGOs questioned the 3DF's budget
priorities. Mikko Lainejoki acknowledged the discrepancy, noting
that the 3DF would be reviewing disease burden and treatment
information to determine how best to allocate funds for future
years.

--Securing MOUs with the Government/Monitoring and Evaluation
issues: Many of the implementing partners stressed that the GOB's
policy of only issuing one-year MOUs for NGOs posed a significant
challenge. Almost immediately after signing the MOU, NGOs must
begin negotiations for next year's document, they complained.
Additionally, they questioned GOB restrictions on NGO travel, noting
that travel was vital to properly monitor and evaluate programs.
MOH officials responded that NGOs that asked for permission well in
advance were able to travel. In 2007, the MOH granted travel
permission 444 times; through March 2008, the MOH had already issued
travel permits for 303 trips. MOH officials noted, however, that
NGOs should only travel to areas covered by their MOU - if they
wanted to travel to a new area or start a program in a new area,
travel permits might be delayed.


RANGOON 00000308 006.4 OF 006


--Multi-drug resistance for TB and malaria: Participants
highlighted that the availability of inferior TB and malaria drugs
on the market, coupled by patients defaulting on their medicines,
led to higher rates of multi-drug resistant diseases in Burma. NGOs
and 3DF members stressed the need to improve basic health services
and monitoring to ensure that patients completed their drug
protocols. Additionally, they called on the MOH to work with the
Burmese Food and Drug Administration to ensure that drugs available
on the local market were safe.

--Need for Improved Data Collection: Several members of the Board
stressed that NGOs and the MOH needed to improve their data
collection techniques and share information. Without accurate
information at the beginning of the project, it is impossible to
determine success overall, they noted. Many NGOs collect data on
their own, but either do not share it or lack the manpower to
analyze it properly. NGOs pledged to improve data collection and
cooperation with other NGOs during 2008.

Comment
-------

12. (SBU) Burma's national disease programs - the NAP, the NTP, and
the NMP - provide solid, albeit inconsistent, health care treatment
for Burmese throughout the country. The 3DF and its donors believe
the best way to reach Burma's needy populations is to work through
the existing structures, strengthening the capacity of township
level health providers so they can better detect and treat diseases.
The Ministry of Health, which is woefully underfunded and receives
a budget of less than 1 percent of Burma's GDP annually, cannot do
this alone and must rely on the assistance of donors to supplement
its programs. The 3DF, like most donors, refuses to provide money
directly to the GOB and instead works through 26 implementing
partners to establish a public-private partnership for health
services and education. The 3DF cannot address Burma's health needs
on its own, with minimal financial support from the regime.
Additional humanitarian assistance helps the Burmese people who
should not have to suffer for their terrible government. Assistance
not only will help the Burmese people survive, but will halt the
spread of these highly infectious diseases to the rest of the world.


VILLAROSA

© Scoop Media

 
 
 
 
 
World Headlines

 

Werewolf: Gordon Campbell On North Korea, Neo-Nazism, And Milo

With a bit of luck the planet won’t be devastated by nuclear war in the next few days. US President Donald Trump will have begun to fixate on some other way to gratify his self-esteem – maybe by invading Venezuela or starting a war with Iran. More>>

Victory Declared: New Stabilisation Funding From NZ As Mosul Is Retaken

New Zealand has congratulated the Iraqi government on the successful liberation of Mosul from ISIS after a long and hard-fought campaign. More>>

Gordon Campbell: On The Current US Moves Against North Korea

If Martians visited early last week, they’d probably be scratching their heads as to why North Korea was being treated as a potential trigger for global conflict... More>>

ALSO:

Gordon Campbell: On The Lessons From Corbyn’s Campaign

Leaving partisan politics aside – and ignoring Jeremy Corbyn’s sensational election campaign for a moment – it has to be said that Britain is now really up shit creek... More>>

ALSO:

Another US Court: Fourth Circuit Rules Muslim Ban Discriminatory

ACLU: Step by step, point by point, the court laid out what has been clear from the start: The president promised to ban Muslims from the United States, and his executive orders are an attempt to do just that. More>>

ALSO:

 
 
 
 
 
 
  • Pacific.Scoop
  • Cafe Pacific
  • PMC