Sunday, August 3, 2014

Thailand :Donor funding shift affects Mae Tao Clinic

Patients wait to register for treatment at the Mae Tao Clinic, which provides medical care for tens of thousands of people a year. Photos: Portia Larlee

A shift in funding priorities by donor organisations is affecting the work of the famous Mae Tao Clinic, says its founder, Dr Cynthia Maung.
The clinic has provided healthcare for tens of thousands of Myanmar migrants, refugees and orphans since being founded by Dr Cynthia in the Thai border town of Mae Sot 25 years ago.

But an “interest in prospects of political change in Myanmar” has resulted in a change of priorities by some of the government aid agencies and international NGOs on which the clinic has relied for funding, Dr Cynthia told Mizzima Business Weekly.

Donors were shifting their attention to programs aimed at supporting the return of refugees to Myanmar and it seemed that the Mae Tao Clinic, which also trains healthcare workers in Thailand and Myanmar, did not meet the change in funding criteria, she said.
The quietly spoken doctor, who started the clinic with few resources and a powerful determination to help those in need of healthcare, is the recipient of more than a dozen awards honouring her exemplary humanitarianism.

In 1999 Dr Cynthia, 54, was the first person to receive the Jonathan Mann health and human rights award from the Global Health Council, a network of hundreds of healthcare NGOs based in the United States. She won a Ramon Magsaysay award, often regarded as Asia’s Nobel prize, for community leadership in 2002, an award from the US National Endowment for Democracy in 2012, and in 2013 an honorary doctorate in medicine from Thailand’s Ubon Ratchathani University and the Sydney Peace Prize, which cited Dr Cynthia for “her dedication to multi-ethnic democracy, human rights and the dignity of the poor and dispossessed, and for establishing health services for victims of conflict”.

The Australian government has ceased providing funding support for the clinic, which in 2012 spent nearly US$3 million (about K2.9 billion), divided between its health services and child protection programs and had a caseload of more than 100,000 in 2012.

AusAID, the Australian government aid agency which was merged earlier this year with the Department of Foreign Affairs and Trade, provided A$1.5 million (about K1.5 billion) in funding to the clinic from 2011 to 2013. Funding from the Australian government ended in March, said Dr Cynthia.

Signalling its change in funding priorities, the Australian government says on the DFAT website that its humanitarian aid commitments from July 2013 to June 2014 included the provision of “essential services and support preparations” for refugees from Myanmar living in the nine official Thai camps “who may wish to return home in the near future”.

In July 2013, DFAT announced funding totalling A$8 million (about K7.8 billion) over two years for fiveorganisations, including US-based international NGOs International Rescue Committee, Save the Children and the Adventist Development and Relief Agency as well as France-based international NGO Aide Medicale Internationale.

The Border Consortium, an alliance of 10 NGOs based in Thailand which provides food and shelter to refugees in the nine refugee camps, was also among the successful applicants for funding.

They were selected “on the basis of the quality of their proposals through a competitive, merit-based process,” the development assistance counsellor at the Australian embassy in Yangon, Michael Hassett, told Mizzima Business Weekly in an email.

“Due to the number of the proposals received, it was unfortunately not possible to fund them all,” said Mr Hassett.
However, the Department of Foreign Affairs and Trade would continue to coordinate the placement of Australian volunteer staff at the Mae Tao Clinic, he said.

The unsuccessful funding proposal from the Mae Tao Clinic and a partner group, the Back Pack Health Worker Team which works in Kayin, Mon and Kayah states and other areas, was a training program for health workers in Myanmar and Thailand.

“Maybe we didn’t articulate our work very well,” said Dr Cynthia of the clinic’s unsuccessful application for funding from the Australian government in 2013.

Explaining the rationale for the application, she said the Mae Tao Clinic and the Back Pack Health Worker Team strongly believed that both sides of the border did not have enough health workers or funding for training. "We need to help the health workers improve their skills,” Dr Cynthia said.

To help offset the funding shortfall caused by Australia's decision, she said the clinic received financial support from Asian-based foundations to cover operating costs in 2014 and 2015.

Projects supported by the US, Canadian and British government aid agencies - which provide the clinic with up to 60 percent of its funding - are due to end in 2015, said Dr Cynthia, who is concerned that these donors may also discontinue financial assistance.

“Our recognition of the existing health infrastructure and facilities in ethnic states makes it look like we [Mae Tao Clinic] have not caught up,” with the shift by donors to fund organisations that focus on helping refugees to prepare to return to Myanmar, she said.

Mae Tao Clinic works with the Burma Medical Association, an NGO which operates throughout Myanmar, to train healthcare providers who work in areas including Kayah, Kayin, Shan and Mon states and to standardise training courses in partnership with international NGOs, such as the International Rescue Committee, said Dr Cynthia. The two organisations are also in the process of “reviewing all health systems in different ethnic areas,” she said.

Along with preparing refugees for return, donors are also focussing on integrating the health systems in ethnic minority areas into a national system, known as convergence of social services, she said.

Mae Tao Clinic representatives have met government health officials and NGOs working in Myanmar to discuss convergence, said Dr Cynthia.

The main barrier to convergence in Myanmar is its “highly centralised” health system, she said. “When you say convergence, you're talking about the policy level; dialogue at this level can be difficult because ceasefires are fragile.”

Despite challenges in “decentralising” the health system and creating more space for ethnic organisations, Dr Cynthia acknowledges that the issue is challenging for state governments. “They have goodwill but this is a difficult situation,” she said.

The clinic and its partners, including the Back Pack Health Worker Team and Burma Medical Association, will continue to “strengthen relationships” with the government and to provide health services, said Dr Cynthia.

Dr Cynthia believes that community healthcare providers, such as the clinic, are essential to fill gaps in the Myanmar health system.

“In ethnic states [in Myanmar] the health workforce is minimal; doctors and nurses are only in the city,” she said. “The community itself needs to train and provide basic level services.”

Residents of rural areas in Shan, Kayah, Kayin and Mon states face a range of barriers if they need healthcare. They include language differences and the cost of transport and healthcare for more serious cases at district level hospitals, she said. “The township or district level hospitals need to be prepared to accept these referrals.”

The clinic is constantly striving to improve its clinical services and only about one percent of the patients it sees each year are referred to Mae Sot Hospital, but this accounts for nearly 20 percent of the clinic's health budget, said Dr Cynthia.

For example, basic emergency obstetric cases can be treated at the clinic but caesarian section cases need to be referred to Mae Sot Hospital.

Up until about 1995, the clinic's caseload was mainly workplace injuries and malaria cases. However, Dr Cynthia said an influx of migrants from Myanmar in the mid-1990s meant the clinic saw more female patients and its services were expanded to include reproductive health and child care.

In Myanmar and Thailand, child care and education are a “big worry” for the Mae Tao Clinic, said Dr Cynthia.

“Every day we see me more babies delivered; they will grow up and access to health and education needs to be strengthened for them,” said Dr Cynthia.

The clinic’s activities include a school in Mae Sot for displaced children from Myanmar. The school, known as the Children's Development Centre, enrolled 949 children from nursery age to grade 12 at the start of the 2012/2013 school year, shows the clinic’s report for 2012.

The Bamboo Children's Home in Umpiem refugee camp, in Thailand's Tak Province, is also supported by the clinic and provides food, shelter and access to education for young people who for various reasons are living apart from their parents.

Asked about the clinic’s future at a time of political reform in Myanmar and changing donor priorities, Dr Cynthia said refugees and migrants would continue to live along the border.

“In the future they will need more protection and services,” she said.

About half of the clinic’s patients cross the border illegally and the other half are from the estimated 250,000 Myanmar migrants living in the Mae Sot area, many of whom do not have legal immigration status in Thailand, said Dr Cynthia.

Many migrants and refugees have been traumatised by displacement and many families have been separated, she said. “Children need to grow up feeling like they are in a community and have a family.”

Until the trauma experienced by migrants and refugees as well as their citizenship issues are addressed, Dr Cynthia said migrants and refugees will remain in Thailand, a situation with implications for the peace process in Myanmar.

“Without addressing trauma how can Burma [Myanmar] reach reconciliation and peace?” she said.

The Mae Tao Clinic will continue to focus on providing healthcare in communities on both sides of the border, said Dr Cynthia.

“It is very important that we are not just an institution, but a community network,” she said.

This Article first appeared in the July 31, 2014 edition of Mizzima Business Weekly.