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Myanmar Study Group: Final Report

Anatomy of the Military Coup and Recommendations for U.S. Response

Tuesday, February 1, 2022 / By: Myanmar Study Group

Publication Type: Report

In March 2021, the Myanmar Study Group was organized by the United States Institute of Peace (USIP) in response to the evolving conflict in Myanmar following the military coup of February 1, 2021. To support U.S. policy toward Myanmar, the Institute convened a study group of nine prominent experts on Myanmar and Asian affairs from April through September 2021. The study group held five discussions on topics of critical relevance to the crisis in Myanmar, supplemented by consultations with key stakeholders in the country and the region. Although convened by USIP, the views and recommendations contained in the report are solely those of the Myanmar Study Group, not USIP.

Executive Summary

Today’s crisis in Myanmar directly challenges interests and values that are foundations of U.S. foreign policy: democracy, human rights, rule of law, prosperity, and security. It would be an abrogation of those foundations were the United States to ignore or neglect the tragedy unfolding in Myanmar today. The crisis in Myanmar also presents an opportunity for the United States to demonstrate its commitment to diplomatic engagement that promotes a rules-based international order.

The United States and its major Asian and European allies share many geostrategic interests in Myanmar, the largest country in mainland Southeast Asia. For the United States, which is a leading source of foreign development assistance in Southeast Asia and key trade partner to the region, the possibilities offered by a free and prosperous Myanmar—given its strategic location, wealth of resources, and educated and widely pro-American population—are of vital interest.

Under the current circumstances, Myanmar is highly vulnerable to powerful external and internal forces seeking to dominate its territory given the instability, dire poverty, and lack of effective governance and rule of law brought on by the February 1, 2021 military coup. Among the most immediate of these threats—in addition to the Myanmar military and its supporters—are China, Russia, and international criminal networks.

In particular, the United States risks ceding important geostrategic influence to China and others in the region if it fails to take a more active role in the current conflict. Myanmar could also become a haven for criminal groups to operate from unregulated spaces, protected by the corrupt junta, elevating U.S. concerns about the rise of international organized crime in Asia that also targets the United States. Myanmar’s military has already demonstrated a wanton disregard for regional stability by causing serial mass migrations into neighboring countries. A chaotic Myanmar also risks becoming a petri dish for new COVID variants and other deadly diseases in ungoverned or unreachable areas of the country.

The United States is deeply committed to promoting human rights, pursuing accountability and justice for the military’s abuses, and supporting survivors of human rights violations. The United States has allocated more than $1.3 billion for assisting Rohingya refugees who were displaced across the region after the military’s atrocities in 2016 and 2017. These investments have been undermined by the coup, rendering the prospects for the safe return of Rohingya and other refugees impossible in the near future.

The United States cannot afford to treat the grave setback in Myanmar as a distant distraction of little consequence to its larger interests in Asia.

Key Assessments and Findings

The following assessments and findings are based on the deliberations of the Myanmar Study Group over the course of discussions between April and September 2021. The study group’s expertise was supplemented by consultations with key stakeholders in Myanmar and throughout the region to ensure that the perspectives of those most directly affected were taken into account.

1. Myanmar’s February 1, 2021 coup, staged by military leaders to topple the democratically elected government, has reversed ten years of progress and reform, returning governance to autocratic military rule.

2. Perpetrators of the coup seriously misjudged the determination of the majority of the civilian population to refuse to return to military dictatorship and relinquish the freedoms gained under elected government. Led by youth groups and civil servants in the newly formed Civil Disobedience Movement (CDM), people took to the streets in mass peaceful protest, later forming several political coalitions to challenge the legitimacy of the coup regime.

3. Soon after the coup, the CDM was joined by a faction of the deposed elected National League for Democracy (NLD) government, which formed the Committee Representing the Pyidaungsu Hluttaw, to serve as the interim elected legislature. In turn, the National Unity Government (NUG), including several ethnic minority leaders, was formed to serve as the executive branch. While the NUG has strong public support, especially among the Bamar ethnic majority, the diverse anti-coup movement, which includes a range of ethnic and religious minority organizations and armed groups, has failed to fully unify because of residual distrust between the NLD, civil society, and ethnic minority communities. The NUG, civil society, and some ethnic minority representatives, including key political parties, established a negotiation platform, the National Unity Consultative Council (NUCC), to discuss a political roadmap for a future Myanmar. Through the NUCC, the anti-coup movement has achieved agreement on a range of topics, including the abolition of the 2008 constitution, but negotiations on interethnic power sharing and a future federal democratic governance structure remain fraught.

4. The violence of the military response led some protesters to flee to remote areas under the control of ethnic armed organizations (EAOs), where they received refuge and military training to protect their communities from the marauding army. Fanning out across the country, they organized into a multitude of local People’s Defense Forces (PDFs) in villages, towns, and cities in the center of the country to challenge military and police forces, local administrators, and civilians connected with the junta. By October, PDFs were operating in most of the country’s townships but remained highly atomized in their struggle against military rule, lacking unified leadership or common longer-term objectives.

5. Several EAOs, such as the Arakan, Kachin, Karen, Shan, and Wa forces, have used the situation to expand their territorial control in defiance of military domination, gaining significantly greater autonomy over their own administration. PDF fighters have gained battle experience by joining EAOs in fighting the military. All EAOs hold in common a bottom line that the military’s actions have deeply damaged their security and economic prospects but are far from a shared vision of Myanmar’s future.

6. Twelve months on, the violence has descended into full-scale civil war. This fighting has resulted in significant casualties, and hundreds of thousands of people have been displaced internally and across borders as the army deploys heavy weapons and air assaults, wiping out entire villages in attempts to dislodge EAOs and PDFs. Yet EAOs are still gaining territory and the PDFs continue to expand in size, capability, and coordination, inflicting significant damage to military forces and local administration.

7. A collapse in governance has sparked a multidimensional crisis. The economy is in free-fall; the COVID-19 pandemic is raging virtually unchecked in the absence of a viable health system; food is scarce to nonexistent in many areas; local administrative and service infrastructure is deteriorating under attack by warring forces; lawlessness has emerged in communities as the army orders the police to take repressive actions, negating their law enforcement role; public education has been decimated; and the telecommunications system is collapsing.

8. The relative freedom and improving quality of life that Myanmar enjoyed for a decade is now a thing of the past. Draconian new laws have been introduced to jail and prosecute senior NLD government officials and punish political protesters, striking civil servants, and civil society activists. Ethnic activists and faith leaders, especially in Chin, Kachin, Karen, Karenni, Mon, and northern Shan States, have also been targeted. Journalists have been jailed, and the majority of free media outlets have been banned, even as coup authorities use government media and social media platforms liberally to spread falsehoods about their achievements and to promote hate speech.

9. The international community has reacted to the coup with alarm, but largely failed to mount an effective response:

• The five-point strategy for restoring elected government in Myanmar, put forward by the Association of Southeast Asian Nations (ASEAN), has been ignored by the coup leaders despite their having agreed to it. ASEAN’s decision to exclude the head of the military regime, Commander-in-Chief Min Aung Hlaing, from the October ASEAN leaders’ summit and the November ASEAN-China dialogue demonstrated a willingness to apply pressure. The bloc remains deeply divided over next steps. With Cambodia assuming the ASEAN presidency in 2022 and Prime Minister Hun Sen’s controversial January visit to Naypyitaw to meet with General Min Aung Hlaing, it remains to be seen how ASEAN will proceed to deal with the junta.
• China has blocked UN efforts to address the crisis, instead pushing for the international response to be managed by ASEAN. Simultaneously, China is trying to hedge its bets on the coup regime by supporting efforts of the most powerful actors, including both the junta and the EAOs, to consolidate power in their areas so that it may eventually rescue its infrastructure investments. China has initiated engagement with the coup regime and met with senior coup figures. It has shunned the NUG and PDFs yet maintains limited ties with the NLD, pressing the coup regime not to dissolve the party. Overall, the junta’s dependence on China’s political and economic support presents Beijing with a golden opportunity to secure one-sided agreements that will harness Myanmar to its southwestern provinces. China may soon discover, however, that the junta lacks all capacity to deliver on any such agreements.
• Russia has stepped in to serve as a key security partner to the junta, sending senior military officials to join key events in Naypyitaw, supporting the junta’s establishment of a new coast guard in October, selling the junta an unspecified number of weapons systems and components since the coup, and even making a port call in Myanmar as the military was launching a scorched-earth campaign in the northwestern part of the country. Russia’s posture has strengthened China’s strategic interests by ensuring that China is not the only major country supporting the junta.
• India ’s response to events in Myanmar has been deeply conflicted. On the one hand, India fears the coup offers China an opportunity to gain advantage with the military, leading New Delhi to avoid offending the military leadership by continuing to supply lethal military equipment. On the other, India is a member of the Quadrilateral Security Dialogue (Quad)—along with Australia, Japan, and the United States—and its northeastern states have strong cross-border ethnic ties and a deep affinity for Myanmar’s pro-democracy actors. The Indian Defense Ministry has begun to enhance relations with the opposition National Unity Government as PDF strength and activity grows.
• The community of Western democracies, led by the United States, has condemned the coup; lodged a variety of sanctions against military and coup leaders, their supporters, and businesses; provided technical and other forms of nonmilitary support to the NUG and the CDM; and provided humanitarian assistance through nongovernmental organizations and UN agencies. It has also sustained high-level engagement with Asian allies Japan and Korea as well as key Southeast Asian states, including Indonesia, Singapore, and Thailand, on the response to the crisis.
• The United Nations has persisted—against junta obstruction—in developing a response to the COVID-19 emergency in Myanmar through the Global Fund, COVAX, and the GAVI Alliance to ensure that the regime allows vaccines and anti-COVID assistance to reach all needy communities. When the UN General Assembly reconvened in September, an agreement between the United States and China made it possible for Myanmar’s Permanent Representative appointed by the NLD government to remain in place; this deal was renewed in early December, with further action to come only later in 2022. This dealt a blow to the junta’s attempt to seat its own representative, but the agreement stipulated that the Permanent Representative would limit public engagements.

What Comes Next?

The prospects are extremely low that the military, having lost the support of the majority of the population, can regain enough control of the country to govern it. Any elections staged by the junta regime will be rejected by the population and international community as illegitimate. The course of events since the coup has ruled out the eventuality of returning Myanmar’s governance to the status quo ante with an NLD government under the 2008 constitution.

Possible outcomes are boundless and unpredictable but include

• continuation over the short to medium term of chaotic and increasingly bloody civil war that could become internecine,
• partial or complete secession from the union by some of the ethnic minority groups as their armies gain ground against the military,
• consolidation of harsh military control over some parts of the country,
• failure of the opposition movement to unite effectively around an agreed future for the country, or
• emergence of an empowered opposition government conceived as an inclusive federal democracy with security forces reconfigured along federal lines, some early signs of which are already emerging in conflict areas where opposition forces and EAOs are increasingly taking over local administration, health services, and security control.

Key Recommendations for U.S. Policy

Because of the persistent domestic anti-coup movement, the Myanmar military is perhaps as weak and vulnerable as it has ever been. Although the United States has few options for influencing Myanmar’s current military leadership to abandon its campaign of violence and oppression against Myanmar’s people, it could support five lines of effort that, in combination with ongoing resistance strategies in Myanmar, might alter the generals’ calculations:

1. Strengthen trust and unity within the opposition.

The opposition movement comprises diverse actors, many of whom were competitors before the coup and remain deeply divided over interests and historical grievances. Although united around a shared revulsion toward the military and a common strategy to make the country ungovernable under the junta, the movement will need to build greater trust and unity if it is to succeed in defeating the military and—more important—in rebuilding a war-torn country. The United States should support dialogue and reconciliation efforts, from the community level to the national level, that help achieve this objective. If successful, these efforts would not only increase the likelihood of the movement prevailing in the near term but could be a first step toward long-term sustainable peace in Myanmar. The United States should also emphasize the need to incorporate civilian protection in opposition strategies to guard against extrajudicial killing and avoid an endless cycle of retribution.

2. Strain the military’s resources and legitimacy with international pressure.

The Myanmar military is severely depleted and, due to popular resentment, faces mounting difficulty recruiting troops and administrative staff for the State Administrative Council (SAC), the caretaker government formed by the junta. The country’s economic deterioration further constrains the resources available to the military to consolidate control. Negotiated efforts to squeeze the generals with an expanded international arms embargo and coordinated sanctions would go a step further. The military’s domestic legitimacy—including among its soldiers—is at an all-time low. Continuing efforts to exclude the coup regime from international forums, such as ASEAN and the United Nations, would weaken its remaining domestic legitimacy as a governing institution and increase the incentives for defections, desertions, and noncompliance.

The U.S. government has already placed a wide range of targeted sanctions on military leaders, senior members of the coup government, military industries, and crony businesses, but the impact of these sanctions is unclear. Targeted unilateral sanctions are unlikely to have a decisive effect, but a coordinated and targeted sanctions regime among U.S. allies and regional partners could deliver a powerful blow to the military, given its diminished circumstances. Conversely, if general sanctions were imposed, the impact would likely fall most heavily on the civilian population.

More broadly, the United States should intensify diplomatic interaction with key neighboring countries, especially India and Thailand; work closely with ASEAN; and explore ways for the Quad to apply pressure and support efforts that marginalize the coup regime and encourage restoration of civilian democratic governance. To avoid misunderstandings and ensure active channels of communication, the United States should stay open to consultations with China, to the extent that China is willing to engage. Sustained high-level engagements, including the possible appointment of a senior U.S. envoy or coordinator, would send a strong signal of U.S. intentions to both the United States’ partners and competitors in the region.

3. Lead an international effort to get humanitarian assistance to civilian populations under siege in Myanmar.

The chaotic conditions in the country and the hostility of the coup regime to foreign “interference” make it difficult, though not impossible, for the United States to channel humanitarian and other forms of assistance through civil society organizations. Given the various constraints and the need to remain adaptive in a highly volatile environment, the U.S. Agency for International Development and the State Department should evaluate their procurement and assistance requirements and procedures to ensure adequate flexibility to support local civil society organizations (which know best how to deliver assistance in conflict areas) and to prioritize partner security. It is also incumbent on the United States in the near term to act in concert with regional allies and international organizations, such as the United Nations and the International Committee of the Red Cross, as they respond. Coordinated international action could help remove obstacles to getting material assistance to the country’s beleaguered civilian population, help ensure that the coup regime remains internationally isolated, provide material and moral support to the democratic opposition, and ultimately lay a viable foundation for the country’s stabilization and reconstruction under an elected civilian government.

4. Expand relations with the civilian nonstate authorities that govern significant parts of the country, especially those democratically elected by ethnic minorities.

This would recognize the nascent rapport and practical collaboration that has developed between the minority and majority populations opposing the coup. Several of these authorities and the EAOs with whom they affiliate are collaborating closely with other resistance groups and gaining ground against the Myanmar military. In addition to providing humanitarian assistance to vulnerable minority populations through nonstate authorities, the United States should help the authorities think through how they can best collaborate to achieve an inclusive union for all the country’s residents. The United States should further explore enhanced dialogue with nonstate authorities and encourage them to embrace democracy, respect human rights, and deploy their resources toward ending the coup regime.

5. Develop a transition plan resistant to another military power grab or the explosion of other forms of violence.

The United States should supply technical and other nonmilitary assistance to opposition actors involved in transition planning, including but not limited to the NUG and the NUCC.

To promote democratic values, sustain the development of Myanmar’s leaders, and deepen U.S. relationships with Myanmar’s future leaders, the United States should not only provide protection and support through educational grants and fellowships to preserve Myanmar’s wealth of intellectual talent that has emerged within the younger generation, it should also support civil society organizations in Myanmar and outside the country. This would encourage the emergence of a strong cadre of civilian leaders who can formulate viable future plans for a democratic federal Myanmar and build a prosperous economy. The United States should leverage this moment of relative unity against a shared enemy—the junta—to build interreligious and interethnic trust and pursue reconciliation.

To support transitional justice, the United States should provide robust assistance to local initiatives to document the ongoing atrocities and war crimes being committed by the junta. This support should aim to complement international accountability measures, including by the Independent Investigative Mechanism for Myanmar, while exploring ways to use documentation to build international pressure on the regime.

●   ●   ●

The military’s ill-considered coup has triggered a revolution in Myanmar that promises a successful conclusion to decades of effort by the United States and its international partners to nourish the seeds of democracy and bring an end to one of the world’s oldest military dictatorships.  These seeds have clearly taken root in the younger generation willing to pay with their lives to keep democratic progress alive. The United States’ support for them must not fail at this critical moment.

Note: This above text originally stated that Russia sold $2.3 billion of weapons to Myanmar in the months following the coup. That figure, based on reporting by The Irrawaddy in September 2021, was for weapons deals Russia signed with multiple countries, including Myanmar, in August 2021. The total of Russian transfers of and new contracts for weapons and components to the junta in 2021 was likely in the range of $300 million to $1.3 billion.

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Myanmar Study Group

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In March 2021, the U.S. Institute of Peace organized the Myanmar Study Group in response to the evolving crisis in Myanmar following the military coup a month prior. To support U.S. policy towards Myanmar, USIP convened a group of 9 prominent experts for a series of discussions about the dynamic context within the country and U.S. government policy options.

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Creativity in Crisis: Re-envisioning Higher Education in Myanmar’s Spring Revolution

• Regular Article
• Open access
• Published: 17 October 2023

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• Mary Shepard Wong   ORCID: orcid.org/0000-0001-9444-4523 1 &
• David Kareng 1  

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We need to change the entire generation through education so that social justice and peace education can successfully permeate into our society. In this case, I would say education is the most important weapon to conquer injustice. (S8)

In the spring of 2022, we (a teacher–educator from the USA and a Kachin graduate research assistant) interviewed 14 participants from Myanmar who were engaging in an unprecedented educational re-imagining during the Spring Revolution following the 2021 military coup that gripped the county. Three preliminary findings of our study focus on creativity in crisis in higher education, which we categorized as actors, actions, and procedures, or who, what, and how. ‘Who’ refers to actors and their creativity in forming new alliances among inter-ethnic and inter-generational educators and activists to remake education. ‘What’ refers to creativity in content in addressing inequity and ‘fake history’ in the national curriculum. ‘How’ addresses creativity in the delivery of education in the midst of extreme challenges and opposition. This look into the way crises can lead to creativity in education, with a focus on higher education, presents a unique opportunity to witness how grassroots actors in Myanmar are seeking to transform higher education in a ‘radical bureaucratic overhaul,’ as one participant put it, making it more inclusive, critical, and just.

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Introduction

In his article ‘Creativity in Conflict Zones,’ Canagarajah ( 2021 ) encourages readers to reflect upon creative pursuits developed during traumatic conditions as this could yield valuable lessons. He states,

For many of us, life in the conflict zone is often off-limits for reflection or contemplation. Some are in denial, as we don’t want to acknowledge the injustices and inhumanity we experienced. It is too painful to relive those events. [ . . .] But it is important to reflect on those experiences as there are lessons for us, for our children, and perhaps for outsiders beyond our community. (p. 1)

Canagarajah ( 2021 ) found that living in conflict zones can foster creativity, noting ‘there are experiences of vulnerability, pain, and suffering that accompany everyone’s creative enterprises’ (p. 1). The response of educators to the 2011 coup in Myanmar is an example of how creativity can be found in crisis and is where we now turn.

Background of Burma/Myanmar

At first glance, one of the last places one might expect to find creativity in higher education is in Myanmar’s public education system. Known as Burma until 1989, Myanmar has one of lowest budgets for education in the world and is notorious for its outdated, non-inclusive, rote-learning style of national education. The military-controlled government has used ‘slave education’ (Metro, 2021 ) to indoctrinate its people for seven decades with ‘fake history’ that ignores and seems to want to erase the linguistic and ethnic diversity of its people. From 2011 to 2021, it appeared that the grip of the military was easing with new political leadership and proposed education reforms, however, that came to abrupt halt in February 2021 when the military Junta overthrew the lawfully elected National League of Democracy (NLD) government and unleashed violence on its people. The people revolted and teachers and students boycotted schools. By June of 2021, it was estimated that 90% of college instructors had left their positions to join the Civil Disobedience Movement (CDM) (Frontier Myanmar, June 8, 2021 ; January 17, 2022a ), many going into hiding or exile, where a shadow government, the National Unity Government (NUG), and parallel higher education systems that are critical, inclusive, and free of military control started emerging. Creativity was found in crisis as people united in what some call the Myanmar Spring Revolution.

Myanmar is the largest of the mainland Southeast Asian states. India and Bangladesh are on its western border, and China, Thailand, and Laos are on the North and East borders. Myanmar has 14 provinces comprising seven divisions and seven states, the latter named for the non-Burman ethnic groups who reside in those regions (Mon, Kayin, Rakhine, Kayah, Shan, Chin, and Kachin States). Myanmar is rich with natural resources, including its diverse cultures and languages, but is perhaps best known for having the longest civil war in history. Non-Burman ethnic groups have suffered for decades from oppression under military rule. Buddhism is supported by the state in many ways and is the majority religion of Myanmar (close to 90 percent claim to be Buddhist). Other religions are practiced in Myanmar, such as Christianity, the majority religion among the Chin and Kachin, and Islam, the majority religion of the Rohingya. Animists and Hindus, each make up less than 1 percent of the nation’s roughly 54 million people.

While there have been brief periods of civilian rule in Myanmar, such as after independence from the British in 1948 following two decades of colonial rule and the emerging democracy taking shape from 2011 to 2021, these periods ended with the military taking back control. The gains made with the emerging democracy in Myanmar in the second decade of this century, came to an end on February 1, 2021 when the military junta staged a coup. In the first phase of the coup, the junta arrested many legally elected NLD officials. After one year, the number of detained citizens was over 12,000 and those killed over 1500 (AAPP, 2022 ), many who were protesting peacefully on the streets during the early months of the anti-coup movement. This coup, like the two that came before it in 1962 and 1988, has had a devastating impact on all sectors of society. However, unlike the previous coups, this one has resulted in a revolution, with active participation from students, health providers, teachers, and citizens who envision a new Myanmar.

The history of education in Myanmar is complex. Myanmar once held the distinction of having one of the top universities in all of Southeast Asia, Yangon (Rangoon) University (Lall, 2016 ) with English as the medium of instruction in many subjects. But after five decades of isolation and neglect of its education sector, Myanmar’s economy and education budgets were ranked among the lowest in the world. Before the 2021 coup, reforms in education were underway, with millions of dollars from international organizations supporting large-scale education sector reviews and revisions. These reforms were sorely needed, but critics felt the reforms did not go far enough, and did not reflect the rich diversity of Myanmar that had been ignored in the previous nationalistic curriculum. In response to the inadequate education provided by the government, many ethnic groups in Myanmar living in the remote areas had established ethnic-based education systems in which they could use their home languages to teach about their own histories. Even in urban areas, educational alternatives to military-backed education were created by local and international actors who provided alternative educational opportunities.

It can be said that education in Myanmar falls within three spheres: state-led education, which educates the majority of students; ethnic-based education (South & Lall, 2016a , 2016b ), conducted mostly in minority languages; and civil society-based education, led by local citizens and sometimes supported by international actors. The most notable and creative forms of higher education in Myanmar before the 2021 coup are those created and administered by Ethnic Armed Organizations (EAOs) and by Civil Society Organizations (CSOs). Several ethnic-based education systems are well established in many parts of Myanmar and unlike state-supported schools, many opt for more learner-centered pedagogy, often using mother tongue-based multilingual education approaches. Their success is notable given the lack of state support and resources and the constant threat of providing education in conflict zones.

The 2021 Coup and Its Impact on Myanmar

In the aftermath of the military coup in Myanmar during the spring of 2021, many sectors of society united in protest, including the medical community, students, teachers, factory workers, clerks, and citizens. What makes this uprising unique is that many who are from Bama majority have joined the resistance, aligning with other ethnic groups in solidarity, to take a stand against the unlawful military junta. Seeing the violence that the military unleashed on common citizens in urban areas, many of the Bama majority have now been ‘unlocked’ as one participant put it, with enhanced sensitivity to the violence that non-Burman ethnic groups in remote areas have been experiencing for decades. ‘Now they know’ as one participant put it, ‘what we have been experiencing for seven decades’ (S10). Many citizens, community leaders, and members of civil society organizations (CSOs) supported the thousands of teachers and others in the CDM to oppose the coup, some actively participating in the newly emerging shadow government, the NUG.

The impact of the February 1, 2021 military coup on education in Myanmar is substantial. In June 2021, over 139,000 K-12 and higher education educators, who took part in CDM were dismissed from their teaching positions, with many in hiding to evade being arrested (Frontier Myanmar, June 8, 2021 ). In addition, over 19,000 university professors were dismissed for joining the CDM and had to leave their homes on campus and work from undisclosed locations seeking to support their students however they could. In the summer of 2021, dismissed university faculty would be arrested if they tried to teach online due to their participation in CDM. As few as 10% of students returned to schools in June 2021 (Metro, 2021 ), hoping their boycott would demonstrate their resolve in seeking democracy and social justice in Myanmar. A year later in June 2022, reports from the Junta indicated that only half of K-12 students (5.2 million) were registered for school nationwide. Many who register did not attend classes (Frontier Fridays, June 3, 2022b ), so the negative impact of the coup on education is continuing.

In response to this, the people of Myanmar established a parallel government and began to develop new and alternative education systems. The educational re-designers are several: teachers’ and students’ unions, the NUG, ethnic nationalities’ education departments, non-profit organizations, civil society groups, international organizations, and overseas scholars invited to participate in the educational transformation by the NUG. The content of these reimagined education systems is both inclusive and critical, in sharp contrast to the military-backed nationalism promoted in government schools. The hope of transformation of the educational landscape of Myanmar is real and is taking place in many forms. Metro ( 2021 ) states that if these emerging innovative and collaborative educational systems succeed, education in Myanmar can become a driver of change. This collaborative vision of a new alternative, more socially just education system is a prime example of creativity in demonstrating how people in Myanmar can come together across generational, ethnic, religious, regional, and economic differences to accomplish a common goal for the greater good. It is these activists, educators, and peace workers, who this study seeks to learn from in their efforts to re-envision higher education in Myanmar.

A recent report of higher education providers in post-coup Myanmar provides more context, with findings from interviews and focus groups of over 50 key informants and data from over 2500 surveys of students and teachers (Spring University Myanmar, 2023 ). They list five key interim education providers (IEPs) that offered education following the coup:

Ethnic Education Departments.

Online Education Platforms.

Interim University Councils and Students’ Unions.

Ministries under the National Unity Government (NUG).

Community Initiatives in Conflict Areas.

They state that of these five, only Ethnic Education Departments were established pre-coup. These were well-established offering post-secondary campus-based education programs that granted certificates, diplomas, and bachelor’s degrees in fields such as Social Sciences, Computer Sciences, Public Administration and Governance, Federalism, Peace and Conflict Studies, and STEM. The list of ethnic groups with established colleges includes Chin, Kachin, Karen, Karenni, Kayan, Shan, Lahu, Mon, Pa-O, and Ta'ang. Our study had participants from all but one of these five IEPs and had participants representing at least six of the ethnic groups listed. A key finding of their report is that participation of CDM university teachers in these interim education systems was relatively low given their large number, which might be due to personal issues, intermittent internet connectivity, power outages, or security concerns. (See the SUM 2023 report for more information.)

The Researchers

The two researchers in this study provide an insider/outsider perspective and bring different expertise and experiences that made the study possible. The second author is a Myanmar citizen, a Kachin from Myitkyina, and a graduate student who was enrolled in a Master’s program at the start of the inquiry. He brought to this study the ability to conduct interviews in English, Burmese, Jinghpaw, and Hka Hku. His network of close relationships with key actors in Myanmar within educational institutions, activist groups, and various ethnic communities provided access to key participants. Trust is crucial when interviewing participants and especially when they are activists. His years of living in a conflict zone in northern Myanmar and his lived experience during the coup in Myanmar from February until August 2021 right before he came to the USA to complete his MA degree provides legitimacy to the study. His connections afforded access to key participants and his experiences provided them the trust needed to tell their stories. His perspective of what it is like to be oppressed and on the run, and what it means to experience a coup, added nuance and context to our analysis.

The first author is a teacher educator and was a 2015–2016 Fulbright Scholar at Yangon University. She has researched and written about Myanmar’s linguistic and ethnic diversity (Wong, 2017 ), English language teaching in Myanmar (Wong et al., 2019 ), its language-in-education policies (Wong, 2019 ), and teaching for peace and social justice in Myanmar (Wong, 2022a , 2022b ). She brings experience in international qualitative research and a desire to promote social justice through education in Myanmar. The study was conducted during her spring 2022 sabbatical with an additional small grant from her university. The authors’ teacher/student relationship developed into one of co-researchers, solidified after David's graduation the spring of 2022.

The Research Questions

The research questions in this study focused on the participants’ experience during the February 1, 2021 coup and the impact that the coup and the resulting Spring Revolution is having on higher education in Myanmar. Our research examined the emerging educational alternative spaces being formed at this critical juncture. We interviewed activists, educators, students, researchers, and NUG and community leaders engaged in re-imagining education. We asked about how already established forms of alternative education systems, namely ethnic-based educational systems among the Mon, Karen, Kachin, and Chin were impacted, and how other creative forms of innovation in higher education were emerging, such as virtual higher education and third spaces, created to avoid education using curriculum from the military-backed regime. This inquiry into how a crisis can lead to creativity in higher education presented a unique opportunity to rethink the purpose of higher education, redesign its content, and rework its processes to transform who higher education ultimately benefits.

We conducted this study remotely from southern California through Zoom and Facebook Messenger interviews with 14 participants who were involved in education in Myanmar. Some of the participants were in exile (in the USA or Thailand), and some in liberated areas or in safe undisclosed locations in Myanmar. IRB approval was granted from Azusa Pacific University, and informed consent forms and interview guides were translated into Burmese and checked for accuracy. Both researchers had successfully completed courses offered by the Collaborative Institutional Training Initiative (CITI) certification required by their university’s ethics board. Both researchers were present at the majority of interviews. Participants chose which language to use in the interviews. Four interviews were conducted in Burmese, two in a combination of English and Burmese and eight in English.

After we conducted 14 interviews with an equal gender balance from a range of ethnic backgrounds and roles, we felt we had enough data and perspectives to adequately address our questions. Data analysis was ongoing, taking place during and after the interviews from January to June 2022. During the data analysis we created over 375 codes and sorted them into 12 categories. We listened to the interviews several times, while reading and coding the transcripts, merging and splitting codes when appropriate, and seeking to find responses to our inquiry on the impact of the Spring Revolution on higher education. We met each week for two hours to ensure we understood the participants’ responses by discussing our codes, memos, and insights and discussing questions or concerns. We also shared, read, and discussed numerous related articles on the coup and education in Myanmar. On a few occasions, we emailed participants follow-up questions to confirm we understood their responses. We also said we would try to provide them access to any resulting publications and sought out open-source publications for ease of access for the people of Myanmar.

Participants

We used purposeful and snowball sampling to recruit participants. More specifically, we recruited participants by emailing personal contacts who had connections to education in Myanmar. After we described our study, we asked if they would like to be interviewed or if they could introduce us to someone who might have insights related to our inquiry, provided they were over 18 and in a safe location for a Zoom interview. We sought out a diversity of participants in terms of age range, ethnicity, gender, perspective, and role. Since this research took place around the one-year anniversary of the February 1, 2021 coup, we attended several webinars conducted by numerous universities (Yale, Harvard, Teachers College, Columbia University, etc.) which hosted panels of presenters who were Myanmar activists in exile. We contacted some of the panelists and a few were willing to be interviewed and/or provided introductions to other key actors to interview.

Four of the 14 participants identified themselves as Kachin, four as Burmese (some with additional Shan or Chinese heritage), three as Chin, two as Karen, and one as Mon. Participants identified themselves with overlapping roles, including teachers, curriculum developers, NUG members, leaders in government, CDM members, activists, revolutionaries, scholars, students, and researchers. We sought to provide at least one quote from each of the 14 participants.

Results: Findings on Creativity

Creativity is defined as ‘the interaction between aptitude, process, and environment by which an individual or group produces a perceptible product that is both novel and useful as defined within a social context’ (Plucker et al., 2004 , p. 90). Traditional definitions of creativity include both originality (or novelty) and task appropriateness (or usefulness). Terms associated with creativity found with a simple online search of the term include choice, discovery, joy, risk, imagination, and an out-of-the-box solution to a problem in a specific context. The opposite of creativity is when students are provided word-for-word answers from their teachers to memorize and recite in a competition between schools and in on high stakes exams and when students are penalized for providing their own ideas on exams instead of those teachers had asked them to memorize which has been found in state-run education systems in Myanmar (Wong et al., 2019 ). In a creative approach to teaching, instead of providing one right answer, teachers seek to foster curiosity and discovery, to encourage risk and mistakes, to allow for choice in assignments, and to help students’ imaginations to flourish. Teachers can employ creative pedagogical approaches that seek to instill creative thinking in students by rewarding and assessing creative thinking and solutions among students. In addition, administrators can apply creative solutions in the development, delivery, and management of education. Thus, creativity in education is not limited to what a teacher does in the classroom or to student learning outcomes to think and work out creative (i.e., novel and useful) solutions to problems, but can also be applied to the establishment and running of educational institutions and initiatives.

Change is difficult, and sometimes it takes a crisis to force a change. As one participant in our study noted, ‘We cannot waste this crisis. [...] Now is the best time to create the different educational curricula which are intentionally designed for all of the ethnicities in Myanmar and provide a sense of inclusion’ (S8). In crisis creativity can bloom. The following sections outline some of our findings which we have organized into creativity in terms of who builds and benefits from education, what is included in the curriculum, and how education is delivered.

Who: Creativity in New Roles and Forming Alliances to Reimagine Higher Education

Analysis of the data found creativity in crisis in terms of the actors themselves, notably, who determines what education is, who it serves, who generates the curriculum, and who teaches. In our study on education during the crisis in Myanmar, we found stakeholders taking on new identities and roles, such as college students becoming curriculum developers, young people becoming administrators, teachers becoming government leaders, and scholars becoming activists. In total, we had 13 codes under ‘who’ which refers to actors who engaged in creativity gleaned from our analysis of the 14 interviews. These codes included creativity in:

educators joining online international communities of practice

institutional collaborations with international universities

educators reaching out to international alumni

emerging educational sites hiring students to rebuild education

emerging educational sites hiring unemployed CDM teachers to teach new students

student unions creating free education

student-led reforms in education

students and teachers forming armed resistance groups

teachers serving under-resourced groups

teacher/activist collaborations

urban teachers volunteering to teach rural communities

teachers, students, and parents forming networks and coalitions

regional universities forming agreements to accept/recognize one another’s degrees

Many actors took on new roles due to the coup and Spring Revolution. In the following quote, a professor notes his transition from a scholar to activist.

For me, my previous understanding is that a scholar has to write. That is the basic task of being a scholar. We have to write, we have to publish, but when I experienced the rise of the coup, I felt that that was not sufficient. We cannot simply write what we know or what we think in the paper or in the articles, we really need to step out of that comfortable zone and then go into the public lives and engage with the grassroots people. We need these people and then do it together, bring out their voices when you write, and then you could also be their advocate as a speaker. So, this is how I see myself as a scholar, advocate, or maybe an activist. (S7)

Many of the tens of thousands striking CDM teachers fled their homes in fear of being arrested and were now without a means to support themselves. They were left extremely vulnerable, but demonstrated remarkable resilience. New alternative educational systems were being formed, and many CDM teachers were being hired to teach in them, whether it was online or community-organized classes located in students’ homes. Thus, teachers were changing their roles from teaching the state-run curriculum to replacing it with a curriculum they designed in the new system. As one participant said, ‘Now, we have CDM teachers, and we can apply their workforce in the field of creating the best possible educational curriculums which are intended for different ethnicities and backgrounds’ (S8).

The leading role of education and of teachers and students in the revolution is described by this participant:

This revolution involved education as well. Very strong resistance from education sectors, by CDM teachers, university students, and CDM students. Many of the students are Gen-Z and very strong. They are the pillar of this revolution. Students and parents are resisting the [state] education system. There’s a very strong resistance going on in education. (S9)

We also found creativity in forming new alliances among students, student unions, teachers, parents, ethnic groups, community organizations, and the international communities. Here, one participant discussed the importance of higher education to the revolution and connecting with alumni from her international educational experiences.

Higher education is really crucial in this revolution. [T]he students who got higher education from abroad are forming new alliances by themselves. For example, I have a large network of Harvard alumni, and we have the WhatsApp group. So, I can just reach out through my alumni groups, requesting what we need. I just need to text. The same thing happened to many others. (S1)

Mentioned here are new alliances formed among ethnic groups to support quality education.

We meet at least once a month online, especially with teachers from Mon, Karen, Shan, and Rakhine. Kachin people are doing a good job over there which is very motivating. In the past, we did not contact [Kachin educators/ethnic-based education] as we were teaching most of our time in lower Myanmar. But now we invite each other [to meet], and we support each other whenever we are in need. (S11)

This quote shows that while these ethnic-based schools had well-established education systems in place, the coup brought some of them together forming new alliances.

In a crisis, such as Covid or a coup, a commitment to diversity and inclusive and multilingual education in educational institutions can wane, with the loss of previous gains which can hurt the most vulnerable students. Although this was sometimes the case (see next section), we also found a doubling down on valuing equity and diversity in education even in the midst of the coup and Covid in Myanmar.

What: Creativity in Content of Higher Education

We also found creativity in crisis in our data in terms of what was taught including the curriculum and program development. Ten codes from our analysis of the 14 interviews in these areas included creativity in:

adding awareness or more emphasis on social justice in the curriculum

adding peace-building skills to the curriculum

adding foreign languages (especially minority languages) to the curriculum

adding conflict resolution to the curriculum

forming ethnic-based higher education programs in their own languages

forming new higher education programs for and across ethnic groups

offering new majors and courses related to nation building and leadership

teaching the histories of all peoples of Myanmar, not just Bama people

rethinking higher education from the ground up (what it is, who it serves, how it’s offered)

offering online seminars, short courses, certificates, and programs in new content areas

In terms of content, the following participant noted the need to train up leaders and prepare ethnic people for the political arena as stated here ‘All the different ethnic students can study together, can share, we can train new leaders for the future, especially political preparation’ (S4). This was also mentioned by this participant: ‘So education is one of the most important sectors, and it is very important to include in the curriculums which are intended for all ages so that it will be very effective in nation-building tasks’ (S8).

This participant notes that ethnic language education is a right and should be taken on by those who speak those languages. She calls for decentralization and autonomy.

This is ethnic language education and it is a national right. [. . .] We have our own right to teach our generation our language. We are responsible for this teaching. So, we cannot expect the state to support us because the Myanmar government is dominated by the Burma majority. So, they will never understand the way we think, our identity. So, it’s always good to support our education system run by us and run by our curriculum. (S5)

Policy is also in need of reform as noted by this participant: ‘If we reform educational policy [and] appreciate the value of all kinds of ethnicities and reduce the concept that Burmese people are the most important in Myanmar, then people [...] will respect and value each other and peace will be maintained (S13).

Valuing ethnic languages and histories and using home languages in education was often mentioned as a priority, and as discussed previously there was a desire to not wane in this commitment, but Covid and the coup chipped away at this as mentioned here.

If possible, we need to design our curriculums with our own languages. [ . . .] For example, we taught our traditions, practices, and history. But that was just before Covid-19 hit, during the era of NLD. These days, we do not teach the ethnic languages. It has been three years since we could include those things in the school curriculum. (S14)

We include this to note that creativity alone is not always enough. Participants lamented the lack of equity of access to education for the working-class families in remote areas as stated here: ‘The current problem is that the students from the rural areas and normal daily wage earners do not have the access to education’ (S14).

How: Creativity in the Formation and Delivery of Higher Education

Thirteen codes emerged in our analysis under the broader theme of creativity related to how education was delivered. These included creativity in:

alignment with a new government (NUG) to create new curriculum and policies

creation and delivery of extended home-based or community-based learning in ethnic areas

creation and delivery of new online courses, programs, and support

new ways to deliver education, such as podcasts, radio, modems, and ‘boxes’

evacuation of scholars to safe locations to deliver online education from there

providing free education or scholarships to those in rural areas

organizing online webinars for teacher support in conflict zones

international university collaborations to create and teach courses

offering new certificates, short programs, degree finishing courses

solving problems, such as rising internet costs and connectivity problems

using a church umbrella to offer social justice education in urban areas

using the crisis for a total overhaul of the higher educational system

using education as a pillar to the revolution

Our participants were engaged in creating new and alternative educational systems in response to the need for students trying to avoid education from the state, as stated here:

A lot of students are reluctant to go to the universities and to the schools because you know they don’t want this military system, but at the same time, they still need to get some sort of education within this period. So, our institution [and] other institutions are able to provide that for them. As more institutions started, we have discussions like what should we be doing? What’s the best way forward? And even though it’s only been a year, it’s been developing well. (S3)

Another participant discussed the importance of mother tongue language use in education. This Burmese teacher was transformed by his year of teaching in Shan state. His creative suggestion is that all teachers from the Burmese majority should teach in rural areas for a period of time.

Sadly, most of the students in Shan State especially in the rural areas do not have access to quality education. If they had a chance, there would be an improvement. I mean in Yangon; they have much more opportunities than any other regions. If Shan students were given lectures in their own language, I am sure, I know my students very well, and they will also have that kind of quality education and opportunities like in Yangon. Before, I often thought that they have equal opportunities like us. It’s something I often thought. But when I was there [in Shan State], my view and my mindset totally changed and I [began to] love them. I have a duty to change their minds, to educate them. That really amazed me and I don't know how or what had changed my mind but surely, it totally changed. [ . . . ] For these students, learning in the Burmese language is like being in hell! Ok, the truth is that they hate Burmese. [ . . ] But they didn’t hate me. I think almost every Burmese should have to go to teach in the ethnic zone in the ethnic areas and I think that would do a lot to change people’s views. (S12)

A Karen teacher discussed a creative way to teach children, village by village.

One month after the coup most of the parents told me that we should do something for the students to continue their study. So, we decided to have home school teaching. We go to one village and make small groups like home teaching. We got the opportunity to teach students with their parents and the community. We learned from the community, their daily lives, and their living style. [Some] parents don’t teach their children because they are not able to read and write well. But we cannot go to every home. So, we collected students from the same grade in one house and another grade in another house and we rotated from one village to the next. (S6)

Another Karen teacher noted that establishing ethnic-based colleges is a start, but if their study, certificates, and degrees are not recognized either in their own country or internationally it presents a problem. We include this to acknowledge that creative educational solutions may need international cooperation and support.

The Ethnic Armed Organizations (EAOs) that founded their own education systems before the military coup were not recognized in Burma. Even though we graduated from high school in the territory of the EAO, we were not allowed to study in Mandalay or in Rangoon. We would like to establish our colleges or universities in our own territory, like Karen, Kachin, Shan, and Arakan, but do you think our education system will be recognized? How do we need to improve in order to qualify and be accepted by the international universities? (S10)

The February 2021 coup has negatively impacted all sectors in Myanmar and most notably education. In some cases, creativity and innovation was used to find solutions to problems, although we also found that without a safe and secure environment even the most creative solutions could prove ineffective. However, the crisis has opened a space for deep change and dialogue about education and its purpose as noted in this quote:

There is a need for education and [now] we are having more dialogue about what education should be and how we should approach it. What should happen to go forward, as open classes start to expand? We have a better idea of how to proceed and not just us, other institutions are providing education, and we learn from them as well. I believe after the coup, after the revolution is done and we have won, the education for Myanmar students will proceed in a different fashion than it did before because this coup has opened up a lot of space for dialogue. So, I do believe that it will change for the better. (S3)

Many actors in Myanmar have responded to this crisis in creative ways. While the NUG has shown creativity in offering alternative educational online opportunities and even an alternative college entrance exam (Thang & Fishbein, 2023 ), the formation of the NUG has not been unproblematic and is by no means able to address this crisis on its own. Creativity in the form of alliances among EAOs and education programs offered by CSOs was also evident in our study and has great potential. Questions that could be explored in future research include the following: How can we support CDM teachers and professors, many of whom may not be involved in post-coup alternative higher education (SUM, 2023 )? What is the relationship between ethnicity, language use, citizenship, and education and how can education be used to support greater understanding of the benefits of ethnic diversity and the peace dividend of supporting linguistic diversity in Myanmar (Wong, 2019 )? What can new educational alternative systems in Myanmar learn from the more well-established ethnic-based school systems? Do the EAO and CSO-administered systems offer a potential road map for a future de-centralized education sector that would function under a new federal system in Myanmar? Can the development of a federal system in Myanmar that grants autonomy and legitimacy to ethnic-based educational programs be fostered and if so, how? What is needed to establish accreditation agencies that can empower non-state programs to offer national and/or international transferable certificates, diplomas, or degrees?

We want to acknowledge the vulnerability, pain, and suffering that our participants have undergone and express our gratitude to them for sharing their reflections and lessons. Finally, we want to reiterate the sentiments expressed in quotes of this chapter, namely the value of being able to teach one’s own histories and teach in one’s own languages, the importance of equity of access to quality education, and the potential of education to empower people to resist oppression.

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Acknowledgements

Note that some of the quotes were edited slightly for length and clarity. We want to thank our participants for sharing their time and their stories. We hope this article allows readers to see the resilience and creativity of people of Myanmar who in their struggle for social justice and peace and have taught us much about what education should and can be.

Open access funding provided by SCELC, Statewide California Electronic Library Consortium. This study was funded in part by the Provosts’ Office at Azusa Pacific University through sabbatical leave and a Faculty Research Grant.

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Wong, M.S., Kareng, D. Creativity in Crisis: Re-envisioning Higher Education in Myanmar’s Spring Revolution. Asia-Pacific Edu Res (2023). https://doi.org/10.1007/s40299-023-00776-4

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Doing Research in Myanmar

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Name of the Asset |  Doing Research in Myanmar: bridging the research gap and improving development policies

Type of Asset | Research report

Date |  May 2020

Over the last decade, Myanmar’s transition to democracy has faced multiple milestones and challenges. The country observed its first free elections in 2015. As Myanmar prepares for a second round of free elections later this year, the turbulence unleashed by COVID-19 will undoubtedly introduce new risks in the transition. It will also provide an opportunity for the small—but active—community of scholars from universities, think tanks and other institutions, inside and outside Myanmar, to provide evidence and advice on how to face these risks. A recent article in the New Mandala Post calls for, “the next generation of Myanmar scholars, whatever their backgrounds or ambitions, … to support knowledge creation throughout this time of fear, change and hardship and beyond.”

Boosting investment in knowledge production and the use of locally-grounded social science research in Myanmar remains a critical element for a sustainable democratic transition. Leaders and scholars in social science research can assist local policy processes by asking the relevant policy questions, and by undertaking rigorous research and analyses to provide the evidence needed for public policy decision-making. Building a functional knowledge ecosystem is a major challenge for social science researchers themselves and for policy makers, not only in Myanmar but across the developing world.

This research highlights, amongst other aspects, the need to invest in boosting research capacity, infrastructure and funding for HEIs as a priority goal of the HEI reform agenda so that HEIs can meet the growing demand for evidence-based policy research while promoting the local ownership of research projects in order to leverage the expertise of Myanmar scholars for better-informed policymaking, along with stronger partnerships between researchers and policymakers. The report not only presents what has emerged from their research but also proposes some 'Levers of Change', a set of measures or actions which could be taken in order to address the shortcomings identified like the establishment of a national research body to oversee, facilitate, coordinate, support and document research activities conducted in Myanmar or the increase of the budget for research while improving its management and allocation flexibility among many others.

The webinar, like the research itself, was developed together between the local team, and GDN and the Knowledge for Democracy Myanmar (K4DM) initiative of IDRC, where the state of Myanmar's social science system was presented, as the country struggled with its Covid-19 response and prepared for the second round of free elections later this year.

• Zu Xian (Anders) Lee, Centre for Economic and Social Development
• Jana Rue Glutting, Centre for Economic and Social Development
• Naing Lin Htet, Centre for Economic and Social Development
• Ngu Wah Win, Centre for Economic and Social Development
• Nyein Chan Aung, Centre for Economic and Social Development
• Thaint Zar Chi Oo, Centre for Economic and Social Development
• Zaw Oo, Centre for Economic and Social Development

Country and/or Region |  Myanmar

Name of the Program |  GDN’s Doing Research for Measuring the Production, Diffusion, and Use of Social Science Research

Funder(s) |  This work was carried out with the aid of a grant from Global Affairs Canada, and the International Development Research Centre, Ottawa, Canada. The other studies in Bolivia, Indonesia and Nigeria of the current phase of the Doing Research program is being funded by GDN’s core funds. The Doing Research pilot phase was generously supported by the Bill and Melinda Gates Foundation, Agence Française de Développement, French Ministry of Foreign Affairs and International Development, and Swiss Agency for Development Cooperation for US$785,000 from 2014-2016.

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An Oxford Forum for New Perspectives On Burma/Myanmar

Doing research in myanmar: bridging the research gap to improve development policies.

• by teacircleoxford
• Posted on July 27, 2020 March 9, 2022

Francesco Obino, Zaw Oo and Edgard Rodriguez introduce a report on the state of social science research in Myanmar.

Introducing ‘Doing research in Myanmar’

The recent report, ‘ Doing Research in Myanmar’ , published in June 2020 by the Global Development Network (GDN), kick-started a flurry of important conversations about the state of Myanmar’s research culture and institutions, and what can be done to strengthen them.

Locally-grounded social science research remains key to democratic debate and planning for sustainable development, not only in Myanmar, but elsewhere in the developing world. Since 2014, GDN has been investigating the challenges of doing quality social-science research in developing countries. Working in partnership with local research institutions, who act as Principal Investigators, GDN’s Doing Research program aims to analyse weaknesses and opportunities that can be addressed through better-informed national research policy. In 2018, the GDN and Canada’s Knowledge for Democracy – Myanmar (K4DM) Initiative joined forces to include Myanmar in a new cohort of countries (along with Bolivia, Indonesia and Nigeria) undertaking Doing Research Assessments across 2019 and 2020. At the time, as part of an initial scoping exercise, GDN held a public talk at the Parami Institute in Yangon and attended other events that facilitated exchange with relevant stakeholders and potential collaborators, such as the Centre for Economic and Social Development (CESD). GDN has documented the progress within the new cohort of 2020 Reports in a recent article by Asia Research News.

A methodology for understanding national research systems

The Doing Research Assessment , a methodology developed by GDN, is designed to deliver an in-depth analysis of a country’s research system, and allow comparisons with other countries surveyed. It combines literature review, a survey of three main groups (researchers, research administrators and policy actors) and interviews with key informants. The data is captured in 54 indicators , which describe social science production, diffusion and uptake in the country. Ultimately, the reports identify ‘levers of change’, based on the evidence collected and discussed during the study, that can strengthen the environment for doing, circulating and using social science research in a country.

The reports also aim to spur research capacity and debates on the state of health of social science research systems. In December 2018, GDN hosted a methodological inception workshop with all four national teams in Delhi, GDN’s headquarters. This was followed by an intense year (2019) of desk research, interviews, and local consultations by each of the participating country teams, including Myanmar’s CESD. In October 2019, all teams met again in Bonn to take stock with their international advisors for a presentation and writing workshop on the side lines of the 19 th GDN conference “Knowledge for Sustainable Development: The Research-Policy Nexus” . Reports were to be launched in early 2020 but delayed due to the start of the pandemic.

Implementing the Doing Research Assessment in Myanmar met with a number of challenges: from lengthy authorization processes to the lack of familiarity of the research community, particularly in higher education, with concepts such as research policy, research council, ethics review processes and mentoring. The institutional research landscape proved extremely fragmented, with 174 higher education institutions scattered across the country, but only very few individuals formally trained in research, and less than 2% of academics in public universities having published a paper during their tenure. These aspects were discussed in a global public webinar on 27 May 2020, which launched the Myanmar Report, the first of the series, in conversation with institutions such as ANU Myanmar Research Centre —advisor to the Myanmar team–and the Swedish International Development Agency (SIDA) —a key funder of research in the developing world.  Around 80 people from 8 countries took part in the 90-minute session, which revolved around the key fact that Myanmar’s social research community still lacks resources, despite nearly a decade of political and economic reforms, and growing demand for evidence-based policymaking.

Key findings

The report launch began with a welcome by Canada’s Ambassador to Myanmar, François Lafrenière. “Capacity building is key to restoring Myanmar’s research culture” he said. “Canada is committed to evidence-informed policymaking and central to this is a focus on gender equality. We believe that gender equality is one of the most powerful tools to reducing poverty and as 75% of researchers in Myanmar are women, this is not just a value statement – it is a value-for-money statement.” Ms Ngu Wah Win, Senior Policy Coordinator with CESD, dedicated the study to the founding figures of research in Myanmar.

The Report finds that, as in other developing countries, the government continues to overlook social science in the pursuit of national development objectives and specific policy goals. Although the country received a healthy injection of research funds with the new government, most of this has gone to science, technology, engineering and maths. In 2017, social sciences and humanities had a mere 0.38 percent share of total investment in research, as opposed to science, technology, engineering and mathematics with 32.8 percent, agricultural sciences with 32.6 percent, medical sciences with nearly 30 percent, and natural sciences with 4.2 percent (See Main Findings below).

International donors play a critical role in national development in the country, but this often means that too little attention is given to growing the local research system, especially in social sciences, in favour of producing consultancy-type analysis. The ‘Doing Research’ report is part of a series of ongoing initiatives that try to redress this imbalance. At the May 2020 global webinar, Dr. Zaw Oo, Executive Director of CESD said that the increased flow of funds after the country’s democratic election has led to increased interest in the research system but resulted in less local ownership over the research agenda. Reflecting on the challenges of accessing both data and permissions for the study, he spoke about the importance of informal networks in Myanmar’s research landscape and said they needed to be recognised and incorporated into frameworks for developing the broader ecosystems. “Knowing about our past helps us to understand the present”, he said.

Main findings from the Report

• Research funding for social sciences remains low on the list of government priorities.
• Research funding disbursed to higher education institutions and other public research institutions come with stringent budgetary rules, which makes it difficult to manage research projects.
• There is currently no national research policy in Myanmar.
• As ‘civil servants’, academics in public universities are often burdened with administrative duties, the supervision of students or heavy teaching loads.
• Women make up 75 per cent of researchers in Myanmar.
• There is limited collaboration or partnership among government research institutions, public higher education institutions and other relevant government departments.
• There is no formal peer review culture in Myanmar, reflecting the lack of a conversation about research quality.
• Popular opinions supersede research evidence in policy discussions.

The Report is available online with a summary in English and Burmese. The Report and global launch have helped create a 20-minute podcast by Asia Research News , another partner of the K4DM Initiative, to present a range of voices from key stakeholders to discuss Myanmar’s knowledge ecosystem today.  The Report is a stepping stone to a more vibrant debate at a time when Myanmar is embarking in a reform of the country’s entire education sector. The Levers of change identified in the report seek to expand and prioritize this debate.

Levers of change recommended by the Report

• Establish a national research body that will oversee, facilitate, coordinate, support and document research activities conducted in Myanmar, and a structure that ensures that sufficient attention is paid to social sciences as part of the national research system.
• Set up a robust and functioning research evaluation mechanism or peer review system for research in higher education institutions.
• Prioritize investment in research capacity, infrastructure and funding for higher education institutions
• Empower local researchers to provide relevant and timely technical assistance to policymakers.
• Enhance collaboration and partnership among government research institutions, public higher education institutions and other relevant government departments.
• Increase the budget for research and improve flexibility.
• Effectively coordinate international funding for research in Myanmar
• Strengthen international funding support to boost quality, ethics and equity in the research system.  

(Image courtesy of K4DM Initiative.)

Francesco Obino is Head of Programs at the Global Development Network (GDN). His main research interest is the interplay of institutional development and organisational functioning for actors that focus on producing research across the global North and the global South.

Zaw Oo is Executive Director of the Centre for Economic and Social Development (CESD), an independent think-tank dedicated to providing evidence-based policy research, results-orientated knowledge sharing, and people-centered public advocacy to support the peaceful and sustainable transformation of Myanmar.

Edgard Rodriguez is a senior program specialist who leads the International Development Research Centre – Global Affairs Canada funded Knowledge for Democracy Myanmar  (K4DM) Initiative, aiming to build the capacity of leaders to carry out research and evidence-based public policy.

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• Nagoya J Med Sci
• v.78(2); 2016 May

Healthcare in Myanmar

Nyi nyi latt.

1 Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

Su Myat Cho

Nang mie mie htun.

2 Women Leaders Program to Promote Well-being in Asia, School of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan

Myat Noe Htin Aung Myint

Fumiko aoki, joshua a. reyer, eiko yamamoto, yoshitoku yoshida, nobuyuki hamajima.

Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan

E-mail address: [email protected]

Myanmar transitioned to a civilian government in March, 2011. Although the democratic process has accelerated since then, many problems in the field of healthcare still exist. Since there is a limited overview on the healthcare in Myanmar, this article briefly describes the current states surrounding health services in Myanmar. According to the Census 2014, the population in the Republic of the Union of Myanmar was 51,410,000. The crude birth rate in the previous one year was estimated to be 18.9 per 1,000, giving the annual population growth rate of 0.89% between 2003 and 2014. The Ministry of Health reorganized into six departments. National non-governmental organizations and community-based organizations support healthcare, as well as international non-governmental organizations. Since hospital statistics by the government cover only public facilities, the information on private facilities is limited. Although there were not enough medical doctors (61 per 100,000 population), the number of medical students was reduced from 2,400 to 1,200 in 2012 to ensure the quality of medical education. The information on causes of death in the general population could not be retrieved, but some data was available from hospital statistics. Although the improvement was marked, the figures did not reach the levels set by Millennium Development Goals 4 and 5. A trial prepaid health insurance system started in July 2015, to be followed by evaluation one year later. There are many international donors, including the Japan International Cooperation Agency, supporting health in Myanmar. With these efforts and support, a marked progress is expected in the field of healthcare.

INTRODUCTION

Myanmar is a country with an area of 680,000 km 2 (1.8 times of Japan) surrounded by Thailand, Laos, China, India, and Bangladesh. According to the Census 2014, the population in the Union of Myanmar was 51.41 million in September 2014. 1 ) There are 135 different ethnic groups with their own languages and cultures in Nay Pyi Taw Union Territory and 14 states/regions. In addition, illegal immigration across the border is not rare. In this heterogeneous society, there are many obstacles to the provision of health services to the whole nation.

The election of 2010 led Myanmar to a civilian government in March, 2011. Since then, the democratic process has accelerated, but there are many problems to be resolved in every field. In the field of healthcare, there are problems in maternal and child health, nutrition, infectious disease controls, tobacco controls, access to healthcare services, and quality of services. 2 - 5 )

This paper briefly describes the current situations of healthcare in Myanmar, based on sources available in English from the Internet, as well as scientific papers in English and Myanmar language newspapers reporting the recent changes. The main sources are the official website of Ministry of Health (MoH), Myanmar (http://www.moh.gov.mm) and the 2014 Myanmar Population and Housing Census (http://countryoffice.unfpa.org/myanmar/ census/). This article covers general information on population and birth rate, structure and function of MoH, healthcare facilities and professionals, health insurance, mortality, Millennium Development Goals (MDGs), and support from international donors.

POPULATION AND BIRTH RATE

Accroding to the Myanmar Population and Housing Census 2014, the population in the Republic of the Union of Myanmar was 51,419,000 (24,821,000 males and 26,598,000 females) as of March 29, 2014, which includes an estimated population of 1,206,000. Yangon was the most populated area (7,355,000, 14.3%), and the capital, Nay Pyi Taw, had 1,158,000 (2.3%). According to the Union Report, 28.6% were aged under 15 years, 65.6% were aged 15 to 64 years, and 5.8% were aged 65 years. 6 ) At the same time, another source, the World Factbook, reports that the estimated population for July in 2015 is 56,320,000; 26.1% for those aged 0–14 years, 68.6% for those aged 15–64 years, and 5.4% for those aged 65 years or over. 7 )

Based on the Census 2014, the government estimated that the crude birth rate in the previous one year was 18.9 per 1,000 population. The annual population growth rate was estimated to be 0.89% between 2003 and 2014. 6 ) Despite the government historically encouraging population growth and adopting a laissez-faire policy towards fertility in the past, 8 ) fertility has been steadily falling. Myanmar’s total fertility rate estimated by the Census 2014 was 2.29, which down from 6.1 in 1965. 9 ) Fertility rates in the urban areas were low (1.7 in Yangon Region and 1.9 in Mandalay Region), and those in the surrounding regions were hovering just above replacement fertility (2.1 in Magway Region, 2.1 in Nay Pyi Taw Union Territory, 2.2 in Bago Region, 2.6 in Ayeyarwady Region, and 2.3 in Sagaing Region). Further away from the urban areas, the rates were relatively high (2.4 in Mon State, 2.7 in Shan State, 2.8 in Kachin State, 3.0 in Tanintharyi Region, 3.3 in Kayah State, 3.4 in Kayin State, and 4.4 in Chin State). While providing direct support to family planning in order to improve women’s reproductive health, it has only been in the last 20 years that the government has taken actions with regards to fertility, seeking to maintain replacement-level fertility. 10 )

ADMINISTRATIVE STRUCTURES

Myanmar healthcare systems have drastically evolved with recent changes of political and administrative systems. Although the healthcare systems are a mixture of public and private sectors both in the aspects of finance and supply, MoH remains the major provider of healthcare services. As shown in Fig. 1 , there are 6 departments in the MoH, which facilitate all aspects of health for the whole population. 11 )

Administrative structures supporting healthcare in Myanmar

The Department of Public Health is mainly responsible for primary healthcare and basic health services; nutrition promotion, environmental sanitation, maternal and child health, school health, and health education. The Disease Control Division and Central Epidemiology Unit under this Department cover prevention and control of infectious diseases, disease surveillance, outbreak investigations, and capacity building. The Department of Medical Services provides effective treatments and rehabilitation services. Curative services are provided by various categories of health facilities under the control of the Department. The Department of Health Professional Resource Development and Management is mainly responsible for training and production of all categories of health personnel, except for traditional medicine personnel, to attain equitable healthcare for the whole population. The Department of Medical Research conducts national surveys and research for evidence-based medicine and policy making. The Department of Food and Drug Administration ensures safe food, drugs and medical equipment, and cosmetics. The Department of Traditional Medicine is responsible for the provision of healthcare with traditional medicine, as well as training of traditional medicine personnel. There were 6,963 private traditional practitioners in 2014. Most of them were trained at the Institute of Traditional Medicine until 2001, and at the University of Traditional Medicine from 2002 onwards.

In line with the national health policy, non-governmental organizations such as the Myanmar Maternal and Child Welfare Association and the Myanmar Red Cross Society are taking a share of service provision. Nation-wide non-governmental origanizations, as well as locally acting community-based organizations and religion-based societies, also support and provide healthcare services.

HEALTHCARE FACILITIES

Although there are substantial number of private facilities for the wealthy, the English documents concerning these are limited. In 2007 the government issued “The Law Relating to Private Health Care Services”. Private Health Statistics 2015 by the Department of Medical Services reported that there were 193 private hospitals, 201 private specialist clinics, 3,911 private general clinics, and 776 private dental clinics. In Myanmar, many charity hospitals run by private sectors are operating for the poor. There are private non-profit clinics run by community-based organizations and religion-based societies, which also provide ambulatory care. Among them, some have developed to provide inpatient care in Nay Pyi Taw, Yangon, Mandalay, and other large cities in recent years, although the funding and provision of care were still fragmented. Since Hospital Statistics by the government covers only public facilities, 12 ) the information on private facilities both for the rich and the poor is limited.

Public hospitals are categorized into general hospitals (up to 2,000 beds), specialist hospitals and teaching hospitals (100–1,200 beds), regional/state hospitals and district hospitals (200–500 beds), and township hospitals (25–100 beds). In rural areas, sub-township hospitals and station hospitals (16–25 beds), rural health centers (no beds), and sub-rural health centers (no beds) provide health services, including public health services.

Table 1 shows the number of public healthcare facilities in Myanmar in 2014. 13 ) There were 1,056 public hospitals with 56,748 beds in total. These facilities mainly provide curative and rehabilatitive services. There are 87 primary and secondary health centers, 348 maternal and child health centers, 1,684 rural health centers, and 80 school health teams. These facilities are mainly responsible for preventive services and public health activities. There are 16 traditional medicine hospitals and 243 traditional medicine clinics. 13 )

Public health facilities in Myanmar, 2014

Data from Health in Myanmar 2014 13)

The Ministries of Defense, Railways, Mines, Industry, Energy, Home and Transport also provide healthcare for their employees and families with their own medical facilities and budget. 11 )

HEALTHCARE PROFESSIONALS

1) current manpower.

The numbers of healthcare professionals are shown in Table 2 . 13 ) Classification of public sector or private sector was available only for medical doctors, dentists, and traditional medical practitioners. Some of the public professionals also work at private facilities, while those categorized as private sector work only in private facilities.

Healthcare professionals in Myanmar

* Includes those who had a part time job in private factilities.

** Data from an unpublished source

Almost 70% of the population resides in rural areas. Basic health staff are the main health care providers for them. Generally, one rural health center (RHC) has four sub-centers. The staff is made up of one public health supervisor grade I at the RHC, four public health supervisors grade II (one at each sub-center), five midwives (one at the RHC and one at each sub-center), one lady health visitor at the RHC, and one health assistant at the RHC. The basic health staff is responsible for maternal and child health (clinic or homecare), school health, nutritional promotion, immunization, community health education, environmental sanitation, disease surveillance and control, treatments of common illnesses, referral services, birth and death registration, and training of volunteer health workers (community health workers and auxillary midwives). These health workers face many challenges in their effort to reach out to the remote villages, with meager resources and support.

According to World Health Organization (WHO) health statistics, in 2013–2014 the number of doctors, nurses and midwives, and dental surgeons per 100,000 population in Myanmar were 61, 100, and 7, respectively, while in South-East Asia as a whole there were 59, 153, and 10, respectively. 14 ) Despite an increase in health workforce, there is an uneven spread of skillful health workers between urban and rural areas.

2) Education for healthcare professionals

The MoH, Ministry of Education, and Ministry of Defence are responsible for the training and production of different categories of health workforce for the whole population. There is no private medical university in Myanmar. Under the MoH and Ministry of Education, health professionals are being produced by 15 universities and 46 nursing and midwifery training schools. There are a medical school and an allied university under the Ministry of Defence. Currently, 39 doctorate courses, 12 PhD courses, 47 master courses, and 12 diploma courses are provided in medical and allied universities. 13 )

To produce qualified medical doctors, the 9th Medical Education Seminar agreed to reduce the annual student intake of four medical schools from 2,400 to 1,200 (300 in each university) in 2012 and thereafter. Meanwhile, a new medical school was opened recently in Taung-Gyi, the capital city of Southern Shan State (150 students in 2015). In addition, the study period of medical students was extended from 6 years to 7 years. 15 ) For capacity building, candidates from different disciplines have been selected and sent for oversea training in the courses for PhDs, master’s degrees, and other diplomas, as well as for short term training. Medical doctors, dental surgeons, and nurses must join the civil service in order to pursue postgraduate degrees. In Myanmar, the following examinations have been held with the close collaboration of Royal Colleges of the United Kingdom: Membership of the Royal Colleges of Physicians (MRCP), Membership of the Royal College of Surgeons (MRCS), Membership of the Royal College of Paediatrics and Child Health (MRCPCH), and Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG). 15 )

Under the Department of Traditional Medicine, the University of Traditional Medicine was established in 2001, providing bachelor’s and master’s degrees. The bachelor’s degree is a five-year course, including one-year internship. The curriculum covers traditional medicine, as well as the basic science of western medicine. The yearly intake is about 100 candidates. The University had already produced 1,139 graduates. In the year 2012, the University opened a Master of Myanmar Traditional Medicine course and Bachelor of Myanmar Traditional Medicine bridge course. 16 )

3) Employment

Previously, the members of the public sector health workforce were hired as civil servants by the central government’s Union Civil Service Board (UCSB). The employment rules and regulations were applied for all public health facilities. At present, the health workforces are recruited not only by UCSB but also by the state/region governments. In addition, they are hired with the civil servant benefits such as permanent contracts, career advancement, opportunities for postgraduate medical education, and so on. In Myanmar, the MoH is the key player in public sectors for the production, utilization, and governing of the health workforce.

Private sectors are more flexible in their employment systems. The recruitment systems and the benefit packages offered to the health workforce are designed at each health facility. Compared to public health facility employment, private health facility employment is more attractive in terms of being located in urban areas, offering a higher salary, and providing better working conditions, although there are disadvantages in terms of postgraduate medical education.

Although reporting systems based on ICD 10 exist, 17 ) the mortality data are not completely available. Accordingly, the mortality rate of each cause of death cannot be calculated, but the percentages of causes of death are obtainable from hospitals. 12 , 13 , 18 ) Table 3 shows the frequent causes of death reported from public hospitals, 12 ) which do not reflect all death, such as death outside of hopitals. In addition, the percentages may change according to the method of disease grouping. The figures should be interpreted carefully. The most frequent diseases in Table 3 are infection and parasitic diseases (22.5%), followed by circulatory diseases (17.1%) and deaths at perinatal period (12.3%). Since the age distribution of the deceased patients in hospitals is not described in the document, comparison of the percentages with those in a general population is not possible. Age-specific mortality by cause is not available.

Top 10 grouped causes of mortality in percent by sex from hospital reports, in 2012, Myanmar

* Data from page 48 in Annual Hospital Statistics Report 2012 12)

MILLENNIAUM DEVELOPMENT GOALS

The United Nations Millennium Declaration was signed by 189 countries in 2000, which was translated into eight MDGs by 2015 for development and poverty eradication. Myanmar is one of the signatories for the MDGs. MDGs 4, 5, and 6 are on health, and related to each other. However, the achievements of these health-related MDGs are not uniform, based on limited data reported. 3 )

MDG 4 is on the reduction of child mortality by two-thirds between 1990 and 2015, based on three indicators: under-five mortality rate (U5MR), infant mortality rate (IMR), and proportion of 1 year-old children immunized against measles. Myanmar has shown moderate progress in this goal. The U5MR is trending downwards, falling from 106 per 1,000 live births in 1990 to 79 in 2000 and 52 in 2012. The IMR has also fallen in the past ten years from 79 in 1990 to 41 in 2012. 19 ) The coverage of measles immunization among 1-year-old children was 86.0% in 2013. 20 )

MDG 5 on maternal health encompasses two targets: to reduce the maternal mortality ratio (MMR) by three quarters between 1990 and 2015, and to achieve universal access to reproductive health by 2015. Indicators for the latter include the proportion of births attended by skilled health personnel, the contraceptive prevalence rate, the adolescent birth rate, antenatal care coverage, and unmet need for family planning. In Myanmar, the national MMR has declined from 520 per 100,000 live births in 1990, to 200 per 100,000 live births in 2013. 21 ) Overall, a slow upward trend in maternal health indicators was observed from 1990 to 2010 in Myanmar, though information on some indicators was unavailable. The proportion of skilled birth attendance in 2007 was 64.1%, reaching 72.0% in 2013. 21 ) The rate of antenatal care coverage of at least one visit in 2008–2012 was 83.1%. Regarding antenatal care, coverage of at least four visits was 73.4% in 2008–2012. 19 ) The prevalence of married women in Myanmar using any sort of contraceptive method has also been increasing gradually; yet rates of contraception use remain relatively low, lagging behind those observed in many other countries. The percentage of currently married women using any contraceptive method was 16.8% in 1991, 37.0% in 2001, and 41.0% in 2007. 22 , 23 )

MDG 6 is the control of the “big three” infectious diseases; HIV/AIDS, malaria, and tuberculosis (TB). Among the health-related MDGs, MDG 6 is the only one for which targets have already been reached or are on track to be achieved by 2015 in Myanmar. HIV prevalence in the general population aged 15–49 years has stabilized at 0.6%. 20 ) Among the most-at-risk groups, such as men who have sex with men, female sex workers, and injecting drug users, HIV prevalence rates have significantly declined. However, HIV prevalence among newly diagnosed TB patients has fluctuated around the 10% level. Meanwhile, anti-retroviral therapy coverage among people with advanced HIV infection in Myanmar was still inadequate, at only 24.0% in 2010.

Regarding the MDG 6 targets for malaria incidence reduction, reductions in malaria morbidity and mortality have been observed in Myanmar since the introduction of the rapid diagnostic test and artemisinin-based combination therapy. From 1990 to 2010, morbidity fell from 24.4 per 1,000 to 11.7 per 1,000, while mortality declined from 12.6 per 100,000 to 1.3 per 100,000. 24 ) In spite of progress in combating malaria, it remains a major public health problem in Myanmar because of climate and ecological changes, population migration, development of multi-drug resistant P. falciparum parasite, the rise of insecticide-resistant vectors, and changes in the behaviour of malaria vectors. Two-thirds of the population still live in malaria-endemic area and malaria remains a leading cause of morbidity and mortality. 24 ) As in the other parts of the world, the use of insecticide-treated nets (ITNs) has helped to reduce malaria-related morbidity and mortality in Myanmar, but the total population covered by ITNs was only 4 million in 2011. 24 ) However, data were not available on the percentage of children under 5 years sleeping under ITNs and the percentage of children under 5 years with fever who received treatment with any antimalaria drug.

Regarding TB control, appreciable progress has been made in Myanmar as measured in both case detection and treatment success rates. TB case detection rate increased from 8.0% in 1990 to 71.0% in 2010, and TB treatment success rates rose from 77.0% in 1994 to 85.0% in 2009. 24 ) Deaths due to TB among HIV-negative people has also been reduced from 110 per 100,000 in 1990 to 41 per 100,000 in 2010. 24 )

HEALTH COST PAYMENT AND INSURANCE

In Myanmar, health insurance was only provided for government employees by the government, and for employees of international organizations by private health insurance. Government expenditure on healthcare in Myanmar was 3.4% of general government expenditure in 2014–2015. Although financial allocation to the health sector and education sector has been increased, the percentage of out-of-pocket expenditures was still high. 25 )

Very recently, Myanmar government officially announced that the nation-wide health insurance policies would go on sale for the first time under a one-year trial as of July 1, 2015. 26 ) State-owned Myanmar Insurance and 11 private domestic companies will offer identical policies, with customers able to buy between one to five units of coverage (one unit costs approximately 50 USD), with a single unit providing the most basic level of coverage. Myanmar citizens and foreign nationals residing in the country who are aged 6 to 65 years and in good health can buy the insurance. Insurers will pay approximately 15 USD per day of hospitalization per unit. A policy holder may receive 30 days worth of hospitalization costs per year. If a policy holder dies in hospital, their designated beneficiary will receive approximately 1,000 USD per unit of insurance in compensation. 26 )

Outside of the health insurance, Myanmar has a social security system called “the Social Security Scheme”, run by the Social Security Board under the Ministry of Labour, Employment and Social Security.

INTERNATIONAL DONORS’ SUPPORT OF HEALTHCARE

The main international organizations providing technical and financial assistances to promote the health status of Myanmar people are the WHO, the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the Japan International Cooperation Agency (JICA), the Asia Development Bank (ADB), the World Bank, and the Three Millennium Development Goal (3 MDG) Fund. The United Nations Office on Drugs and Crime (UNODC), the United States Agency for International Development (USAID), the Australian AID, the United Kingdom Department of International Development (DFID), the Korea International Cooperation Agency (KOICA), and the Thailand International Cooperation Agency (TICA) also play certain roles in the support of healthcare systems in Myanmar.

In addition, 57 international non-governmental organizations working in Myanmar, as well as national non-governmental organizations such as the Myanmar Women’s Affairs Federation (MWAF) and the Myanmar Red Cross Society, are listed in a governmental report. 11 ) The list includes five Japanese organizations; the Japan Heart, the Japanese Organization for International Cooperation in Family Planning (JOICFP), the Japan International Medical Cooperation Organization (JIMCO), the Peoples’ Hope Japan, and the Save the Children Japan.

JICA PROJECTS IN THE FIELD OF HEALTH

JICA is the executing agency of Japanese Official Development Assistance (ODA). The ODA is broadly divided into two systems. One is bilateral assistance, which is given directly to recipient countries from Japan. The other is multilateral assistance, which is provided through international organization such as the World Bank, the United Nations Development Programme, the WHO, and so on. JICA has the responsibility of bilateral assistance in the form of Technical Cooperation, Japanese ODA Loans and Grand Aid. 27 ) All of JICA’s assistance is carried out in principal under the international agreement between each recipient government and the Japanese government. Japan ODA began in 1954 as part of post-war reparations, and JICA was established in 1974. 27 - 29 ) The ODA budget has increased in line with Japanese economic growth. In 1989, Japan became the number one donor by amount of ODA. In 2014, Japan was the fifth largest donor in the world. 27 , 30 )

Japan ODA is based on three basic policies, which are “contributing to peace and prosperity through cooperation for non-military purposes”, “promoting human security”, and “cooperation aimed at self-reliant development through assistance for self-help efforts”. Japan considers ODA as “investment in the future”, which secures the development and prosperity of the world as a whole, including Japan. 27 , 28 , 31 ) In the field of health, the international community, including Japan, has been working together to achieve the health-related MDGs. In 2013, Japan formulated “Japan’s Strategy on Global Health Diplomacy”, which positions global health issues as a priority for Japan’s diplomacy. It also sets policies for the private and public sectors to work together on the purpose of improving global health.

In February 2015, Japan revised the ODA charter, which was decided as the foundation of Japan’s ODA policy in 1992 and revised in 2003. The new charter was named the “Development Cooperation Charter”, and contains a broader sense of cooperation. The world is globalizing politically and economically, which makes development issues more diverse and challenging. 28 , 29 ) Japan is trying to expand the scope of traditional ODA and invent synergetic effects with other funds like local authorities or private companies. 31 )

In Myanmar, JICA has been working on promotion of social participation by the deaf community. Through this project, a standard of sign language was decided and sign language teachers were fostered. Today, sign language teachers have become instructors and are teaching others to increase the number of sign language interpreters. 28 ) JICA has been working on a variety of healthcare projects in Myanmar since 2000. The projects include projects related to healthcare system preparation and reinforcement, infection control projects like HIV/AIDS, TB, malaria and others, maternal and children’s healthcare projects and projects related to traditional or alternative medicine.

RECOMMENDATIONS

There seems to be two important views: one for Myanmar government and the other for international donors. The former suggests an increase in fund allocation to public healthcare services, which will not only expand the services, but also improve the quality of health services. Generally speaking, the larger amount of services causes reduction of the cost per service, improving skills for services.

The latter suggests tighter networks among the donors. Networks may reduce the overlapping functions of the donors, avoiding duplicated donations. The civilian government can allow the donors to discuss the healthcare systems more openly one another.

This paper briefly describes the current situations of various aspects of healthcare in Myanmar, based on the most up-to-date data sources. Although the health conditions in Myanmar have been improving as exemplified by MDGs, there is a serious lack of facilities and healthcare professionals. A new attempt to introduce a health insurance is expected to further improve the conditions. National and international support is needed for successful improvement.

ACKNOWLEDGMENTS

This manuscript was derived from the presentations at the 1st Healthcare Administration Symposium of Young Leaders’ Program, held on June 19, 2015 at the Nagoya University Graduate School of Medicine.

COMPETING INTERESTS

The authors have declared that no competing interests exist.

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Programmes > Country Studies Programme > Myanmar Studies

Among the first of its kind to be established in Southeast Asia (and in Singapore), the Myanmar Studies Programme’s ambit is on policy-oriented research pertaining to the reforms taking place in Myanmar, and the emerging issues and trends in the country’s transition to democracy. Through research, seminars, conferences, consultations and publications – undertaken individually or in partnership with other like-minded entities – the Myanmar Studies Programme (MmSP) seeks to give a critical analysis (and policy-relevant recommendations) on issues and events in Myanmar.

In support of ISEAS – Yusof Ishak Institute’s mission, the Myanmar Studies Programme studies the socio-political, security and economic trends and developments in Myanmar. The Myanmar Studies Programme seeks to be an intellectual resource for scholars and policy-makers interested in Myanmar. To this end, the MmSP devotes its research primarily to analysing recent developments and events in Myanmar, so that views, perspectives and recommendations generated from this research can be readily used by all those interested in and following #WhatsHappeningInMyanmar. The programme also seeks to build and maintain collaborative links with academics, analysts, researchers and centres studying Myanmar.

The Myanmar Studies Programme team’s current research projects include:

Developments Following the 1 February 2021 Coup

1. The programme has an ongoing webinar series analysing the impact of the coup:

• The February 1 Coup Aftermath in Myanmar: Impact, Issues, Implications
• Myanmar’s Crisis: What Are the Stakes?
• Myanmar After the Coup: Insights from the Inside
• A Near-Term Economic Outlook for Post-Coup Myanmar
• Post-Coup Myanmar’s Economy: Crisis and Challenge
• The Myanmar Economy Six Months after the Coup: What’s Next?
• Myanmar After the Coup, In the World
• Socio-Economic Impacts of the 2021 Coup in Myanmar
• Whither Myanmar’s Rakhine State?
• The Realities of Humanitarian Assistance for Myanmar
• Myanmar Ten Months After The Coup
• One Year After the Coup: Whither Myanmar?
• Legal Implications of the Myanmar Coup One Year On
• The International Community’s Response to the Myanmar Crisis: What Comes Next?
• The United States and the Myanmar Crisis: Perceptions, Expectations, Options
• Myanmar Twenty-Two Months After The Coup
• Two Years and Counting: What’s Next for Myanmar in 2023?

2. Scholars and researchers have contributed their analyses of different aspects of the coup:

• Back to the Future? Possible Scenarios for Myanmar, by Ardeth Thawnghmung
• Ethnic Armed Organisations in Post-Coup Myanmar: New Conversations Needed, by Andrew Ong
• “The Military in Burma/Myanmar: On the Longevity of Tatmadaw Rule and Influence” by David I. Steinberg
• How Generation Z Galvanized a Revolutionary Movement against Myanmar’s 2021 Military Coup” by Ingrid Jordt, Tharaphi Than and Sue Ye Lin
• Centre-Periphery Relations in Myanmar: Leverage and Solidarity after the 1 February Coup” by Shona Loong

3. Commentaries by MmSP researchers on the coup have appeared on the ISEAS Fulcrum blog since 2 February 2021:

• Myanmar’s State of Emergency: Damn the Torpedoes
• Free falling: Myanmar’s Post-Coup Economy
• Singapore Businesses in Myanmar: Navigating the Choppy Waters of Political Turmoil
• Myanmar’s Garment Industry After the Coup: Threadbare and in Tatters

The State Administration Council Regime

A research paper series by Htet Myet Min Tun, Moe Thuzar and Michael Montesano assesses:

• Min Aung Hlaing and His Generals: Data on the Military Members of Myanmar’s State Administration Council Junta
• Buttressing the Anti-NLD Project: Data on the Civilian Members of Myanmar’s State Administration Council Junta
• An Attempt to Lead Myanmar Back to the Future? Data on the State Administration Council Regime’s Union Ministers, by Htet Myet Min Tun

Aid to and Investment in Myanmar after the 1 February Coup

• A research paper series is forthcoming.

Myanmar’s Foreign Relations

• Webinars and research papers will be forthcoming.

Ms Moe Thuzar  is the Coordinator of the Myanmar Studies Programme.

Current Researchers and Affiliates

• Ms Moe Thuzar
• Dr Tin Maung Maung Than
• Dr Nick Freeman
• Dr Jared Bissinger
• Mr Romain Caillaud
• Dr Su Mon Thazin Aung
• Prof Robert H Taylor

Past Affiliates

ISEAS – Yusof Ishak Institute also hosts researchers and scholars who work on Myanmar. Among those previously affiliated with the Institute are the following:

• Professor Robert H. Taylor
• Associate Professor Sean Turnell
• Associate Professor Fan Hongwei
• Mr Lex Reiffel
• Dr Renaud Egreteau
• Mr Thaung Tun
• Mr Myint Soe
• Mr Stuart Larkin
• Dr Jurgen Haacke
• Dr Maung Aung Myoe
• Dr Amporn Jirattikorn
• Dr Micah Francis Morton
• Dr Lin Htet Aung
• Dr Nyi Nyi Kyaw
• Dr Ong Wai Hoong Andrew
• Dr Michael J. Montesano
• Mr Aung Tun

Webinars and Conferences

For upcoming MmSP events, please check the events section of the ISEAS – Yusof Ishak Institute website.

Past conferences and key events organised by the programme include the following:

Myanmar Forum 2016

The highlight of the Forum was a dialogue session with U Ko Ko Gyi, General Secretary of the 88 Generation (Peace and Open Society) which is a highly respected political organization born out of the student-led democracy protests of 1988. U Ko Ko Gyi is a Burmese politician, democracy activist and former prisoner of conscience.

More than 150 participants attended the Myanmar Forum 2016.

For more information, please click here .

International Burma Studies Conference 2014

ISEAS – Yusof Ishak Institute, together with the Faculty of Arts and Social Sciences and the Centre for Asian Legal Studies of the National University of Singapore organised the International Burma Studies Conference 2014 on “Envisioning Myanmar: Issues, Images, Identities” from the 1st to the 3rd August 2014. This theme has attracted a diverse collection of panels and papers from across the humanities and social sciences, as well as from the fields of law, policy, development, media, civil society and other professional fields.

Our ongoing collaboration with international partners, especially the Center for Burma Studies (based at Northern Illinois University, USA) and the Burma Studies Group of the Association of Asian Studies has enabled us to bring together scholars from Asia, Europe, Australia and North America. Most importantly, we were able to host a number of special guests from Myanmar who spoke at the Plenary and Closing Sessions.

To find out more about IBSC 2014 or access the panel abstracts, click here . To view photos of IBSC 2014, click here .

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Challenged by Uprising, Myanmar Junta Cracks Down Harder

The country’s military rulers have signaled a new wave of detentions and, rights groups say, conditions for existing prisoners have deteriorated.

By Caleb Quinley

Thousands of innocent people killed. Tens of thousands more pro-democracy protesters locked up. The return of military rule has wreaked havoc in Myanmar in recent years.

Now the junta is growing increasingly brutal as a rebel uprising has gained ground in the countryside.

It has put new effort into imprisoning dissidents and the men and women who refuse to join its forces . And it is meting out increasingly lethal treatment to those already in custody. In the first two months of the year, more than 100 prisoners perished, either from torture or neglect, human rights groups and former detainees say. Conditions in military-run prisons have deteriorated further, they say, with prisoners being deprived of food, proper sanitation and health care, and facing horrific torture.

“Since November, conditions have been getting worse and worse,” said Myar Reh, a pro-democracy student activist who was released from a prison in Karenni State in January after being held for nearly three years. “They punched me in the face, hit me with the butt of the gun. My whole body was covered in blood. They also threatened to shoot me in the head, and shot live rounds beside my head.”

Gen. Zaw Min Tun, the military spokesman, did not respond to requests for comment.

In February, the military announced a mandatory draft, in a sign it was on the defensive. That order could be used as a pretext by the military to launch a new campaign of arrests because anyone resisting conscription faces up to five years in prison.

The junta has said that it will start clearing out prisons, releasing thousands of detainees. But any such freedom is likely to be temporary: Rights groups point out that last year, the junta made similar “amnesties,” but soon went on to rearrest many of those released.

One rights group, Myanmar Witness, said it had studied satellite photographs that suggested that whole new prison complexes were being built, and that new buildings were going up near existing prisons.

For those who remain in the military’s hands, detention can be lethal. Ko Yar Shin, 43, who was beaten in prison and denied proper and timely health care, succumbed to his injuries in January, according to the Human Rights Foundation of Monland, a pro-democracy group of the ethnic Mon people of Myanmar. Ko Pyae Phyo Aung, 31, who had an unexplained stomach illness, also died in January under similar circumstances, it said. Both had been arrested by the junta for protesting its rule.

They are among the nearly 120 dissidents who died in the military’s custody in the first two months of this year, according to the Assistance Association for Political Prisoners (Burma), which tracks detentions and uses Myanmar’s former name. That compares with 602 similar fatalities last year.

Since the coup in February 2021, more than 1,500 people have died in the junta’s detention, according to the group. The current regime, it said, has tortured dozens of detainees to death. It estimates more than 20,000 people remain in the junta’s custody, while the civilian death toll has surpassed 4,500.

The governing military, known as the Tatmadaw, has long been known for bombing civilians, using them as human shields, persecuting minorities like the Rohingya people and torturing pro-democracy activists. It briefly allowed a democratically elected government under Daw Aung San Suu Kyi to share power before seizing full authority again three years ago.

“The military in Burma never stopped using torture in its decades-long existence as an institution,” said U Bo Kyi, the joint secretary of the A.A.P.P. “I was tortured by the military when I was arrested and sentenced as a political prisoner in the 1988 uprising.”

The military is now facing its biggest challenge since the coup. While the rebels have notched significant victories and it remains to be seen whether the alliance can overthrow the junta, the military’s response has been clear.

In November, the rebels attacked military positions in Loikaw, the capital of Karenni State, taking large sections of the city. Some junta troops retreated to a prison complex for safety.

They “took away what food we had left,” said Saw Eh Htaw Nay Sweet, 27, who was released in February. “This is when the conditions started getting much worse. And because we were political prisoners, they treated us badly. There was almost no clean food at all, it was like eating cat food.”

The armed conflict in Loikaw presents a new danger to detainees. “Political prisoners feel like they are hostages or human shields, used by the military at the cost of their lives,” Mr. Bo Kyi of A.A.P.P. said.

For many pro-democracy protesters detained by the military, the first stop is a so-called interrogation center. They are often taken there and tortured before they are formally arrested and thrown into prison.

“So much of this ill treatment happens in the interrogation centers even before they arrive at the prisons,” said Nai Aue Mon, the program director for the Monland rights group.

Sai Lin Oo, who spent more than two and a half years in the Loikaw prison, was set free in October.

“I was so lucky because I was released before Operation 1111,” he said, referring to the rebel attack launched in November. “But there are still 150 political prisoners in Loikaw prison today.”