Doctors fighting for democracy in Myanmar

[and all staff] will be able to recognise their own values and attitudes, as well as the impact of these on their practices.”

Addressing the determinants of ill health

The Government has signalled the emphasis in the new structure will be “squarely on primary and community healthcare” to take pressure off our hospital services. The evidence from New Zealand and overseas shows good primary health care helps prevent illness and death, but its effectiveness in taking pressure off hospitals generally falls well short of expectations – or potential – for a whole range of reasons (see ASMS Research Brief “Does more access to primary care and a greater focus on preventing illness and promoting health reduce pressure on hospital services?” on the ASMS website). A more holistic approach is needed to reduce pressure on hospitals. Within the health system itself, well-functioning primary care services depend on wellfunctioning, accessible hospitals. And policies with the most potential to reduce the need for hospital care are those that address the well-known determinants of ill health, such as poverty and poor housing. The evidence indicates efforts to improve the effectiveness of health services will struggle to make headway in reducing the need for acute hospital care without also addressing these broader issues.

Removing the cost barriers to primary health care

Health equity, a primary aim of the restructuring, cannot be achieved while those most in need – Ma -ori, Pasifika and the poorest – cannot access primary care services due to user charges. Nor does the cost barrier help in the aim of reducing pressure on hospitals: these are the same groups who have the highest primary care preventable hospitalisation rates. Finally, if there’s one over-arching ‘must’ to make the new structure work, it’s a lesson from the Covid-19 pandemic: Heed the evidence – even when it means spending money.

Michael Naylor | Executive Officer UnionAID

The military coup in Myanmar on 1 February this year has shattered hopes for democracy, but workers, unions and youth in the country have been fighting back.

While major street demonstrations have been violently supressed by the military, hundreds of thousands of public sector workers are continuing a three-month civil disobedience movement, refusing to work for the military junta. This movement is seen as one of the most effective tools against the junta and was initiated by Myanmar’s doctors and nurses. Many doctors are now facing the wrath of the junta. Reports received from union partners show that in April, 120 doctors across Myanmar were charged with ‘shaming the state’ and could face more than two years in prison. Those who bravely continue their strike action have been offering free care through community hospitals or other means but have now gone months without pay. Many doctors joined the massive street protests that gripped Myanmar during March and April, often organising to provide emergency medical care to shot protestors. They did so at great personal risk. Two doctors were shot and killed by the military soldiers in Mandalay on 27 March. UnionAID has had a long relationship with Myanmar. We have supported the establishment of trade unions and run the Myanmar Young Leaders Programme to promote democracy and human rights. Throughout this crisis UnionAID has worked to assist unions, journalists, and striking workers with resources to sustain their pro-democracy fight.

Many doctors joined the massive street protests that gripped Myanmar during March and April, often organising to provide emergency medical care to shot protestors.

The coup and ensuing crisis in Myanmar os one example of rising authoritarianism in our Asia-Pacific region. Coupled with Covid-19, it is devastating for many working people, especially the poorest. The World Bank estimates 120 million people fell into extreme poverty last year – the first increase in poverty in a generation. UnionAID is holding a special appeal calling for donations from New Zealand union members so it can provide unions in developing countries with resources and tools to organise and provide education and training to build strong unions. The funds raised will go towards brave campaigns for human rights against authoritarian and military governments in Myanmar, Thailand and the Philippines. If you would like to make a donation, visit

www.unionaid.org.nz/2021-appeal/

*UnionAID works to alleviate poverty and achieve social justice for working people in Asia and the Pacific. It is a registered New Zealand charity and is an accredited New Zealand Aid Programme partner.