Human resources for health: task shifting to promote basic health service delivery among internally displaced people in ethnic health program service areas in eastern Burma/Myanmar
For over 50 years, Burma/Myanmar’s ethnic areas lacked access to basic health services due to military rule. Ethnic health organizations (EHOs) and community-based health organizations (CBHOs) filled this gap by providing care in border regions. This case study focuses on how these groups reach vulnerable populations, particularly in 14 townships of Karen/Kayin State. Using surveys, interviews, and document reviews, the study found that despite limited skilled professionals, health coverage was achieved through task shifting and well-organized mobile and clinic-based teams. Human resource density ranged from 1.8 to 3.9 health workers per 1,000 people. Over 20 years, EHOs and CBHOs built a functioning health system in conflict-affected areas. However, they remain vulnerable due to limited international recognition and political complexities, especially amid ongoing peace negotiations and ASEAN integration, which could affect migration and healthcare access.
Access To Essential Maternal Health
Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
This article assessed maternal health service coverage and the impact of human rights violations in eastern Burma, specifically among communities in Shan, Mon, Karen, and Karenni regions. Surveys were conducted with 2,914 ever-married women of reproductive age (15–45 years) between September 2006 and January 2007. The findings revealed very low access to essential maternal services, including skilled birth attendance (5.1%), antenatal care, iron supplements, and family planning, with high rates of home births (88%) and unmet contraceptive needs (over 60%). Many women were anemic, and 7.2% had malaria. Human rights violations were common—such as forced labor and displacement—and significantly linked to poor health outcomes. Forcibly displaced women had higher odds of anemia and were much less likely to receive antenatal care. The study concludes that maternal health service coverage is critically low in these conflict-affected areas, calling for substantial political and resource investment to improve care access.
After Cyclone Nargis struck Burma in 2008, killing over 138,000 people, the military government blocked international aid, leaving community-based groups like EAT to lead relief efforts. EAT documented ongoing human rights abuses, including aid misappropriation, land confiscation, and harassment of relief workers. Over a year later, many survivors still lacked basic needs and healthcare. The study highlights the importance of independent, community-led responses in humanitarian crises, especially where censorship and state control persist.
A systematic review of factors influencing
participation in two types of malaria prevention
intervention in Southeast Asia
This systematic review explores what influences the use of insecticide-treated bed nets (ITNs) and participation in mass drug administration (MDA) for malaria prevention across Southeast Asia. Drawing from 30 studies—mainly focused on Myanmar—the review highlights that people’s knowledge and attitudes play a key role in ITN usage, while participation in MDA depends on community attitudes, incentives, and group decision-making. The findings suggest that community engagement, education, and locally informed strategies are critical for achieving malaria elimination in the region by 2030.
Balancing Reproductive and Productive Responsibilities:
Childcare Strategies Implemented by Migrant Mothers in the
Thailand–Myanmar Border Region
This study explores how migrant mothers from Myanmar living in Mae Sot, on the Thailand–Myanmar border, manage both caregiving and income-generating responsibilities while facing displacement and instability. Through 62 personal narratives, the research identifies four key childcare strategies: bringing children to work, staying home to care for them, sharing responsibilities with family, and relying on formal or non-family caretakers. Most women preferred to keep childcare within the family, but often struggled to find work that allowed them to do so. The findings call for better employment opportunities that support mothers living in protracted refugee settings.
Perceptions of child physical discipline among Burmese migrants living in
Mae Sot, Thailand
Burmese migrant families in Mae Sot, Thailand face complex parenting challenges shaped by displacement, economic hardship, and cultural norms. Drawing from 80 first-person accounts, this research sheds light on how physical discipline is viewed and practiced within this community. Many parents rely on physical punishment—often using a stick—as a response to disobedience or stress, though some also mention using discussion-based approaches. The acceptability of these methods varies, influenced by cultural attitudes and life circumstances. To reduce reliance on physical discipline, the authors recommend a combination of legal reform, educational outreach, and long-term support such as securing legal status for migrant families.
Mortality rates in conflict zones in Karen, Karenni,
and Mon states in eastern Burma
Objectives: To estimate mortality rates among populations living in civil war zones in Karen, Karenni, and Mon states of eastern Burma.
Methods: Indigenous mobile health workers conducted cluster sample surveys in 2002 and 2003, interviewing household heads to collect demographic and mortality data.
Results: In 2002, 1,290 households (7,496 individuals) were surveyed; in 2003, 1,609 households (9,083 individuals). Infant mortality rates were 135 and 122 per 1,000 live births; under-five mortality rates were 291 and 276; crude mortality rates were 25 and 21 per 1,000 persons per year.
Conclusions: Conflict-affected populations in eastern Burma face high mortality. Indigenous mobile health workers offer a feasible method to monitor health status in inaccessible areas.
Keywords: Burma, mortality, internally displaced persons, malaria, landmines, civil conflict
Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma
In eastern Burma, human rights violations in conflict zones are not only widespread but also closely linked to serious health consequences. Using data from over 1,800 household surveys conducted in 2004, this study found that families experiencing forced displacement, food theft, or multiple rights abuses faced sharply higher risks of child mortality, malnutrition, malaria, and landmine injuries. For example, child death rates were more than five times higher in households reporting three or more rights violations. These findings highlight the urgent need for humanitarian interventions and show that population-based data can effectively quantify the health impact of human rights abuses.
Health and human rights in eastern Myanmar
prior to political transition: a population-based
assessment using multistaged household cluster
sampling
Before Myanmar’s 2010 election and political transition, communities in eastern regions faced alarming levels of disease, child mortality, and human rights violations. This large-scale household survey—covering over 5,500 households across six areas—revealed that one in three families experienced forced labor, displacement, or other abuses in the previous year. These violations were linked to significantly higher rates of child death and malnutrition. Malaria, respiratory infections, and diarrhea were the top reported causes of death. The findings serve as a crucial baseline for tracking the impact of future humanitarian aid and development efforts on health and human rights in Myanmar.
Migration patterns & their associations with
health and human rights in eastern
Myanmar after political transition: results of
a population-based survey using
multistaged household cluster sampling
Following Myanmar’s political transition in 2011, migration out of eastern regions far exceeded migration into them, with international departures—mainly to Thailand—outnumbering returns by 29 to 1. A 2013 survey of over 6,600 households found that most people left for education or work, while returns were primarily driven by family ties. Out-migration was linked to higher rates of depressive symptoms among remaining household members, while in-migration was associated with increased malnutrition and unmet contraceptive needs among women. These findings highlight the complex relationship between migration, health, and human rights in post-transition Myanmar.
An exploration of gender-based violence in eastern Myanmar inthe context of political transition: findings from a qualitativesexual and reproductive health assessment
Abstract: In March 2011, the Myanmar Government transitioned to a nominally civilian parliamentary government, resulting in dramatic increases in international investments and tenuous peace in some regions. In March 2015, Community Partners International, the Women’s Refugee Commission, and four community-based organisations (CBOs) assessed community-based sexual and reproductive health (SRH) services in eastern Myanmar amidst the changing political contexts in Myanmar and Thailand. The team conducted 12focus group discussions among women of reproductive age (18–49 years) with children under five and interviewed 12 health workers in Kayin State, Myanmar. In Mae Sot and Chiang Mai, Thailand, the team interviewed 20 representatives of CBOs serving the border regions. Findings are presented through the socioecological lens to explore gender-based violence (GBV) specifically, to examine continued and emerging issues in the context of the political transition. Cited GBV includes ongoing sexual violence/rape by the military and in the community, trafficking, intimate partner violence, and early marriage. Despite the political transition, women continue to be at risk for military sexual violence, are caught in the burgeoning economic push–pull drivers, and experience ongoing restrictive gender norms, with limited access to SRH services. There is much fluidity, along with many connections and interactions among the contributing variables at all levels of the socioecological model; based on a multisectoral response, continued support for innovative,community-based SRH services that include medical and psychosocial care is imperative for ethnic minority women to gain more agency to freely exercise their SR rights.
Creating a locally driven research agenda for the ethnic minorities of Eastern Myanmar
Research in fragile states like Myanmar is often shaped by external priorities. In Eastern Myanmar, where conflict has long undermined the formal health system, community-based and ethnic health organizations have taken the lead in healthcare delivery. To strengthen local research capacity and set their own agenda, health leaders from this region organized a 3-day forum with 60 participants from 15 organizations. The forum included research training, a nominal group technique (NGT) session to identify priority topics, and mentorship support. While the NGT effectively generated consensus on 15 top research priorities, follow-through on local research projects was limited. Stronger leadership engagement is needed to translate such initiatives into sustained research development.
Association between biological sex and insecticide-treated net use among household members in ethnic minority and internally displaced populations in eastern Myanmar
Abstract
Malaria remains prevalent among ethnic minority and displaced populations in remote, forested areas of eastern Myanmar. This study used 2013 survey data to examine age and sex disparities in insecticide-treated net (ITN) possession, access, and use among 37,927 household members. While nearly 90% lived in households with at least one ITN, only half had sufficient supply and used them. Children under five and pregnant women had the highest usage. Adult women (15–49 years) were more likely than men to use ITNs (RR: 1.4). These findings highlight gaps in ITN coverage and use, and can guide efforts to ensure equitable malaria prevention in vulnerable communities.
Community-based delivery of maternal care in conflict-affected areas of eastern Burma: Perspectives from lay maternal health workers
Abstract
In conflict-affected eastern Burma, access to facility-based maternal health care is limited. The Mobile Obstetric Maternal Health Worker (MOM) project addresses this gap through a community-based approach led by Lay Maternal Health Workers (MHWs), who deliver essential maternal services, including emergency obstetric care. Insights from MHWs—gathered through focus groups, interviews, and case studies—reveal how they build trust, overcome challenges, and manage complications in remote settings. The findings suggest that some obstetric services can be safely provided outside formal health facilities. This study highlights the importance of community-led, rights-based care in areas where health systems are disrupted and human rights violations are common.
Impact of Community-Based Maternal Health Workers on Coverage of Essential Maternal Health Interventions among Internally Displaced Communities in Eastern Burma: The MOM Project
Abstract
Background: Access to maternal and reproductive health care is severely limited in eastern Burma, especially among internally displaced communities. Innovative, community-based approaches are urgently needed.
Methods: Between 2005 and 2008, four ethnic health organizations piloted a three-tiered network of community providers to deliver maternal health services. Two-stage cluster surveys among ever-married women (ages 15–45) before and after implementation assessed changes in service coverage.
Results: Among 2,889 women surveyed in 2006 and 2,442 in 2008, significant improvements were observed. Antenatal care coverage increased (71.8% vs. 39.3%), as did malaria screening, urine testing, deworming, postnatal care, and modern contraceptive use. Births attended by trained providers rose from 5.1% to 48.7%.
Conclusions: Community-based delivery significantly improved maternal health service coverage. The MOM Project’s task-shifting and empowerment model may inform strategies in other conflict-affected or resource-limited settings.
Mortality rates in conflict zones in Karen, Karenni,and Mon states in eastern Burma
Abstract
objectives: To estimate mortality rates for populations living in civil war zones in Karen, Karenni, andMon states of eastern Burma.methods Indigenous mobile health workers providing care in conflict zones in Karen, Karenni, andMon areas of eastern Burma conducted cluster sample surveys interviewing heads of households during3-month time periods in 2002 and 2003 to collect demographic and mortality data.results In 2002 health workers completed 1290 household surveys comprising 7496 individuals. In2003, 1609 households with 9083 members were surveyed. Estimates of vital statistics were as follows:infant mortality rate: 135 (95% CI: 96–181) and 122 (95% CI: 70–175) per 1000 live births; under-fivemortality rate: 291 (95% CI: 238–348) and 276 (95% CI: 190–361) per 1000 live births; crude mor-tality rate: 25 (95% CI: 21–29) and 21 (95% CI: 15–27) per 1000 persons per year.conclusions Populations living in conflict zones in eastern Burma experience high mortality rates.The use of indigenous mobile health workers provides one means of measuring health status amongpopulations that would normally be inaccessible due to ongoing conflict.keywords Burma, mortality, internally displaced persons, malaria, landmines, civil conflict.