US embassy cable - 03RANGOON657

UNCLAS SECTION 01 OF 03 RANGOON 000657 
 
SIPDIS 
 
SENSITIVE 
 
STATE PASS AID/ANE, HHS FOR OGHA - STEIGER 
STATE FOR EAP/BCLTV, IO/EDA, PRM/POP 
PHNOM PENH FOR AID - CAROL JENKINS 
USPACOM FOR FPA 
 
E.O. 12958: N/A 
TAGS: AORC, EAID, SOCI, BM, UNFPA, NGO 
SUBJECT: UNFPA'S BURMA SCORECARD IS GOOD, SO FAR 
 
REF: STATE 137010 
 
1. (SBU) Summary: UNFPA, into the second year of its 
four-year "special program" in Burma, is encouraged by its 
successes.  To help ensure further progress, though, the 
agency's Rangoon office hopes that a chronic shortage of 
contraceptives will be remedied in short order.  The agency 
plans to expand both the width and depth of its program in 
the next two years, continuing to work with local and 
international NGOs, other UN agencies, and the Burmese 
government.  UNFPA's programs address serious health and 
social needs in Burma, and thus expansion will benefit many 
underserved women and adolescents.  However, we'll keep an 
eye on two potential pitfalls of expansion: a deterioration 
in monitoring, and an expansion in leakages.  End summary. 
 
UNFPA Spreads its Wings in Burma 
 
2. (U) The UNFPA established itself well in the first year of 
its program in Burma.  Though UNFPA has worked in Burma since 
1969, it only established a country office in the summer of 
2002.  UNFPA's representation in Burma was raised in 2003 
from chief of operations to representative level.  Currently 
UNFPA is into the second year of its $16 million, four-year 
program. 
 
3. (U) UNFPA's programs in Burma address behavior change, 
adolescent reproductive health, and general reproductive 
health services.  It generally tries to build the capacity of 
the decrepit rural healthcare network of health centers and 
sub-centers by providing resources and training.  On the 
population side, UNFPA continues its work analyzing the 
numbers from a 2001 fertility and reproductive health survey 
it carried out with the Burmese government.  UNFPA recently 
took over the responsibility, normally held by UNICEF, to 
provide drugs for people with sexually transmitted diseases. 
The agency is also involved in HIV/AIDS education and 
prevention as part of the UN country team's Expanded Theme 
Group on HIV/AIDS, and is awaiting Ministry of Health 
approval to begin its own HIV/AIDS programming -- centered on 
education and "100 percent condom usage." 
 
Maternal Mortality is the Key Problem, Focus 
 
4. (SBU) There's no question that UNFPA's mission to address 
maternal mortality tracks with the country's needs.  In 1997, 
the maternal mortality rate in Burma was about 255 per 
100,000 live births.  Raw statistics collected at the end of 
2001 indicate that the rate has increased since then. 
 
5. (U) There's also strong evidence of demand for UNFPA's 
activities, both education and contraceptive supplies. UNFPA 
estimates that only 29 percent of married women of 
reproductive age use contraceptives.  In its operating area, 
UNFPA is only able to supply 12-15 percent of likely clients. 
 Consequently, urban women avail themselves of a booming 
black market for counterfeit, expired, or uncertified 
contraceptive devices brought over from China.  In rural 
areas, UN agencies, NGOs, and other commentators tell us, 
women turn to illegal abortions as a contraceptive measure. 
 
6. (U) Additionally, UNFPA, along with various INGOs, helps 
fills a niche for contraceptive choice.  Though the 
government has focused on 100 percent condom distribution as 
part of its HIV/AIDS program, there's not been much attention 
on other modes of contraception. 
 
7. (U) Through its training programs, aimed at the vastly 
female rural health corps and health statisticians, UNFPA 
helps build capacity among female caregivers and 
administrators. 
 
Relations with NGOs, Donors, and the Government 
 
8. (U) UNFPA carries out its work in conjunction with rural 
government health workers, other UN agencies (especially the 
WHO), international NGOs, and local government-controlled 
NGOs (including the Myanmar Maternal and Child Welfare 
Association and the Myanmar Medical Association).  UNFPA's 
condom distribution is contracted to PSI, with which U.S. AID 
works closely to implement its nascent $1 million HIV/AIDS 
program in Burma.  Other partner INGOs include Marie Stopes 
International, the International Planned Parenthood 
Federation, and the Japanese Organization for International 
Cooperation in Family Planning.  Save the Children and World 
Vision also provide reproductive health services here, but 
are not currently affiliated with UNFPA. 
 
9. (SBU) The INGOs with whom we spoke were generally positive 
about UNFPA's operations here.  Some were a bit critical of 
UNFPA's, and all UN agencies', dealing with the regime and 
government NGOs.  However, they admitted that the UN had 
little choice but to work with the government to some degree, 
and UNFPA was more vigilant than others in minimizing GOB 
interference. 
 
10. (U) UNFPA's usual bilateral donors (the Netherlands and 
the Scandinavian countries) are not active in reproductive 
health in Burma, having put their limited Burma assistance 
funds into the fight against HIV/AIDS.  However, the Japanese 
government is doing some work on reproductive health.  UNFPA 
receives some limited grassroots funding from the Japanese 
Embassy in Rangoon for renovating rural health clinics.  We 
were told that Japan International Cooperation Agency (JICA) 
was planning a $2-$3 million multi-year program to provide 
reproductive health alongside UNFPA in several dozen 
townships. 
 
11. (SBU) UNFPA's relations with its two government 
interlocutors, the Ministry of Population and Immigration 
(MOPI) and the Ministry of Health (MOH), are generally good. 
UNFPA's representative reports that MOPI has been 
surprisingly helpful and efficient in collaborating to 
improve population statistics (there's been no official 
census taken since the one UNFPA helped organize in 1983). 
The Ministry of Health (MOH) has been somewhat more 
bureaucratic and slow -- a complaint heard from many UN 
agencies and health INGOs.  However, the UNFPA representative 
reported that under the new Health Minister, Dr. Kyaw Myint, 
cooperation and efficiency have increased.  For example, 
Minister Kyaw Myint responded rapidly to UNFPA's request to 
establish 20 new clinics/information centers/social halls 
aimed at adolescents.  This proposal had languished for 
months under the previous minister. 
 
12. (SBU) Though UNFPA does not channel its funds through the 
MOH or other government ministries, it does work directly 
with local health officials and government-run clinics.  It 
also relies on the MOH's central distribution network to get 
contraceptive devices sent to the various townships.  The 
UNFPA representative complained that this distribution 
network is slow and inefficient, but that there is no other 
alternative if the GOB is to allow UNFPA to continue its 
operations. 
 
Future Plans are Ambitious 
 
13. (SBU) Aside from the hoped-for HIV/AIDS program, UNFPA 
intends to expand its capacity-building work.  The Rangoon 
office intends to bring in consultants in 2003 to conduct a 
thorough gender analysis.  In part, the impetus for this 
study is the evolving economic role for women in Burma, as 
more and more men seek economic opportunities outside the 
country.  Following up this study, UNFPA, alongside the 
Myanmar National Working Committee for Women's Affairs, plans 
to do several workshops on gender issues and trafficking in 
persons aimed at male policymakers at all levels of 
government. 
 
14. (SBU) Though it is limited by its MOU with the government 
to reproductive health, UNFPA is also examining a pilot 
project to work with the UN Interagency Project to Combat 
Human Trafficking in the Mekong Sub-Region's (UNIAP) 
expanding Burma operations.  Specifically, UNFPA is looking 
to assist a small, local development group (headed by 
Catholic and Buddhist nuns) in Mon State to provide small 
loans and other assistance to women and girls who might 
otherwise seek a more dangerous living over the border in 
Thailand. 
Problems and Obstacles Remain 
 
15. (SBU) UNFPA's small operation in Burma allows it to exist 
with fewer obstacles than other, larger UN agencies. 
However, there are three issues worth watching.  First, a 
major problem faced by UNFPA in Burma is a lack of funding 
for contraceptive supplies.  Though condoms are not a 
problem, procurement of contraceptive pills, injections, 
IUDs, and the "morning after" pill has been inadequate.  The 
representative said that UNFPA's procurement for Burma is 
$800,000 in the hole for 2003, in large part due to a drop 
off of bilateral donations and a general reduction of UNFPA's 
funding around the world. 
16. (SBU) Exacerbating this problem is leakage and government 
misuse of what contraceptive supplies UNFPA can bring into 
the country.  That being said, at this point leakage of 
contraceptives for resale into the black market is not as 
large a problem as it is for drugs and other high-value 
items.  There are allegations that the government hijacks 
some supplies of condoms, in particular, for their own use, 
or for "donation" to a government-controlled NGO.  However, 
the seriousness of this problem is unclear. 
 
17. (SBU) Monitoring, always a difficult task in Burma, is 
easier for UNFPA because of the small size of its program. 
Currently the agency is operating in 84 townships (about 25 
percent of the country's total), mostly in more heavily 
populated rural areas that have better transportation 
infrastructure.  Thus it is easier for UNFPA staff to make 
regular monitoring missions.  The representative said that he 
or his staff are making about four monitoring trips per month 
to various program sites.  However, UNFPA aims to expand to 
100 townships by 2005, which could put a strain on monitoring 
effectiveness without additional hiring. 
Martinez