BURMA: NGOS, UN IN FAVOR OF GLOBAL FUND RETURN

C O N F I D E N T I A L SECTION 01 OF 03 RANGOON 000842

SIPDIS

STATE FOR EAP/MLS, G, S/OGAC, OES
PACOM FOR FPA
BANGKOK FOR USAID HEALTH OFFICE; REO FOR HHOWARD
DEPARTMENT PLEASE PASS TO USAID/AME

E.O. 12958: DECL: 10/29/2018
TAGS: SOCI EAID PHUM KHIV PGOV SENV BM
SUBJECT: BURMA: NGOS, UN IN FAVOR OF GLOBAL FUND RETURN

REF: A. RANGOON 797

B. RANGOON 279

C. STATE 105179

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Classified By: Economic Officer Samantha A. Carl-Yoder for Reasons 1.4
(b and d)

Summary
--------------


1. (C) International NGOs and UN agencies active in Burma
have been approaching us, seeking USG support for the Global
Fund's possible return to Burma, citing their perception of
an urgent humanitarian need for increased health assistance
and their experience that they can achieve life-saving
accomplishments in Burma, despite a third-world bureaucratic
environment. Several NGO representatives argue that
additional engagement with the Ministry of Health on
communicable diseases may motivate the GOB to reform its
health system - in part because of the embarrassment another
Global Fund withdrawal would bring. The Minister of Health
confirmed the "embarrassment" factor to the Charge during a
UN Day event in Nay Pyi Taw October 24, saying that, if the
USG is not willing to support the Global Fund's return to
Burma, the GOB will forgo its application plans. End
Summary.

UN, NGOs See a Fundamental Need for Assistance
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2. (SBU) Burma-based UN and NGO representatives have been
appealing to us in recent days to support the return of the
Global Fund to Burma, arguing that Burma's health statistics
show an acute need for increased health assistance. They
assert that Burma needs the Global Fund to cover funding
shortfalls and ensure that people receive necessary medicines
for HIV/AIDS, Malaria, and TB. Several NGO representatives
concede that the GOB could allocate additional government
funding for such health programs, but note that countries
wealthier than Burma receive Global Fund grants. UN and NGO
officials argue that the Burmese people have a fundamental
human right to medical treatment, and stress to us their view
that the humanitarian need for Global Fund support in Burma
outweighs any potential counter-arguments.


3. (SBU) NGO and UN officials have expressed concerns about
the spread of tuberculosis and malaria throughout the country
and possibly the region, as Burma's incidence rates continue
to skyrocket. Officials note that the 2009 end of the Global
Drug Facility grant, which has provided USD three million
annually for first-line TB drugs, will only exacerbate
Burma's TB problems, creating an environment conducive for
new strains of multi-drug resistant and extremely drug
resistant TB (Refs A and B).

Health NGOs: We Are Able to Operate Successfully
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4. (C) NGO and UN representatives acknowledge that
conducting their health activities in Burma is not easy, but
all emphasize that they have been successfully providing
health assistance to the Burmese people. Since the
withdrawal of the Global Fund in 2005, many NGOs have
expanded their health programs to new regions. Frank
Smithuis, Director of Medecins Sans Frontiers (MSF)-Holland
and long-term resident of Burma, points out that NGOs have
found ways to work in Burma, circumventing many of the
regime's more archaic policies. For example, the Three

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Diseases Fund (3DF),which was established in 2006 by a
consortium of donors after the withdrawal of the Global Fund,
has, in collaboration with partners, successfully treated
more than six million patients by working through the private
sector and by maintaining good relations with township-level
officials who approve of the programs (septel).


5. (C) During a recent NGO roundtable, several NGO
representatives observed to us that there are more
challenging places to work than Burma. Smithuis is convinced
the number of lives saved by humanitarian assistance
outweighs the high cost of doing business in Burma and the
hoops that NGOs and UN agencies have to jump through to get
the job done. He said several NGOs, after being told by the
Ministry of Health that they could not implement a specific
program, did so anyway, and have had local authorities laud
the program. In another instance, many NGOs, which had
experienced problems and delays when procuring and importing
medicines, turned to the 3DF, which has drug import permits,
for assistance. NGOs have been able to get the job done, he
emphasized, but often have to think outside the box to do so.



6. (C) Several NGOs and some bilateral donors have urged
the U.S. not to "politicize" humanitarian assistance to
Burma. Smithuis, noting that wealthier and more corrupt
countries than Burma receive Global Fund support, told us he
believes Burma's dire health situation warrants a Global Fund
grant. He added that NGOs operating in Burma know how to
implement and monitor such a grant to ensure that funds are
used properly. Other NGO health implementers have emphasized
the same.

The "Leverage" Argument
--------------


7. (C) Several NGO representatives have argued that the
return of the Global Fund would give the international
community increased leverage over the GOB. They believe the
Ministry of Health, anxious to keep a Global Fund grant,
could potentially improve cooperation and access to the
health sector. John Hetherington, PSI Director, told us that
under the Round 9 application, the Country Coordinating
Mechanism (CCM) will select two principal recipients (PRs) in
Burma - one for civil society and one representing the
government (since Global Fund restrictions on Burma prohibit
the government from directly receiving money); Global Fund
grants would flow through the PRs to the implementing
partners. According to Hetherington, if the situation in
Burma becomes too difficult, the Global Fund could adjust the
PRs' funding levels, reallocating money to the civil society
PR vice the PR representing the Burmese Government.
Hetherington argues that a two PR system provides the Global
Fund with flexibility, and could leverage the GOB to perform.
Several NGO representatives told us the GOB would view
another Global Fund withdrawal as more embarrassing than an
outright rejection of the GOB's Round 9 application.

Expanding Geographic Reach
--------------


8. (SBU) Several UN and NGO officials told us they believe
the enhanced engagement that would be facilitated through a
Global Fund grant could allow the international community to
expand the opportunities created by Cyclone Nargis and
increase presence in areas outside the Irrawaddy Delta.

Technically Sound Global Fund Application

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9. (C) Members of the CCM oversight mechanism for the 3DF,
recently expanded for use with Global Fund issues as well,
have told us that the Burmese Government has been working
hard to meet the Global Fund's eligibility criteria,
including the establishment of a transparent CCM with
peer-elected members. UN officials are working with the
Ministry of Health to ensure that any Round 9 application
will be technically sound.

Ministry of Health Inquires about USG Position
-------------- -


10. (C) On the margins of the UN Day celebration in Nay Pyi
Taw on October 24, the Minister of Health approached the
Charge and raised the issue of the GOB's planned Round 9
application. The Minister clearly had been briefed on USG
issues concerning any new GOB Global Fund application. He
said the GOB has no wish to be embarrassed by a rejection.
He asked that, if the USG decides not to support Burma's
application, we let the GOB know; and the Ministry will not
even submit it. The Charge briefly summarized U.S. concerns,
per Ref C, regarding the significant problems and impediments
the Global Fund faced in Burma prior to the withdrawal in

2005. He stressed it is crucial for the GOB to convince the
USG and other donors that such problems would not recur under
a new Global Fund grant, should one be approved.

Comment
--------------


11. (C) U.S. concerns about Burma's pending Global Fund
application have clearly made an impact here among the UN and
NGO crowd. The Minister of Health also obviously has
received the message. UN and health-NGO representatives
believe strongly that the Global Fund needs to return to
Burma. They are taking every opportunity to stress to us
that such a grant would benefit the Burmese people, not the
government. They emphasize that a new Global Fund grant
would include safeguards, similar to those in place for the
3D Fund (septel),which would prevent the GOB from receiving
any direct or indirect funding. They also describe with
pride their ability to implement 3DF and other aid programs
successfully, often by working around GOB restrictions or
securing the cooperation of local officials. No doubt the
bureaucratic environment for a Global Fund return to Burma
would be less than perfect, though donors see Burma as no
more difficult an environment than many other third-world
countries in that respect. On the other hand, NGOs and some
bilateral donors like the UK and Australia argue persuasively
that the need is real and that the 3DF experience shows it is
possible to achieve acceptable results here, thereby saving
lives.


12. (C) The Minister of Health clearly wants to avoid an
embarrassing denial of Global Fund monies, hence his apparent
willingness to forego a Global Fund application if the USG is
unwilling to support it. Given the Minister's generally
positive performance regarding 3DF and his favorable track
record in cooperating with donors (by GOB standards, at
least),we should be as up front with him as possible, as
early as possible, concerning USG intentions regarding
Burma's Global Fund application. Post would appreciate
further Washington guidance on any additional response we can
provide the Health Minister.

DINGER