ADVISORY COMMISSION ON RAKHINE STATE HEALTH Access to health services in Rakhine is low, both for the Rakhine and Muslim population. The World Health Organization (WHO) has recommended that the minimum number of health workers to maintain a functional health system is 22 health workers per 10,000 inhabitants. Currently, there are only 5 health workers per 10,000 people in Rakhine, compared to the national average of 16 per 10,000 people. Rakhine has a higher child mortality rate than the national average, and only 19 percent of women give birth in professional health facilities (compared with 37 percent nationally).13 The immunization coverage is among the lowest in the country, and there have been multiple outbreaks of vaccine-preventable diseases over the recent years, predominantly in the northern part of the state. In a 2016 state-wide study, 52 percent of the respondents reported that they do not have access to adequate health care.14 The nutritional status of children in Rakhine State is the worst in the country, with 38 percent of children stunted and 34 percent underweight.15 Widespread poverty, exacerbated by conflict, has resulted in protracted trends of both acute and chronic malnutrition across the state. The provision of healthcare is not standardized throughout the state. The result is a patchwork of inconsistent services. In some locations, only primary health care access is available, while in other locations secondary health care is offered. The disparity in equipment, medication and supplies available at different health facilities serves to undermine the general quality of services, which has particularly detrimental effects on marginalized populations. As of today, only Sittwe General Hospital has a blood bank, while all other hospitals rely on stand-by donors. Although the referral pathway has improved over time, there are inconsistencies in the way that medical authorities apply established protocols, which contributes to inequitable access and services. Because Rakhine has an acute shortage of qualified medical staff, many villages lack full-time access to a health worker. Many health workers are hesitant to spend time in Muslim villages and hard-to-reach areas, especially when not assisted with transportation costs and per diem. Some health workers also avoid such areas due to real or perceived security risks. Retaining medical personnel in the state is a major challenge. There are no medical universities, which means that staff must be recruited from other parts of 13 Myanmar Demographic and Health Survey 2015-16, Myanmar Ministry of Health and Sports, March 2017. 14 Rakhine State Needs Assessment II, Center for Diversity and National Harmony (CDNH), January 2017. 15 Myanmar Demographic and Health Survey 2015-16, Myanmar Ministry of Health and Sports, March 2017. 42 Towards a Peaceful, Fair and Prosperous Future for the People of Rakhine