Although Burma has opened up its political system, brokered cease-fires with some ethnic militias and loosened media restrictions in the past year, aid workers say their jobs have not gotten easier.
Health workers in Burma are warning about the spread of a form of drug-resistant malaria that was first spotted several years ago in Cambodia.
Frank Smithuis, the founder of Medical Action Myanmar, an aid organization working to help stop the spread of the artemisenin-resistant malaria, says the issue is a serious public health concern that highlights the need for a rapid response.
But he says that, despite recent political openings, humanitarian aid organizations are still finding it hard to gain access to areas most in need of aid, especially those ravaged by decades of ethnic conflict along Burma's eastern border.
"There are now very good opportunities because of the cease-fire agreements with the Karen and the Mon," said Smithuis. "Larger areas should now be open for access to a joint activity to stop this artemisenin resistance spread .… However that has not happened yet and we definitely need to have more openness and more activity and more international donor money. And that’s very very important."
Some groups in Burma, including previously banned exile political organizations, are finding it easier to operate in the country.
The Vahu Development Institute, a think tank that does economic and political research is looking into establishing an office inside Burma.
Top Vahu leaders are now acting as counsel to the presidential economic adviser.
Aung Thu Nyein, an analyst at Vahu, says some of the difficulties for those trying to work inside Burma have more to do with a complicated bureaucracy than the government's unwillingness to cooperate with dissidents or outsiders.
"The problem is division of labor within the central government and the state and regional governments," said Aung. "Nobody is sure what kind of powers they belong to and what kind of authorities they could make. And at the same time it is quite difficult for the humanitarian agents to find the right way to get the authorization from the authority."
In the past, many non-governmental organizations simply worked without official authorization and lower level government officials largely ignored organizations who did not adhere to procedures.
Until 2009, just three of the upwards of 100 international non-governmental aid organizations inside Burma were properly registered. Many were able to acquire a memorandum of understanding that allowed them to work without an official registration.
Heads of aid organizations say, following the political changes in recent years, lower level bureaucrats now appear to be adhering to procedures more stringently than before because their authority and responsibilities are now unclear.
Kelland Stevenson of Save the Children, an aid organization which does purely apolitical work, mostly related to maternal and child health in Burma, agrees that the obstacles humanitarian workers now face are largely bureaucratic and that ministries and government workers, in general, have become much more cooperative.
"It shouldn’t be a political discussion," said Stevenson. "There remains a bit of command and control from the government and it’s not going to open up overnight. The discussion about getting access to new areas is underway. You have to remember these changes have been extraordinarily dramatic in such a short time. I mean, we're talking a year. It has been hard for people to keep up. Because things are changing so quickly."
Despite those rapid changes, groups warn that some issues, such as the drug resistant malaria, need urgent attention and, unless the government can move more quickly, it may worsen a looming health crisis.