In the past year,Burma has opened its political systemand reached cease-fire agreementswith some ethnic militias.The government has also eased media restrictions.But many aid groups saytheir jobs have not gotten any easier.Health workers are warning about the spread ofa form of drug-resistant malaria.The malaria is resistant to treatment with artemisinin.It was first seen several years ago in Cambodia.Frank Smithuis started a groupcalled Medical Action Myanmar.He says even with the recent political openings,aid organizations still find it difficultto gain access to areas most in need of aid.This is true, he says, especially in areas tornby many years of conflict along Burma's eastern border.FRANK SMITHUIS: "There are now very good opportunitiesbecause of the cease-fire agreementswith the Karen and the Mon.Larger areas should now be openfor access to a joint activityto stop this artemisinin resistance spread.However that has not happened yetand we definitely need to have more opennessand more activity and more international donor money.And that's very, very important."In the past, many nongovernmental organizationssimply worked without official approval.Lower-level government officials largely ignoredorganizations that did not follow the rules.Until two thousand nine,just three international nongovernmental aid organizationshad the required approvals to operate inside Burma.Yet more than one hundred were operating there.Many were able to get a memorandum of understandingthat allowed them to work without an official registration.But then came the recent political changes.Heads of aid organizations say lower-level officialsare now unclear about their powers and responsibilities.In many cases they are enforcing the requirements more closely.Save the Children is an aid organizationwhose work is mostly related to motherand child health in Burma.Kelland Stevenson with Save the Children says,in general, ministries and government workershave become much more cooperative.He agrees with those who say the barriersthat humanitarian workers now face are largely bureaucratic.KELLAND STEVENSON: "It shouldn't be a political discussion.There remains a bit of command and control from government,and it's not going to open up overnight.And the discussion about getting access to new areas is under way.You have to remember these changeshave been extraordinarily dramatic in such a short time.I mean, we're talking a year."Kelland Stevenson says "things are changing so quickly."Still, aid groups warn that some issues-- such as the drug-resistant malaria -- may only get worseunless the government also takes action quickly.And that's the VOA Special English Health Report.For more health news for people learning English,go to 51voa.com.