Bridging the Gap: Ethnic Health Organizations Present Plans of Action to Contribute to Health for All in Myanmar
On Wednesday January 22, 2019, more than 80 representatives from the Myanmar Ministry of Health and Sports (MoHS), international governments, non-governmental organizations (NGOs), and ethnic health organizations (EHOs) gathered in Yangon to witness five EHOs present their Plans of Action up to 2021 for developing their service readiness to deliver a Basic Essential Package of Health Services (BEPHS). The seminar, entitled “Health Systems Updates in the Ethnic Areas of Myanmar” showcased the key role and future potential of these EHOs in supporting Myanmar’s aspiration to attain universal health coverage (UHC) by 2030.
Myanmar’s National Health Plan (2017-2021) specifically acknowledges the key role of EHOs in supporting the attainment of UHC. A core component of the NHP is to extend access to the BEPHS for the whole country by 2020-2021. Many thousands of people in communities with little or no access to the national health system continue to rely on EHOs for access basic health services. With health personnel and facilities on the ground, years of experience operating in challenging contexts, and strong relationships of trust in the communities that they serve, EHOs play vital and unique roles in the delivery of basic essential health services.
A key consideration for the involvement of EHOs in the rollout out of the BEPHS is their service availability and readiness. In 2018 and 2019, Community Partners International (CPI) conducted a series of assessments with five EHOs to assess service availability and identify areas of improvement, further investment and strengthening. The five participating EHOs were the Civil Health and Development Network (CHDN) Karenni, the Karen Department of Health and Welfare (KDHW), the Mon National Health Committee (MNHC), the Pa-Oh Health Working Committee (PHWC) and the Shan State Development Foundation (SSDF).
The outcomes of these assessments were organized into Plans of Action published by each participating EHO and organized according to the following four pillars: human resources, infrastructure, service delivery and health financing (which represent a re-categorization of the World Health Organization’s six building blocks of a health system: service delivery, health workforce, health information systems, access to essential medicines, financing and leadership/governance). For each pillar, based on the assessment findings, the EHOs identified actions for improvement, and ranked these actions according to priority to create three-year Plans of Action.
At the seminar on January 22, representatives from these five EHOs presented their Plans of Action for the first time to an audience of peers and key stakeholders engaged in transforming Myanmar’s health system.
The welcoming remarks at the seminar were made by H. E. Dr. Myint Htwe, Union Minister for Health and Sports. In his video address, Dr. Myint Htwe underlined why coordination between MoHS and EHOs was an essential component in attaining UHC. The Union Minister also highlighted the role of EHOs in geographic as well as service coverage expansion and health promotion.
Dr. Myint Htwe’s remarks were followed by keynote speeches by Ms. Rea Bonzi, First Secretary, Head of Health and Local Governance, Embassy of Switzerland, and Mr. Will Niblett, Deputy Head of Office, DFID Myanmar, and welcoming speeches by Saw Diamond Khin, Acting Head of Department of KDHW, on behalf of the Karen Ethnic Health Organizations Consortium (KEHOC) and Nai Banyar Mon, Deputy Director of MNHC on behalf of the Ethnic Health Consortium (EHC).
Dr. Tom Lee, CPI’s Founder and Board Chair, then addressed the floor to reflect on the long and pivotal role played by EHOs in providing essential health care to their communities, and the importance of their inclusion at the heart of Myanmar’s health system moving forward. He expressed his sense of hope in seeing the increased levels of coordination and cooperation between EHOs and the MoHS and underlined how important it is for the future of health care in Myanmar that these relationships continued to expand and evolve.
Dr. Lee’s remarks were followed by the opening of the main section of the morning session of the seminar. Dr. Zaw Toe Myint, CPI’s Health Systems Strengthening Director presented an overview of the ethnic health system assessment process and the development of the and Plans of Action. Then, Ms. Rachel Whelan, CPI’s Research Director, presented key findings from the EHO assessments. Ms. Whelan provided an overview of the 119 health facilities operated by these five EHOs that serve an estimated 486,000 people. She presented information about the basic amenities, equipment and diagnostic tools that currently in these facilities as a percentage of the total required to provide the BEPHS. These are summarized in the table below:
Ms. Whelan also touched upon the infrastructural aspects of the EHO clinics in their catchment areas, including the average number of beds per clinic, the clinic construction materials, water and electricity sources available to the clinic, and the average population size in each catchment area. These are summarized in the table below:
The findings presented by Ms. Whelan illustrated the varying strengths and areas for improvement of EHOs in meeting the service requirements of the BEPHS.
Following Ms. Whelan’s presentation, each EHO presented their Plan of Action to the floor. The Plan of Action presentations were made by Ms. Evelyn, Deputy Director, Operations (Karenni State), for CHDN; Dr. Naw Wah Kapaw, Assistant Director, Health Programs, for KDHW; Dr. Nay Win Naing, Technical Advisor for MNHC; Khun Sithu, Director, for PHWC; and Dr. Sai Saung Kham, Senior Program Support Manager, for SSDF.
After the presentations, EHO representatives joined Dr. Si Thura, CPI’s Executive Director, on stage for a moderated panel discussion about the Plans of Action. During the session, they touched on the difficulties of strengthening health systems when donor investments are often focused on vertical projects for specific health issues. They also explored some of the challenges encountered during the development of the Plans of Action, and how the EHOs were planning to move ahead with the implementation of improvements in order to fully deliver the BEPHS to the coverage areas.
In the afternoon session, Saw Kyaw Hla, representing the Karen Ethnic Health Organizations Consortium (KEHOC) and Ms. Evelyn, representing the Ethnic Health Committee (EHC), took to the stage to discuss health alliances in conflict-affected areas, and the strategic directions of their respective alliances. This session was followed by a lively question and answer session with the audience.
Following this session, CPI Lead Health Economist Mr. Tom Traill presented the concept of strategic purchasing of health services and explained how this innovative approach to health financing can promote better health services through greater EHO autonomy. Mr. Traill explained how development partners can help support EHOs to achieve greater autonomy as health service providers.
In the final presentation of the seminar, Dr Zaw Toe Myint, CPI’s Health Systems Strengthening Director, returned to the stage to talk about how efficiency gains can be achieved by strengthening health information systems (HIS). He explained the increasing areas of alignment between government and EHO HIS, the challenges encountered in developing EHO HIS, and how HIS can support progress towards UHC.
In the final session of the seminar, representatives from KEHOC and CPI participated in a panel discussion on strategic purchasing of health services. They addressed the challenges of implementing strategic purchasing and the need to adapt the purchasing model to meet the needs of the local context, and discussed the major steps needed to establish a strategic purchasing mechanism in EHO coverage areas. They emphasized that, in these areas, buy-in, advocacy and EHO involvement are essential. They stressed that it cannot be a top-down model of implementation: successfully achieving universal health coverage will depend on increasing decentralization of health service delivery.
The seminar closed with final remarks delivered by Karen Cavanaugh, Director, Office of Public Health, USAID Burma, and Dr. Thu Hlaing Min Kyaw, Head of Strategy at the Access to Health Fund.
The “Health Systems Updates in Ethnic Areas of Myanmar” seminar was organized and funded by Community Partners International (CPI). The development of the EHO Plans of Action was supported by the Access to Health Fund (ATH), USAID, the Swiss Agency for Development and Cooperation (SDC) and CPI.