For Myanmar to achieve the stated ambition to provide Universal Health Coverage (UHC) by 2030, universal access to health services remains a key challenge. This is particularly true for the hundreds of thousands of people living in conflict-affected and hard-to-reach areas of the country where the Ministry of Health and Sports (MoHS) has historically had little or no coverage, and where trust in the national government has been severely eroded by decades of conflict.
In many of these under-served communities, ethnic and community-based health organizations sprang up to fill the service gap. Over the years, these organizations have grown into a significant health provider force, with thousands of trained health workers providing the first line of clinic-based and mobile health services to their communities. However, as health service reforms continue, no formal and agreed framework still includes and defines the role of these ethnic and community-based health providers within the national health system.
Given the history of conflict and the fragile progress of the peace process in Myanmar, a centralized ‘command model’ health system cannot deliver the shared goal of UHC within the 2030 timeframe. So what can? This was the question explored at a recent CPI-supported seminar organized by the Burma Medical Association (BMA) entitled, ‘Universal Health Coverage: Towards a Decentralized Health System.’
In Mae Sot, Thailand, on May 20-21, 2018, the seminar hosted more than 50 participants, including representatives from ethnic and community-based health organizations and international non-governmental organizations.
Seminar sessions focused on various themes to explore models and approaches to achieving UHC within a decentralized health system. These included: a discussion of the basic principles of UHC and health equity; critical features of a devolved health system; the role of ethnic and community-based organizations in achieving UHC in Myanmar and approaches to implementation in contested areas; decentralized models of health financing; and public-private partnerships for health services.
At the close of the seminar, participants agreed on a series of recommendations to support and formalize the role of ethnic and community-based health organizations as one of the key contributors to the achievement of Universal Health Coverage within a decentralized health system. These recommendations will form the basis of continued advocacy, planning, dialogue, and cooperation with key stakeholders in Myanmar’s health system.