Discussion Topic for Seminar 9 (Presented by Zarni)

[Zarni Lynn Kyaw]

I hope to paint a picture of Myanmar during the presentation but the gist of my presentation is

-Two parallel health systems have emerged in Myanmar: the Ethnic Health Organization’s (EHO) health system and the government health system. Both stakeholders are discussing unification of the health systems, but there is no consensus on how to achieve this.
-The study aims to shed light on obstacles to unifying the parallel health systems
-To explore the experiences of health workers in the ethnic health system and understand their perspectives
-An analytical framework was developed and revised based on discussions with authors and Back Pack Health Worker Team (BPHWT) staff.
-Triangulation of data sources was used, including interviews, BPHWT annual reports, and MoH official documents.
-The current situation in Kayin State, Myanmar is considered “fragile” situation due to an unstable ceasefire and lack of political agreement.
-There is a significant lack of trust between ethnic health workers and the central government health system.
-The National Health Plan (NHP) is not fully implemented in some ethnic areas, making it difficult to provide comprehensive healthcare services in conflict-affected regions.
-Ethnic health organizations want a federal political system where the health system is devolved, equitable, and accessible to all ethnic people.
-The integration of the ethnic health system with the MoH is dependent on the progress of the peace process in Myanmar.

I hope this gist can help if someone didn’t have a chance to join the Zoom meeting.

Here are my two discussion points.

1) The paper discuss about health convergence between MOH and EHOs, in other words, health as a bridge for peace. Health is a bridge for peace paper (http://dx.doi.org/10.1136/bmjgh-2022-010577) suggest that health can be a catalyst for peace, do you think it is possible?

2) Health Information Management Systems have various sub-categories like Logistic Management Systems, Clinical Decision Support Systems and Human Resource Management Systems, in Myanmar current context and resource envelope it is impossible to invest in every category. Where should Myanmar start?

[PREUT ASSAWAWORRARIT]

Please allow me to express my opinion. Health as a bridge for peace is very difficult but it is possible. To do so, the policy in public health of the government and EHO/CBHOs should be mostly similar. In addition, decentralization of MoHS should be conducted, so it can encourage health workers from different organization to work together. Collaboration between EHO/CBHOs and MoHS have to maintain and entrust that the primary benefit is good health of people. If the collaboration is sustained for few years, collaboration in other fields between the government and public sectors can be established. Later, peace is possible.

For health information management systems, Myanmar should start with logistic management system because it can increase efficacy of logistic. The system can summarize what, when, where, and how the device and medication to be delivered. For example, repetitive logistic frequently occurred if we use the conventional logistic. A messenger has to carry drugs from the same pharmaceutical counter to the same wards with consecutive laps. After implement the system, the similar route at the same time can be included in one lap. Moreover, urgent medication can be delivered with first priority.

[Zarni Lynn Kyaw]

Dear Preut,

Thanks for your ideas. I like them. Regards to Health as a bridge for peace, I also think it is very possible, with a lot of Myanmar public eager for a federal systems, if there is cessation of conflicts soon, we should be able to start a dialogue for decentralization. I hoped the 2021 Military coup won’t have much permanent demages.

For HIS, I think one comment during the Zoom call suggest to focus on HR, but I think both HR and LMIS are important. According to the World Bank survey, Myanmar waste 10% to 20% of our health budget on inefficiencies, medical wastes is in the top 3 cause. So, investing in LMIS will be critical.

So, thanks for your comments.

[Author]

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