Bridging the Gap: Ethnic Health Organizations Present Plans of Action to Contribute to Health for All in Myanmar

On Wednesday, January 22, 2020, 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 critical 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) expressly acknowledges the crucial 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. Thousands of people in communities with little or no access to the national health system continue to rely on EHOs to 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 they serve, EHOs play vital and unique roles in delivering basic essential health services.

A key consideration for the involvement of EHOs in the rollout 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).
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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). Based on the assessment findings for each pillar, 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.

H. E. Dr. Myint Htwe, Union Minister for Health and Sports, opened the seminar. 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 and 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).
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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 hope to see increased coordination and cooperation between EHOs and the MoHS. He underlined how important it is for the future of health care in Myanmar that these relationships continue to expand and evolve.

The opening of the main section of the morning session of the seminar followed Dr. Lee’s remarks. 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 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 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, and the average population size in each catchment area. These are summarized in the table below:

Ms. Whelan’s findings illustrated the varying strengths and areas for improvement of EHOs in meeting the BEPHS’s service requirements.

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 Operations Director (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 discussed 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 implement improvements to deliver the BEPHS to the coverage areas fully.

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 also explained how development partners can help support EHOs in achieving greater autonomy as health service providers.
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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 the government and EHO HIS, the challenges encountered in developing EHO HIS, and how HIS can support progress toward 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. They discussed the significant steps 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 implementation model: 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.

​Community Partners International (CPI) organized and funded the “Health Systems Updates in Ethnic Areas of Myanmar” seminar. The Access to Health Fund (ATH), USAID, the Swiss Agency for Development and Cooperation (SDC), and CPI supported the development of the EHO Plans of Action.