Partners: Burnet Institute Myanmar, Queen Margaret University & Liverpool School of Tropical Medicine, UK
This study aims to explore the changing role that non-state actors have played and currently play in the delivery of health services in the shifting political, security and socio-economic environment of Myanmar, both retrospectively (2015-20) and prospectively (2021-22). The specific focus is in understanding how service delivery organisations (including delivery modes, disease/service focus, funding, etc.) havev been adapted/transformed to respond to shocks and changing circumstances, and what are the consequences, in terms of accessibility, equity and quality of services, but also on the broader health system resilience.
Myanmar is one of the most fragile and conflict-affected countries in Southeast Asia region. Almost since independence in 1948, unrest and civil wars have been happening in the country, involving numerous ethnic groups. In 2000, local non-governmental organisations (NGOs) and Civil Society Organisations (CSOs) and international NGOs started to directly provide and support/fund health services in central Myanmar and ethnic-controlled border areas. At the same time, in the border areas controlled by Ethnic Armed Organisations (EAOs), the Ethnic and Community-Based Health Organisations (ECBHOs) were established to address gaps in health service provision and fulfill the health needs of populations in the non-government-controlled areas. Overtime, they developed their own health system and in the period from 1990 to 2000, due to sanctions to the Myanmar government, international funding to the health sector often flowed to ECHBOs close to the borders. External support and the engagement of the international community further increased following the hit of Cyclone Nargis in 2008 and with the establishment of a civilian government in 2010. During this period, government and ECHBOs started engaging with the aim of bringing together the separate health systems. However, progress has been slow and then halted by the military coup in early 2021.
Given the prominent role that non-state actors (which include INGOs, NGOs, CSOs and ECBHOs) had for health service delivery in Myanmar for marginalised groups during the different crises, it is important to better understand their changing role(s) over time in the shifting political, security and socio-economic environment and how this affects service delivery and health system resilience.