Conflict affected, parallel health systems: challenges to collaboration between ethnic and government health systems in Kayin State, Myanmar
| Autor: | Barry Munslow, Colette Pang Biesty, Aung Ja Brang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Kayin/Karen state Health (social science) 020205 medical informatics Ethnic group Context (language use) 02 engineering and technology Myanmar 03 medical and health sciences 0302 clinical medicine Political science Universal health coverage 0202 electrical engineering electronic engineering information engineering medicine Devolved healthcare 030212 general & internal medicine Accreditation Government Indigenous health business.industry RC86-88.9 Research Public health Ethnic health system Public Health Environmental and Occupational Health Health services research RC952-1245 Medical emergencies. Critical care. Intensive care. First aid Access to healthcare Public relations Health as a bridge to peace Special situations and conditions Political system Health system strengthening business Qualitative research |
| Zdroj: | Conflict and Health, Vol 15, Iss 1, Pp 1-17 (2021) Conflict and Health |
| ISSN: | 1752-1505 |
| Popis: | Background Myanmar has had a long history of civil wars with its minority ethnic groups and is yet to see a sustainable peace accord. The conflicts have had a significant impact on health in Myanmar, with ethnic populations experiencing inequitable health outcomes. Consequently, to meet the health needs of ethnic people, Ethnic Health Organisations and Community-Based Health Organisations (EHO/CBHOs) created their own health system. The EHO/CBHO and Government health systems, provided by the Myanmar Ministry of Health and Sports (MoHS), remain parallel, despite both stakeholders discussing unification of the health systems within the context of ongoing but unresolved peace processes. EHO/CBHOs discuss the ‘convergence’ of health systems, whilst the MoHS discuss the integration of health providers under their National Health Plan. Methods A qualitative study design was used to explore the challenges to collaboration between EHO/CBHOs and the MoHS in Kayin state, Myanmar. Twelve health workers from different levels of the Karen EHO/CBHO health system were interviewed. Semi-structured, in-depth interviews were digitally recorded, transcribed, and coded. Data was analysed thematically using the Framework method. Topic guides evolved in an iterative process, as themes emerged inductively from the transcripts. A literature review and observation methods were also utilised to increase validity of the data. Results The challenges to collaboration were identified in the following five themes: (1) the current situation is not ‘post conflict’ (2) a lack of trust (3) centralised nature of the MoHS (4) lack of EHO/CBHO health worker accreditation (5) the NHP is not implemented in some ethnic areas. Conclusions Ultimately, all five challenges to collaboration stem from the lack of peace in Myanmar. The health systems cannot be ‘converged or ‘integrated’ until there is a peace accord which is acceptable to all actors. EHO/CBHOs want a federal political system, where the health system is devolved, equitable and accessible to all ethnic people. External donors should understand this context and remain neutral by supporting all health actors in a conflict sensitive manner. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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