Spurred by ongoing peace negotiations in many ethnic areas of Burma, the BPHWT, other health community-based organizations (CBOs) and ethnic health organizations (EHOs) have been working together to converge the extensive community-based/border-managed (administrative offices in Thailand) health system with the Burma government’s health system in order to provide better healthcare, access more of the population, improve health systems and policy, and gain government recognition of community-based border-managed health programs and workers. Over the past decade, the government of Burma has spent less than 3% of its national budget annually on healthcare and as a result, the healthcare system is rather inadequate, particularly in rural areas. In contrast, over the last twenty years, international aid agencies and donors have invested heavily and successfully in building the capacity and network of the community-based/border-managed health system.
In concert with the ongoing ceasefire and peace negotiations between the Burma Government and the Ethnic Armed Resistance Organizations (EAROs), various ethnic health community-based organizations (CBOs), including the BPHWT, and ethnic health organizations (EHOs) have been working together to converge the extensive community-based/border-managed health system with the Burma Government’s health system in order to provide better health care, access more of the population, improve health systems and policy, and gain government recognition of community-based border-managed health programs and workers. To coordinate this process from the EHOs’/health CBOs’ perspective, the Health Convergence Core Group (HCCG) was formed in May 2012. The HCCG has eight EHO and health CBO member organizations:
Back Pack Health Worker Team (BPHWT)
Burma Medical Association (BMA)
Karen Department of Health and Welfare (KDHW)
Karenni Mobile Health Committee (KnMHC)
Mae Tao Clinic (MTC)
Mon National Health Committee (MNHC)
National Health and Education Committee (NHEC)
Shan Health Committee (SHC)
The HCCG aims to prepare existing community based health networks inside Burma/Myanmar for future possibilities to work together with Union and state/region government health agencies, ethnic authorities, international donors, international non-governmental organizations (INGOs), civil society organizations, and EHO/health CBOs. To guide its work, the HCCG has adopted the following principles related to health convergence:
- Current health services, which are based on the primary health care approach, must be maintained and expanded.
- The role and structure of the EHOs must be maintained.
- Communities and community-based health organizations must be involved in the decision-making process and the implementation of health care services in the Ethnic States.
- INGOs must cooperate with local CBOs and EHOs by promoting their roles and capacity.
- Health care programming should not create conflict among the community and between the health care providers.
- Development of a national health policy and system should be according to the framework of a Federal Union.
- Health programming and policy should complement and support the federal aspirations of the ethnic peoples throughout the peace process.
- Any acceptance of health-related humanitarian and development aid must be in line with the existing health infrastructure that has been established by EHOs and CBOs.
- The implementation of any health activities in ethnic areas should have approval from the local ethnic health organizations.
Within this context, the BPHWT has hosted and participated in a number of HCCG activities in Mae Sot including Health HCCG Strategy Meetings with its members and Health Program Convergence Seminars which focus upon collaborative primary healthcare activities between the EHOs/health CBOs, local CBOOs inside Burma, and Burma Government health agencies..
Additionally, some HCCG members, including the BPHWT, have met with officials from the Union and Karen State Ministries of Health. At these meetings, the HCCG members spoke to the concept of convergence, recognition of ethnic health workers and infrastructures, procurement strategies, health data sharing, possible health collaborative activities, and national health protocols.
Also during 2013, the BPHWT collaborated with a Pa An-based CBO and retired government Township Medical Office Nursing Matrons to provide two Auxiliary Midwife (AMW) trainings for trainees from three Burma Government-controlled townships in Karen State: Hlaingbwe, Kawkareik, and Pa An. The AWM training consists of four months of classroom theory and three months of clinical internships/training at the Mae Tao Clinic in Mae Sot, Thailand. Following the clinical internships/training, the new AMWs are sent back to their respective communities in Burma Government-controlled townships to implement a Maternal and Child Healthcare Pilot Program planned by the BPHWT. There were 20 participants at each of these AMW trainings
As mentioned earlier, the health convergence initiative works in concert and supports the ceasefire and peace negotiations between the Burma Government and the EAROs. They also serve as a “Bridge for Peace” and a confidence building measure. However, while supporting these negotiations, the movement and timing of health convergence entails certain real risks to ethnic health workers and infrastructures should the negotiations breakdown and fighting resume. The temporary ceasefire agreements are breaks in the offensive military fighting to see if there are common grounds for negotiations among the parties. Hopefully, these negotiations will move to a next stage of a more nationwide ceasefire whereas the parties have agreed that there are genuine common grounds for negotiations and that there should be framework implemented for political dialogue, military code of conduct, and international monitoring of the terms of such a ceasefire agreement. At this stage, the risks to the ethnic health workers and infrastructures will be somewhat lessen and more comprehensive health convergence activities can be undertaken.
The following diagram attempts to depict a parallel process where the timing and direction of primary health care convergence is dependent upon the timing and direction of the power-sharing political negotiations between the Burma Government, EAROs, and domestic political parties. Within this IF>Then structure, primary health care convergence would expect to follow the following path:
IF there are Temporary Ceasefire Agreements > THEN Joint and Collaborative Primary Health Care; IF there is a National (Permanent) Ceasefire Agreement > THEN Complimentary Primary Health Care; and IF there is National Peace Agreement > ONLY THEN will there be Integrated Primary Health Care
The diagram’s slopes reflect positive changes in the direction of primary health care convergence. A key component of any positive movement toward primary health care convergence is that the slope of the Burma Government moves toward the changed slope of the ethnic health groups with an appropriate decentralization of political decision-making and responsibilities, and administrative and financial authority and responsibilities. INGOs can assist with this hoped-for-change in the primary health care convergence activities of the Burma Government by encouraging and otherwise supporting the further movement of health authority and responsibilities down to lower levels of government. Thus, INGOs can be partners with the Burma Government and the ethnic health groups in building this “Health Bridge for Peace”. Primary health care convergence can only be successful if it is mutual.