Health Convergence

The health convergence initiative began in May 2012 with the establishment of the Health Convergence Core Group (HCCG), consisting now of nine ethnic health organizations (EHOs) and community based health organizations (CBHOs):

• Back Pack Health Worker Team (BPHWT)
• Burma Medical Association (BMA)
• Chin Public Affairs Committee (CPAC)
• Karen Department of Health and Welfare (KDHW)
• Karenni Mobile Health Committee (KnMHC)
• Mae Tao Clinic (MTC)
• Mon National Health Committee (MNHC)
• Pa Oh Health Working Committee (PHWC)
• Shan State Development Foundation (SSDF)

HCCG Aims

• Prepare existing border-/Burma-based EHOs/CBHOs, for future possibilities to work together with Union and state/region government health agencies, ethnic authorities, international donors, INGOs and CSOs.
• Explore policy options for achieving the convergence of ethnic health networks with the health system of the Burma government through political dialogue. The HCCG defines “health convergence” as the systematic, long term alignment of government, ethnic, and community-based health services.

Two key partners with the HCCG in convergence are the Health Information System Working Group (HISWG) and the Ethnic Health System Strengthening Group (EHSSG).

The HISWG was established in 2002 and complements convergence coordination, cooperation, and alignment through the provision of key data, analysis, and reports about the ethnic health system to support planning and decision making.

HISWG Member EHOs/CBHOs

• Back Pack Health Worker Team
• Burma Medical Association
• Chin Public Affairs Committee
• Karen Department of Health and Welfare
• Karenni Mobile Health Committee
• Mae Tao Clinic
• Mon National Health Committee
• Shan State Development Foundation

The EHSSG emerged in 2015 and its activities also complement convergence coordination, cooperation, and alignment through the enhancement of the key building blocks of the ethnic health system:

• Leadership and Governance
• Health Information System
• Health Workforce
• Health Financing
• Access to Essential Medicine, Medical Supplies and Medical Technology
• Service Delivery

EHSSG Member EHOs/CBHOs

• Back Pack Health Worker Team
• Burma Medical Association
• Karen Department of Health and Welfare
• Karenni Mobile Health Committee
• Mae Tao Clinic
• Pa Oh Health Working Committee
• Mon National Health Committee
• Shan State Development Foundation

All three of these organizations support the ethnic health system which has been providing healthcare services to the ethnic people in Burma and migrants/refugees in Thailand for thirty years. This system is vast in its scope and size:

•  675,000 served population
•  10 of 14 states/regions of Burma (46/330 townships)
•  Thai border provinces
•  4,400 health workers (Burma)
•  Mobile health teams and fixed health clinics
•  Curative, preventative, promotive, rehabilitative, and palliative health services

Furthermore in understanding convergence, it is important to note that while health is not political, health convergence is political because:

• The EHOs/CBHOs provide primary health care in the EAO-controlled areas.
• The EAOs are engaged in negotiations for “political convergence”.
• The health convergence progress is dependent upon the political convergence progress.
•  A new devolved federal health system requires an amendment to add devolved health political, administrative, and fiscal authorities and responsibility to Schedule 2 – Region/State Legislative List of the 2008 Constitution.
• The health system of the NLD government, envisioned in the National Health Plan, is a deconcentration/delegation model, not a devolved model sought by the EHOs/CBHOs and in line with the federalism political aspirations of the ethnic people.

The Burma Government views the EHOs/CBHOs, in a reformed Burma health sector, as integrated into the deconcentrated Union health system of the Burma Government or a separate healthcare service provider with delegated services provision responsibilities. In stark contrast, the EHOs/CBHOs do not agree that health convergence is integration into a Burma Government centralized, deconcentrated, or delegated health system, but is the creation of a new devolved health system of a Federal Union of Myanmar. In this latter respect, the following chart matrix presents a possible devolved health system authority/responsibility model, for illustration purposes, toward which the health systems of the Burma Government and the EHOs/CBHOs could converge under a Federal Union of Burma:

Draft Devolved Health System of a Federal Union of Burma/Myanmar

Moreover with Universal Health Coverage (UHC), the EHOs/CBHOs agree on the UHC concept, a basic essential package of health services (EPHS), importance of data sharing to inform health planning, and the inability of the Burma Government to implement UHC by itself, especially in the ethnic service areas. Yet, the EHOs/CBHOs do not agree that political decision  making, administrative control, and pooling/purchasing for UHC and the health sector in general  should be at the Union level; only overall  UHC/health sector policy making may be at the Union level in consultation with the state/region governments. Otherwise, primary health authority and responsibility should be at the state/region level. Thus as with the two parallel health systems, there are two different roads to the same destination of UHC.

Key current health convergence issues are:

• Political Convergence:

– The two 21^st Century Panglong Union Peace Conferences, Step Three of the Burma Government’s Seven Step Roadmap, has yet to produce meaningful results toward peace and national reconciliation.

–  The Burma Army continues use force to bring about peace with the ethnic people with active fighting in Kachin, Shan, Arakan, and Chin States.

• Funding of the EHOs/CBHOs:

–  Some major international donors have withdrawn/reduced financial support from the EHOs/CBHOs to work with the Burma Government by funding and implementing Burma Government-approved health programs.

• Registration of the EHOs/CBHOs:

–  EHOs/CBHOs are not officially registered in Burma.

– Imprisonment for those who meet or aid such illegal organizations and an impediment to collaborations between official bodies in Burma and the EHOs/CBHOs.

–  Restricts funding opportunities for many EHOs/CBHOs.

– But, registration reporting requirements may endanger ethnic health workers.

• Recognition and Accreditation:

–  EHOS/CBHOs are not recognized as health organizations by the Burma government and subject to violations of the medical regulations/ laws of Burma.

– Health workers of the EHOs/CBHOs are not accredited as health workers by the Burma government and subject to arrest/detention.

In conclusion, the following about health convergence are important:

• Health convergence is political and directed associated with, and dependent upon, the peace process.
• The situation in ten of the fifteen administrative states/regions/territories is not post-conflict, but ceasefire/conflict. Thus, peace and national reconcilement in Burma is not seen as happening in the near term. Thus, the convergence of the health system of the Burma Government and that of the EHOs/CBHOs into a new health system will not realistically occur until that time.
• The ethnic people want a devolved health system in a Federal Union of Burma.
• Universal Health Coverage is also the goal of the EHOs/CBHOs through their community-based health system and ultimately through a devolved federal health system with primary health authority and responsibility at the state/region level.
• The ethnic health system is vast.
• Continued funding of the EHOs/CBHOs, EHO/ CBHO registration and recognition, accreditation of EHO/CBHO health workers, and political convergence (i.e., sustainable peace in Burma) are critical issues in the health convergence process.