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FIVE lessons from my thesis: possibilities for transformation of the Tai health system in Shan State

Sharon Bell, a PhD Candidate at Massey University, New Zealand, is researching the partnership between a small INGO and a non-state armed group to develop an ethnic health system in Shan State, Myanmar.

A lack of state healthcare provision and ongoing conflict has led to extremely poor health outcomes in many parts of Myanmar. My research aims to understand what it looks like when an international non-governmental organisation partners with a non-state armed group to help them develop an ethnic Tai/Shan health system.

I conducted a case study of a healthcare training program run by a small INGO, where Tai people live on the Thai-Myanmar border for eight months to train as medics. They return to their rural communities - often as the only healthcare workers. I offer five lessons about the possibilities for transformation of the Tai health system through the relationship between the INGO and armed group. As you might expect, there is a mixed bag of positive and negative lessons.

1. The Tai medics’ capabilities increase through the training program and this has very positive impacts in their rural communities. They told many stories of life saving healthcare that they had provided. They also reported improved confidence in their own medical skills along with greater community trust in them.

2. But more transformation of the health system could happen if a less technocratic approach was taken by the expatriate doctors who run the program. Many of the trainee medics have received little formal schooling so struggle with the Western-context resources. The INGO should use training resources developed specifically for low resource, low education contexts.

3. The INGO’s staffing is based on using expatriate volunteers. This volunteerism model is a problem when volunteers are selected primarily on the basis of their availability, and not their ability and skills match for this specific context.

4. The partnership between the INGO and the non-state armed group is highly valued by both parties. It helps to ensure that the Tai health system reaches communities that the government doesn’t. Importantly, it also supports Tai desires to see the health system decentralised to their control.

5. Partnering with a non-state armed group is not a perfect solution as there are many negatives in trying to establish a civilian health system within the parameters of military structures. But this is better than rural communities receiving no healthcare at all.

The healthcare training programme operates within a complex context - with conflict continuing in many areas. There has been a shift in international funding away from cross-border work to working with the government and NGOs inside Myanmar. The Tai organisation reports that the reduction in funding has had a negative impact on its capacity, including having to cut the evaluation of its health clinics.

However, there remain possibilities for transformation while this particular INGO continues to support Tai desires to develop their own health system. I welcome your feedback on these lessons.

Photo S Bell

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