title: Adapting to social and political transitions - the influence of history on health policy formation in the Republic of the Union of Myanmar (Burma).
abstract: The Republic of the Union of Myanmar (Burma) has a long and complex history characterized by internal conflict and tense international relations. Post-independence, the health sector has gradually evolved, but with health service development and indicators lagging well behind regional expectations. In recent years, the country has initiated political reforms and a reorientation of development policy towards social sector investment. In this study, from a systems and historical perspective, we used publicly available data sources and grey literature to describe and analyze links between health policy and history from the post-independence period up until 2012. Three major periods are discernable in post war health system development and political history in Myanmar. The first post-independence period was associated with the development of the primary health care system extending up to the 1988 political events. The second period is from 1988 to 2005, when the country launched a free market economic model and was arguably experiencing its highest levels of international isolation as well as very low levels of national health investment. The third period (2005-2012) represents the first attempts at health reform and recovery, linked to emerging trends in national political reform and international politics. Based on the most recent period of macro-political reform, the central state is set to transition from a direct implementer of a command and control management system, towards stewardship of a significantly more complex and decentralized administrative order. Historical analysis demonstrates the extent to which these periodic shifts in the macro-political and economic order acts to reset the parameters for health policy making. This case demonstrates important lessons for other countries in transition by highlighting the extent to which analysis of political history can be instructive for determination of more feasible boundaries for future health policy action.
authors.affiliation: Deakin University, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Nossal Institute for Global Health, University of Melbourne, Carlton, Victoria 3010, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Grundy
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences, Nossal Institute for Global Health, University of Melbourne, Carlton, Victoria 3010, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Annear
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences, Nossal Institute for Global Health, University of Melbourne, Carlton, Victoria 3010, Australia.
authors.forename: Shakil
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. Electronic address: babiggs@unimelb.edu.au.
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration; D006291:Health Policy; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D002052:Myanmar; D011050:Policy Making; D011057:Politics; D012922:Social Change / Q000266:history*
keywords: Burma; Health history; Health policy; Health systems; Myanmar