Evidence of health system resilience in Myanmar during Cyclone Nargis: a qualitative analysis

Abstract

ObjectiveThe aim of this study is to improve the understanding of the characteristics of health system resilience in Myanmar’s response to Cyclone Nargis and to explore ways to improve resilience at the system level.Design and settingThis is an explanatory qualitative study exploring the institutional capacity of resilience in Myanmar’s health system. Analysis proceeded using a data-driven thematic analysis closely following the framework method. This process enabled comparisons and contrasts of key emergent themes between the participants, which later generated key results describing the foundational assets, barriers and opportunities for achieving resilience in Myanmar.ParticipantsThe study comprised of 12 in-depth interviews conducted with representatives from international organisations and non-governmental organisations (NGOs). The inclusion criteria to recruiting the participants were that they had directly been a part of the Cyclone Nargis response at the time. There was a balanced distribution of participants across UN, bilateral and NGOs, and most of them were either Myanmar citizens or expatriates with extensive working experience based in Myanmar.ResultsKey findings elucidate the characteristics of resilience that have been salient or absent in Myanmar’s response to Cyclone Nargis. Strong social capital and motivation propelled by its deep-rooted culture and religion served as Myanmar’s greatest assets that filled major gaps in the system. Meanwhile, its postcolonial and military legacy posed barriers towards investing in building its long-term foundations towards resilience.ConclusionsThis study revealed that resilience in the health system can be built through strategic investments towards building the foundations of resilience to better prepare for future shocks. In the case of Myanmar, social capital and motivation, which surfaced as its foundational assets, can be channelled into opportunities that can help achieve its long-term health goals, accelerating its journey towards resilience in the health system.

Health systems resilience in fragile and conflict-affected settings: a systematic scoping review

“…Seven studies used Kruk et al’s framework in relation to either the Boko Haram armed insurgency in Nigeria, the West Africa Ebola outbreak, or Cyclone Nargis in Myanmar [ 1 , 41 , 45 – 49 ].…”

“…In FCAS legitimacy was a central theme linked to trust (or lack thereof) from the population towards public health systems [ 2 , 49 , 51 , 54 , 60 , 63 – 65 ]. Such mistrust towards governmental institutions, even when related to shocks that are not related to the conflict, was often described as rooted in the long experience of conflict and fragility, for example in West African countries affected by Ebola [ 2 , 60 , 63 – 65 ].…”

“…The health care workforce was among the most extensively discussed themes in the analysis of resilience of health systems in FCAS, as it was addressed in 31 of the 37 included studies [ 1 , 2 , 14 , 29 , 41 , 45 – 47 , 49 – 54 , 56 – 61 , 63 – 73 ]. The prominence of this theme is rooted in the explicit assumption that HCWs are the “backbone of health systems” [ 69 ].…”

What makes health systems resilient? A qualitative analysis of the perspectives of Swiss NGOs

“…As an applied research, this study builds on a health system resilience conceptual framework developed from a previous systematic review and complementary research on Myanmar [ 11 , 39 ]. This article presents empirical evidence on health system resilience through analysing the perspectives of NGOs operating in low- and middle- income countries.…”

Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis

“…1 Health system resilience is defined as the capacity to absorb external shocks and adequately and promptly adjust to respond effectively, while maintaining all essential functions, including recovering any observed losses. [18][19][20][21] Because of its geographic location, Mozambique is highly vulnerable to floods and cyclones. On March 14, 2019, category 4 Cyclone Idai hit Mozambique's central region (Zambezia, Tete, Sofala, and Manica Provinces), directly affecting 2.1 million people and causing 603 deaths, 1,641 injuries, and the displacement of 400,000 people.…”