Partnerships for Universal Health Coverage in Myanmar: Power and Politics within ‘Immunisation Encounters’ in Kayah State and Kayin State

Abstract

The Sustainable Development Goals (SDGs) emphasise the importance of partnerships in achieving targets like Universal Health Coverage. But how can partnerships between non-state and state actors be established, and what development and political ramifications might they have, within protracted conflict situations? In Myanmar’s Kayah State and Kayin State, decades-long conflict resulted in parallel health systems operating under Ethnic Armed Organisations. In recent years, non-state and state health workers in both areas have forged partnerships to implement an Expanded Programme on Immunisation (EPI). These endeavours demonstrate that partnerships are permeated with power relations and development programmes can become the site of political struggles in contested states. Linking national development plans with the SDGs can enhance non-state actors’ positions in contexts where state and international actors have limited implementation capacity. Comparing Kayah State and Kayin State EPI activities demonstrates the importance of recognising political dynamics of partnerships in conflict situations. In Kayah State, when non-state actors were not recognised as leaders of development in their areas, EPI activities had negative impacts, fuelling local grievances. Conversely, in Kayin State, when state and international actors acknowledged political sensitivities and empowered non-state actors, EPI activities built a ‘working encounter’ with positive development and peacebuilding outcomes.