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

ABSTRACT

OBJECTIVE: The 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 SETTING: This 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. PARTICIPANTS: The 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. RESULTS: Key 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. CONCLUSIONS: This 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.