Title: Health system resilience in karenni/ kayah state : Exploring the role of local interim health services
Author: Miss Khin Sabai Aung
Year: 2024
Keywords: Health System Resilience, Karenni State, Local Interim Health Services, Myanmar, Kayah State
Theme: Health
Advisor(s): Khathaleeya Liamdee
The full thesis available here.
Abstract: This thesis examines health system resilience in Karenni (Kayah) State, Myanmar, by analyzing how local interim health services sustain care delivery, adapt to conflict, and ensure continuity within a fragile and liminal governance context. Guided by the Health System Resilience (HSR) framework, the study draws on semi-structured interviews with doctors, midwives, and a representative from the Karenni Interim Executive Council (IEC). Findings reveal that Karenni’s health system demonstrates absorptive, adaptive, and emerging transformative capacities. These capacities are primarily driven by morally committed individuals and grassroots collectives operating in the aftermath of state collapse.Rather than functioning in isolation, the health system operates in a liminal space where informal peer networks and nascent formal governance structures coexist and negotiate authority, legitimacy, and coordination. Health workers have assumed leadership roles, provided advocacy, and managed care delivery under insecure and resource-constrained conditions. Their work is enabled by strong social capital, including trust-based relationships, community recognition, and collaboration with external actors.The study highlights how decentralized professionalism allows frontline actors to integrate healthcare provision with governance, improvising new institutional forms where formal systems are absent. It argues that while resilience is evident, the long-term sustainability of Karenni’s health system depends on addressing critical tensions between autonomy and coordination, informality and formalization, and flexibility and institutional development. These findings contribute to broader understandings of health system resilience in conflict-affected and fragile settings, particularly where alternative governance is emerging from the ground up