ReBUILD for Resilience is an international consortium focused on examining health systems in fragile settings experiencing violence, conflict, pandemics and other shocks. The consortium of which Burnet Institute Myanmar are a part is led by Liverpool School of Tropical Medicine with research directorship shared with the Institute for Global Health and Development.

As a ReBUILD for Resilience partner, Burnet Institute draws on its extensive regional network of research collaborators across Asia to help disseminate the lessons learned during the 2011-19 ReBUILD for Resilience program. Find out more here.

Community and health system stressors and coping mechanisms during COVID-19: case study from Myanmar

Partners: Burnet Institute Myanmar and Queen Margaret University

This study aimed to understand the lived experiences of linked communities and primary care-level health workers in the context of the COVID-19 pandemic and to contribute to the resilience of the health system in responding to COVID-19.

Insein was chosen because of its high COVID-19 caseload and its response in the early phase of the pandemic (eg the closure of a private hospital and high transmission via close community gatherings).

The gendered experience of close-to-community providers in fragile and shock-prone settings: implications for policy and practice during and post COVID-19

Partners: Liverpool School of Tropical Medicine, HERD International, American University of Beirut, Burnet Institute Myanmar and COMAHS

COVID-19 is has markedly affected our FASP study settings of Lebanon, Nepal, Myanmar and Sierra Leone. Close-to-community (CTC) providers are part of the response to the pandemic in these settings. However, there are evidence gaps, including how policy and practice (eg support structures) have adapted to the realities of the COVID-19 pandemic, and the CTC providers’ experiences during the pandemic and how these are gendered.

This study explored the roles of CTC health care providers and their gendered experiences during the COVID-19 pandemic FASP settings. We conducted document reviews, interviews with CTC providers and key informants in Lebanon, Nepal, Myanmar and Sierra Leone.

This study contributes evidence on gender equitable approaches to supporting CTC providers in FASP contexts to fulfil their vital roles in the COVID-19 response and future disease outbreaks and shocks.

Health systems resilience in fragile and shock-prone settings through the prism of gender, equity and justice: implications for research, policy and practice

Fragile and shock-prone settings (FASP) present a critical development challenge, eroding efforts to build healthy, sustainable and equitable societies. Power relations and inequities experienced by people because of social markers, eg gender, age, education, ethnicity, and race, intersect leading to poverty and associated health challenges.

Concurrent to the growing body of literature exploring the impact of these intersecting axes of inequity in FASP settings, there is a need to identify actions promoting gender, equity and justice. Gender norms that emphasise toxic masculinity, patriarchy, societal control over women, and a lack of justice are unfortunately common throughout the world and are exacerbated in FASP settings. It is critical that health policies in FASP settings consider gender, equity and justice and include strategies that promote progressive changes in power relationships.

ReBUILD for Resilience focuses on health systems resilience in FASP settings and is underpinned by a conceptual framework that is grounded in a broader view of health systems as complex adaptive systems (more on the framework and its components here). The framework identifies links between different capacities and enables identification of feedback loops which can drive or inhibit the emergence and implementation of resilient approaches.

We applied the framework to four different country case studies (Lebanon, Myanmar, Nepal and Sierra Leone) to illustrate how it can be inclusive of gender, equity and justice concerns, to inform future research and support context responsive recommendations to build equitable and inclusive health systems in FASP settings.


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