Progressing health equity in political transition: an analysis of the key determinants of health equity policy space, and its use, in Myanmar, 2006-2016

Myanmar has undergone significant political transition in the past decade, from military rule towards elected democracy. This research explored the premise that examining policy space for heath equity, through this transition, could provide insights into pro-equity policy-making, with potential lessons for policy-makers in Myanmar and similar contexts. The study analysed the policy space for health equity in Myanmar through 2006-2016, focussing on how different actors developed and engaged with space over time, to draw lessons and recommendations for pro-equity health policy-making in transition. A qualitative study design was used and included: (i) 29 individual semi-structured interviews with national and international policy-makers, linked to key policy initiatives and processes, over the 2006-2016 period; and (ii) a review of publicly available documents to complement interview insights. A narrative literature review on health equity in contexts with shared characteristics with Myanmar, was used to provide evidence on health equity theory and current experience and practice. Research was informed by a conceptual framework on policy space, developed from the literature. Findings showed that political transition provided an important “policy window” to develop more equitable health policy in Myanmar. Changing policy circumstances offered opportunities for advancing pro-equity policy. However, lack of visibility of health equity and long-standing inequalities were, and continue to be, important challenges to policy space. Within a changing context, actors at individual and organisational levels used a range of policy spaces to advance pro-equity health policy. Findings highlighted several key lessons for progressing health equity in political transition, which may be useful in the development of pro-equity policy in Myanmar, and other countries undergoing transition.