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THIS PAPER REVIEWS AN IMPORTANT CONTEMPORARY TREND IN NATIONAL HEALTH POLICY: THE MARKET REFORM STRATEGY. THE STRATEGY IS BASED ON THE PRESUMPTION THAT THE FEDERAL ROLE IN HEALTH AFFAIRS FOR MANY YEARS HAS BEEN ESSENTIALLY PERVERSE. ONLY WHEN ENTRENCHED PRIVILEGE IS REMOVED AND HEALTH CARE PROVIDERS ARE FORCED TO COMPETE WILL TRUE ECOMIC SOVEREIGNTY BE RESTORED TO THE HEALTH CARE CONSUMER.

Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).

Frontmatter -- CONTENTS -- PREFACE -- ACKNOWLEDGEMENTS -- LIST OF ABBREVIATIONS -- LIST OF TABLES, FIGURES AND BOXES -- ABSTRACT -- EXECUTIVE SUMMARY -- AUTHORS' NOTE -- 1. Introduction -- 2. Organization and governance -- 3. Financing -- 4. Physical and human resources -- 5. Provision of services -- 6. Principal health reforms -- 7. Assessment of the health system -- 8. Conclusions -- 9. Appendices -- INDEX

Abstract
Background
Myanmar has had a long history of civil wars with its minority ethnic groups and is yet to see a sustainable peace accord. The conflicts have had a significant impact on health in Myanmar, with ethnic populations experiencing inequitable health outcomes. Consequently, to meet the health needs of ethnic people, Ethnic Health Organisations and Community-Based Health Organisations (EHO/CBHOs) created their own health system. The EHO/CBHO and Government health systems, provided by the Myanmar Ministry of Health and Sports (MoHS), remain parallel, despite both stakeholders discussing unification of the health systems within the context of ongoing but unresolved peace processes. EHO/CBHOs discuss the 'convergence' of health systems, whilst the MoHS discuss the integration of health providers under their National Health Plan.

Methods
A qualitative study design was used to explore the challenges to collaboration between EHO/CBHOs and the MoHS in Kayin state, Myanmar. Twelve health workers from different levels of the Karen EHO/CBHO health system were interviewed. Semi-structured, in-depth interviews were digitally recorded, transcribed, and coded. Data was analysed thematically using the Framework method. Topic guides evolved in an iterative process, as themes emerged inductively from the transcripts. A literature review and observation methods were also utilised to increase validity of the data.

Results
The challenges to collaboration were identified in the following five themes: (1) the current situation is not 'post conflict' (2) a lack of trust (3) centralised nature of the MoHS (4) lack of EHO/CBHO health worker accreditation (5) the NHP is not implemented in some ethnic areas.

Conclusions
Ultimately, all five challenges to collaboration stem from the lack of peace in Myanmar. The health systems cannot be 'converged or 'integrated' until there is a peace accord which is acceptable to all actors. EHO/CBHOs want a federal political system, where the health system is devolved, equitable and accessible to all ethnic people. External donors should understand this context and remain neutral by supporting all health actors in a conflict sensitive manner.

Introduction. In the European Union three different health systems could be defined according to service delivery, financing, and economic policies: Beveridge, Bismarck and Mixed system. Although health systems are hardly to compare, various organizations are developing methods assessing performance. In the present work we evaluated the performance of the three systems using European Community Health Indicators according to Organization for Economic Cooperation and Development. Methods. We conducted our study among the 28 states of the European Union using the following indicators: Standardized death rate for diseases of the circulatory system, standardized death rate for malignant neoplasms, road traffic accidents with injury, life expectancy at birth, incidence of Human Immunodeficiency Virus (HIV), infant deaths, pure alcohol consumption, infants vaccinated against Diphtheria Tetanus Pertussis (DTP), public and total expenditure on health over the period 2001-2010. Results. The variation of health indicators shows similar trend of circulatory system diseases and malignant neoplasms death rates, road accidents with injury, infant deaths, life expectancy at birth, public and total health expenditure. Some differences in the trend of HIV incidence, alcohol intake and DTP vaccination rates arise among systems. Grouping countries by health system paradigm and geographical area, resulted in a relevant heterogeneity (I2≥90%, Pvalue<0.0001). No clear superiority of a given health delivery system was found with respect to other paradigms. Conclusion. In accordance with the evidence of our study, we can suppose that best performances are more likely to be linked to country specific economic factors. In conclusion, it was not possible to identify the best health system model

SummaryThe World Health Organization (WHO) introduced the concept of stewardship to clarify the practical components of governance in the health sector. For the WHO, stewardship concentrated on how government actors take responsibility for the health system and the wellbeing of the population, fulfill health system functions, assure equity, and coordinate interaction with government and society. This article overviews the contents of this special issue, which offers examples of how health stewards in a variety of countries have addressed issues of health security, primary care expansion, family planning, and quality of care. The contributors' articles draw lessons for policy, programs, and management useful for practitioners and scholars. Our overview identifies several themes emerging from the articles: the foundational role of legal frameworks for effective stewardship, the importance of institutional arrangements as enablers, the influence of regional and global entities on national stewardship, the connection between credible decision‐making structures and stewardship, and pathways to sustainable financing and domestic resource mobilization. The discussion concludes with highlighting several gaps in knowledge and practice related to health stewardship.