Topic Discussion 1 : Improving health system

[Wirichada Pan-ngum]

Please providing an example of health system improvement in any health setting and discuss the possible barriers that could occur in that system improvement process. (10 Marks)

[Wannisa Wongkamchan]

The “Cancer Anywhere” policy is an important example of healthcare system improvement in Thailand. Its main goal is to help cancer patients with the Universal Coverage Scheme (UCS) get quick, complete, and free treatment. Patients can receive treatment in hospitals across provinces with the necessary capabilities without needing a referral. Technology like the Cancer Anywhere application and the TCB Plus system is used to manage patient information and make transfers easier. Additionally, The One program is used to book specific medical equipment, such as radiotherapy machines or MRI scans.

However, while the policy has good intentions, its implementation still faces many challenges. These can be analyzed using the WHO Framework: The Six Building Blocks:

1. Service Delivery
Services still face long waiting times, especially at large hospitals like medical schools, as patients trust their quality of care. Hospitals in rural areas often lack equipment and specialized doctors. Better distribution of patients and upgrading community hospitals can help reduce overcrowding.

2. Health Workforce
Specialized medical staff, such as oncologists and radiologists, are limited and mostly concentrated in urban areas. Current staff also face heavy workloads, which may affect care quality. Training staff at community hospitals to provide basic cancer care is essential.

3. Health Information Systems
While the Cancer Anywhere application is helpful, data sharing between hospitals is not yet complete. This causes delays, and patients still rely on referral documents. A fully integrated digital health system across the country is crucial.

4. Access to Essential Medicines
Budgets for cancer drugs and related treatment costs are insufficient, forcing some hospitals to cover expenses themselves. Centralized purchasing can help reduce costs and improve fairness in drug access.

5. Financing
Although patients do not have to pay, the complex reimbursement system and insufficient budgets cause financial problems for many hospitals. Improving clarity and efficiency in payment systems is necessary.

6. Leadership and Governance
Frequent changes in treatment and reimbursement policies create confusion among patients and healthcare workers. Proactive communication and establishing a national management committee could help reduce problems and improve project oversight.

In conclusion
The “Cancer Anywhere” policy is a positive effort to improve cancer care in Thailand. However, its success depends on solving key issues, such as distributing patients more evenly, increasing staff and equipment, improving data systems, and allocating sufficient budgets. If these challenges are addressed, Thailand’s healthcare system can advance and better meet the needs of its people.

References:
– https://thaicancersociety.com/rights-to-health-care/cancer-anywhere/
– https://www.hfocus.org/content/2025/01/32695 

[Cing Sian Dal]

Providing free treatments for cancer patients under the UCS is the first significant step towards healthcare equity.

Regarding the long waitlist, I think that prioritizing case by case (urgent cases) would be a fair system rather than a first-come-first-served order. Or, it means that more specialists are demanding.

I agree that there should be a nationally monitored committee for this, and simplifying policies promotes trust and reliability while complicating policies is deceitful.

[Siriluk Dungdawadueng]

Thank you for your sharing. Your explanation of Thailand’s “Cancer Anywhere” policy showcases its innovative design for delivering comprehensive cancer care. I fully concur that, while the policy promotes greater accessibility and equity, significant operational hurdles persist. Addressing these through better resource allocation, improved data sharing, and stronger leadership will be crucial for long-term success.

[Wirichada Pan-ngum]

Good and up to date example for Thailand.

[Cing Sian Dal]

As an example, let’s assume that a non-government organization (NGO) manages public health programs in Chin State, Myanmar. This remote, conflict-affected region has no government health infrastructure except for the NGO. The normal data flow of health information is done by taking pictures of paper records and compiling them into different spreadsheet files, an unsustainable solution.

Now, let’s say that they are planning to launch the initiative of implementing a health information management system (HMIS), specifically, District Health Information System v2 (DHIS2). It would enable data centralization and improve disease surveillance. It provides a stable and sustainable digital solution for both under-resourced and developed communities. This avoids the need for future transitions to other health systems and ensures interoperability with various standards. This could strengthen the information and governance building blocks of the health system, enabling responsiveness and improved efficiency as its outcomes.

However, this initiative could face numerous barriers. The two major problems are financing and resources. To keep the digital system running, they must rely on either on-premises or cloud computing but also maintain the chosen infrastructure. The NGO relies on grants, creating a risk if funding ends. Resource challenges, particularly high staff turnover and the time required to recruit qualified personnel pose significant problems. Each new staff member can lead to delays in data reporting, increased data entry errors, higher training costs, and longer onboarding times.

In terms of allocative efficiency, I would only support this initiative if the inefficiencies of the current spreadsheet-based system are not an evitable problem, significantly impeding the health system’s goals.

[Wannisa Wongkamchan]

Thank you for your sharing. I think implementing DHIS2 is a promising way to improve health data management and efficiency in Chin State. As you mentioned, investing in digital systems needs a lot of resources, so it’s very important to carefully consider the cost-effectiveness and funding stability.

[Wirichada Pan-ngum]

Let’s hope the new system can work as much as possible given the situation.

[Aye Thinzar Oo]

Currently at a non-governmental organization (NGO), I am working on a health system improvement strategy that involves establishing a facility-based program within an existing clinic in a remote, conflict-affected area. This initiative aims to enhance access to healthcare, improve patient follow-up, and boost patient satisfaction. However, it has not yet fully met its objectives according to the World Health Organization’s six building blocks, which include:
• Service Delivery
• Health Workforce
• Health Information System
• Financing
• Medicine & Technology
• Leadership & Governance
Our implementation process focuses on service delivery, health workforce, and health information systems to sustainably enhance health system performance.
For service delivery, we are establishing standards for essential service packages and promoting access to these services among relevant partners utilizing the facility-based health system. Regarding the health workforce, we are identifying, providing, and supporting community health workers to deliver health services effectively. We also offer feedback on health worker performance to refine health system processes. In the health information systems, we are transitioning to a digital health system to oversee and monitor health data, facilitating informed decision-making.
To summarize, we must work on enhancing the health system using the six building block framework. However, the effectiveness of these functions relies on critical elements like service delivery, health workforce, and health information systems, while improvements in other functions are also necessary.

[Wannisa Wongkamchan]

Thank you for sharing. I think coordination across all six WHO building blocks is essential for achieving sustainable and impactful outcomes. It will enhance healthcare access and improve patient follow-up more effectively. Additionally, I agree that ensuring the quality of health data is essential for a successful digital health system.

[Siriluk Dungdawadueng]

Thank you for sharing. I agree with your assessment that, although the initiative focuses on crucial areas—service delivery, health workforce, and health information systems. There is a need for comprehensive enhancements across all WHO building blocks to fully meet objectives. Continued efforts in financing, medicine and technology, and governance will strengthen overall health system performance.

[Cing Sian Dal]

The six building blocks are useful when strengthening the health systems. As the terms explain, it is the building block, we can build it upon brick by brick / blocks by block. Of all blocks, focusing on the essentials such as service delivery is the realistic approach. In my opinion, I think that a sustainable solution needs financing to keep it up running in the long run.

[Siriluk Dungdawadueng]

Example: Implementing an Integrated Health Data Repository to Enhance Care Coordination:

A regional healthcare network, consisting of several hospitals and primary care clinics, aimed to improve care coordination and patient outcomes by consolidating patient data into a single, integrated health data repository. Previously, each facility managed electronic health records (EHRs) independently, leading to fragmented data, duplication of tests, and gaps in patient information. By creating a centralized repository with secure data-sharing protocols, clinicians across the network gained real-time access to complete patient histories, laboratory results, and care plans.

Key Components of the Improvement
• Centralized Data Integration: Aggregation of clinical, laboratory, and radiology data into one platform.
• Advanced Analytics and Reporting: Automated alerts for abnormal lab results or potential drug interactions.
• Data Governance and Privacy: Clear guidelines on data access, usage, and storage to comply with regulations, Periodic audits to ensure data integrity and security.

Possible Barriers to the Improvement Process
Interoperability and Technical Challenges
– Multiple Legacy Systems: Existing EHRs may use different standards, complicating data integration and requiring significant IT expertise.

Financial Constraints
– Implementation Costs: Upfront expenses for software licenses, data migration, and staff training can be substantial.
– Ongoing Maintenance: Regular upgrades, system monitoring, and technical support add to long-term budget needs.

Data Quality and Standardization
– Incomplete or Inconsistent Records: Poorly maintained legacy data can lead to errors or mistrust in the system if not cleaned and standardized.

Privacy and Security Considerations
– Cybersecurity Risks: Centralized repositories can be targets for cyber-attacks if not properly safeguarded.

By establishing a robust, integrated data repository and accompanying governance structures, healthcare networks can transform disjointed patient records into a unified, actionable resource. Although technical, financial, and organizational barriers can impede progress, strong leadership, comprehensive change management, and a focus on data quality can facilitate successful adoption and sustained improvement in care coordination and patient outcomes.

[Cing Sian Dal]

Your discussion is thought provoking. Although a hospital uses a health data standard while another hospital uses a different standard, then can we call it a standard? In the end, it seems to me that the universal standard is just paper format. The possible solution to a universal standard is to be enforced by the government. It should be nationally determined although it kills innovation or freedom.

[Alex Zayar Phyo Aung]

The primary goal of strengthening health systems in fragile and conflict affected settings is to build resilience which will enhance the health equity across different populations. From my experience in leading health system strengthening initiatives in fragile and conflict settings, our focus was on improving system resilience to withstand any disaster such as manmade, natural or even health threat. We adopted WHO’s Health System Strengthening framework that includes six key building blocks. Among these, leadership and governance (referred to as stewardship in Dr. Piya’s lecture) and health financing are the most significant challenges. In fragile settings, the involvement of multiple stakeholders in managing local health systems often results in system fragmentation due to political dynamics. In that case, we cannot provide “one size fit for all” approach in system strengthening and it is more resource intensive. Meanwhile, implementing health financing and revenue pooling mechanisms remains a goal far to achieve as communities struggle with financial hardships that make meeting even basic needs a challenge.

[Wirichada Pan-ngum]

Great examples from many people and some good discussions here…let’s keep going! Well done 👍

[Tanaphum Wichaita]

I think improving the healthcare system with Artificial Intelligence (AI) can enhance healthcare system. AI has the potential to improve healthcare efficiency, reduce errors, and provide faster, more accurate diagnoses.

However, one of the challenges is data privacy and ethical concerns.For example, patient records must be protected to prevent unauthorized access or misuse. Ethically, AI decisions should be fair and unbiased, ensuring that all patients receive equal treatment.

If we need good AI, we need a large amount of high-quality data to train AI models. Supercomputers and advanced computing systems are also necessary to process and analyze massive medical data. It’s important to ensure data is accurate, secure, and used ethically to gain people’s trust and make the most of AI in healthcare.

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