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Primary Health Care (PHC) is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment (World Health Organization: WHO, 2023). The primary care system assesses how early and convenient a sick person can get treatment. It is the first level of contact between individuals and the health system.
The availability of the primary healthcare system has been widened from centralized, urban-focused to decentralized, community-driven healthcare services in Myanmar. According to Grundy & et., al. (2014), the development of primary health care began after the post-independence period extending up to the 1988 uprising political event; the second period from 1988 to 2005 is when the country launched a free market economic model, but experiencing very low levels of national health investment; the third period (2005-2012) was the first attempts at health reform and recovery including national political reform and international politics; the fourth period was during the democratic transition period (2012-2020) which increased levels of development assistance for the health sector.
Before the 2021 military coup, the primary healthcare system (PHC) of Myanmar was handled by multiple stakeholders: private (for-profit), public (non-profit), ethnic health organizations (EHOs), and international development assistance. In the areas governed by ethnic armed organizations (EAOs), PHC services are provided by EHOs.
During the COVID-19 pandemic, the people-elected democratic government formed the National-level Central Committee on Prevention, Control, and Treatment of Coronavirus Disease 2019 to strengthen governance, scale up testing capacities, and coordinate emergency responses while maintaining essential services such as maternal and child healthcare (Lin et. al., 2023). Several health interventions were implemented at the primary level during the pandemic.
According to the case study by Lin et. al. (2023),_ Scaling up COVID-19 tests: With international support, Myanmar expanded its testing capacities from around 400 tests per day in April 2020 to around 12,000 tests per day by mid-September 2020
_ Expanding public awareness: The Ministry of Health and Sports (MoHS) utilized various media platforms to disseminate information about COVID-19. Celebrities and community leaders were also engaged in public awareness.
_ Telemedicine services: Teleconsultation services were provided by private hospitals and non-profit organizations.One month before the first case was detected, the government began active surveillance, trained health providers and professionals, and pre-allocated essential medical supplies. Nevertheless, Myanmar faced a shortage of human resources. The MoHS invited volunteers with medical backgrounds and community health workers. Volunteer support was critical in ensuring families received medical assistance. Intensive care unit beds and ventilators could not be provided. Generally, challenges included a lack of human resources when needed, limited testing capacities, weak infrastructure, and insufficient medical facilities. Additionally, there was no information and health services in conflict-affected areas.
While the democratic government was trying to control the COVID wave, the military seized power on 1 February 2021. From that point on, Myanmar’s healthcare system collapsed and corrupted. The consequences in the medical sector I encountered firsthand were brutal, for example, (1) a surgeon in Yangon refused to perform a medical procedure because a 2-week-old baby and his parents came from an affected state * * without even offering a COVID-19 test * *, (2) blocking the entry of life-threatening patient to a hospital * * denying them a COVID-19 test first * *, and (3) the military forcefully seizing oxygen cylinders meant for patients from private and public hospitals through armed threats. In the face of such adversity, people managed to struggle for their lives and built support mechanisms through community empowerment and coordination.
In my opinion, just as people were able to struggle through COVID-19 with community empowerment, and just as the people continue to resist the dictatorship system and fight for freedom with their own capabilities until now, Myanmar’s collapsed healthcare sector also has many opportunities to strive to achieve basic healthcare services for the public in rural or urban, or conflict areas or wherever they live, no matter what difficulties exist.
In conclusion, Myanmar’s primary healthcare system demonstrated resilience and innovation by government and non-government organizations including community empowerment during the COVID-19 pandemic despite political unrest. Continued support in community-based healthcare infrastructure from overseas development assistance is essential for maintaining primary healthcare access and ensuring health equity in Myanmar.
References:
World Health Organization: WHO. (2023, November 15). Primary health care. https://www. who.int/news-room/fact-sheets/detail/primary-health-care
Grundy, J., Annear, P., Ahmed, S., & Biggs, B. A. (2014). Adapting to social and political transitions – the influence of history on health policy formation in the Republic of the Union of Myanmar (Burma). Social science & medicine (1982), 107, 179–188. https://doi.or g/10.1016/j.socscimed.2014.01.015
Lin, A. M. H., Tin, N., & World Health Organization. (2023). Myanmar: a primary health care case study in the context of the COVID-19 pandemic. World Health Organization. http s://iris.who.int/bitstream/handle/10665/372726/9789240058811-eng.pdf -
Please share about the work towards the UHC scheme in your country, what works and what needs to be done to make it work, and its strengths and weaknesses, for example.
Universal Health Coverage is about ensuring all people get the quality health services they need, without experiencing financial hardship (World Health Organization: WHO, 2019). Universal Health Coverage (UHC) is not a realistic statement; however, it is a powerful concept that drives responsive governments to accomplish it.Having said that, public health services are not provided for free by governments. Instead, they manage to secure the required budget through various mechanisms including national health insurance plans, tax-funded systems, and employer-based contributions. In the absence of other funding options, philanthropic health NGOs become the exclusive providers of primary healthcare.
#_ The work towards the UHC scheme
Myanmar relies on an out-of-pocket scheme. Myanmar National Plan 2017-2021, based on the UHC concept, was introduced before 2017. The plan focuses on extending access to a Basic Essential Package of Health Service (EPHS) to the entire population by 2020 while increasing financial protection (Ministry of Health and Sports, 2016). In terms of the UHC dimension, it focuses on the population with basic healthcare services while reducing out-of-pocket spending on health.
#_ What works
As a result of this plan, according to the report by The Lancet. Global health (Han et. al., 2018), coverage of health services ranged from 18.4% to 96.2% nationally, however, most indicators such as skilled birth attendance, and the institutional delivery rate fall below the 80% UHC target. In terms of quality of care and services, the progress is limited to success due to underfunded township health facilities and a lack of standardized training for ethnic health workers (Community Partners International, 2024). Regarding cost reduction, 2% were impoverished by healthcare costs while 14.6% of households faced catastrophic health payments (Han et. al., 2018).
#_ What needs to be done
As a solution, increasing funding for township-level health facilities and expanding community-based health workers (CBHWs) to rural areas could strengthen community health systems. According to the World Bank report (2017), one suggestion includes governance reform to increase accountability and eliminate inefficiencies. The Ministry of Health and Sport underspent 15.26% of its budget allocation in 2016–2017(The Ananda, 2018)._ Strength and Weakness
While this plan possesses strengths, it also exhibits weaknesses. Some of the positive impacts are (1) covering more area and more population and (2) reducing out-of-pocket expenses and eliminating financial hardship. Some of the challenges in executing the plan are: (1) lack of human resources and increased medical staff turnover rate, and (2) underfunding leading to health disparities.
However, the military coup in 2021 exacerbated weaknesses. It has devasted healthcare infrastructure leaving the population with severely limited access to basic essential healthcare. Myanmar’s UHC index declined from 52 in 2015 to 52 in 2021 (ASEANstat, 2024). The score is now anticipated to decrease significantly more than in 2021.
In conclusion, the National Health Plan (2017-2021) delivered primary healthcare services more or less than 80% UHC target. The military coup in 2021 jeopardized Myanmar’s healthcare system, undoing years of progress.References
World Health Organization: WHO. (2019, October 3). Universal health coverage. https://ww w.who.int/southeastasia/health-topics/universal-health-coverage
Ministry of Health and Sports. (2016, December 15). Myanmar National Health Plan 2017 – 2021. https://www.mohs.gov.mm/page/5832
Han, S. M., Rahman, M. M., Rahman, M. S., Swe, K. T., Palmer, M., Sakamoto, H., Nomura, S., & Shibuya, K. (2018). Progress towards universal health coverage in Myanmar: a national and subnational assessment. The Lancet. Global health, 6(9), e989–e997. https://d oi.org/10.1016/S2214-109X(18)30318-8
Community Partners International (2024, September 13). Universal health coverage in Myanmar: The way forward – Community Partners International. Community Partners International. https://cpintl.org/type/impact-story/universal-health-coverage-in-myanm ar-the-way-forward
Moving toward UHC : Myanmar – national initiatives, key challenges, and the role of collaborative activities. (2017). World Bank. https://documents.worldbank.org/en/publicati on/documents-reports/documentdetail/991991513148339321/moving-toward-uhc-myan mar-national-initiatives-key-challenges-and-the-role-of-collaborative-activities
The Ānanda. (2018). Giving but not receiving it. https://www.theananda.org/en/blog/vie w/underspent
ASEAN Secretariat & UN Global Database. (2024). ASEAN Health Worker Density (per 10,000 population), 2022. In ASEAN Health Worker Density: Vol. VI. https://www.aseanstat s.org/wp-content/uploads/2024/03/ASEAN-Statistical-Brief-March-2024-FINAL.pdf -
About 84% of Myanmar’s population with lower socioeconomic status resides in rural areas. Most rural areas lack electricity, safe drinking water, and poor sanitation. This contributes to poor health outcomes. For basic health services, there are NGO-established village health centers. However, more serious conditions require travel to the nearest city hospitals.
The political unrest since the military coup has further caused health disparities. Healthcare has become a battleground nationwide except for the urban centers particularly, Yangon and Mandalay.
In rural areas, the quality of care cannot be expected while struggling for basic care. Essential healthcare is facilitated by internally displaced health professionals within the affected communities. Access to medicine and required equipment is obtained through neighboring countries with external support from various countries. In the military-controlled areas, of Yangon and Mandalay, primary, secondary, and tertiary healthcare services are easily accessible.
Addressing these gaps is a complex undertaking. Political considerations matter in this context. Peace is the only medicine that heals wars. However, practically saying, conflict is a transition phase to eternal peace or hell depending on the conqueror.
Within the context of healthcare, continuous external support from people around the world through the neighboring countries and the presence of available human resources would stabilize the current phase of health service (basic service). Sadly, it would not be feasible to advance to a higher level of healthcare in conflict-affected areas since hospitals are easily vulnerable to military airstrikes.
In conclusion, access and quality of care continue to widen between rural conflict areas and military-controlled urban centers. Although there is no way to fill the gaps, maintaining basic health services in rural areas requires external aid.
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After the Feb 1 coup in 2021, the majority of the functioning health workforce exists in major cities: Yangon, Mandalay, and Naypyidaw in Myanmar. The workforce has already been extremely maldistributed across the country before.
The recent suspension of USAID funding in Myanmar has had a significant and devastating impact on a wide range of health programs such as HIV/AIDS, TB, and malaria, and has the potential to increase the risk of disease outbreaks. There are a large number of internally displaced people in the conflict-affected areas and the suspension leads to the difficulty of obtaining access to essential healthcare services (Imagine you were sick and there was a shortage of medicine, in a few days, you died — is the world just?).
In terms of health workforce shortage, urban centers like Yangon, Mandalay, and Naypyidaw have a moderate number of healthcare professionals as most people from other areas which are in conflict, migrated to the major cities. In contrast, areas like Chin, Kachin, Rakhine, and some parts of Shan experience catastrophic shortages, with low sustainability. Other regions, like Ayeyarwaddy, Bago, Magway, Sagaing, and Mon face extreme deficits.
So, what can we do for areas with critical deficits?
If we talk about establishing a healthcare workforce in war zones, it would be an extremely risky undertaking. So, the realistic solution is to employ internally displaced healthcare professionals (doctors, dentists, nurses) from within the affected communities. Even if they can function to provide healthcare services, multiple challenges remain. Among these, access to medical products and equipment is a major obstacle.
If we analyze it on the map, we can see where the solution to delivering medical products and equipment lies, that is simply, from neighboring countries. Remote conflict areas need external support from neighboring countries. Without aid, diseases know no border and will spread relentlessly. Providing essential medicine to border conflict zones protects neighboring countries from disease outbreaks.
Looking at the map, logistically, medicine supply routes could be established from China to Shan and Kachin, from Thailand to Karen and Karenni (Kayah), and from India to Chin and Rakhine. Unlike the logistic delivery, since the delivery is without the involvement of bilateral governments, it is a life-threatening delivery, that is, air strikes, snakebites, drowning and landmines are very likely, unlike normal circumstances in other areas.
In summary, the situation in Myanmar is dire with widespread instability in every sector. There is no other way to provide essential healthcare services in conflict areas in Myanmar except by relying on healthcare professionals from internally displaced communities and external support from neighboring countries to streamline medical products and equipment.
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I was a part of transforming from paper-based medical records to a digital system for underserved communities.
There were no engineering obstacles to digital transformation such as implementation, security and privacy, infrastructure, and resource requirements. However, there are major challenges in user perspectives.
_ Users enjoy writing records on paper more than data entry into the software system.
_ Users spend more time on digital data entry than paper-based recording for a single record.
These two facts remain valid after two years of use.
On the bright side, there are many benefits of using EMR in conflict-affected areas.
_ Data are protected against physical destruction of records.
_ Data are accessible anywhere anytime (stored on the cloud).
_ Displaced patients can access their records at different health facilities.
_ Healthcare providers/donors can review aggregated accurate data summary
_ Assist in disease surveillance and investigation
_ Assist in effective management and provisioning of vaccines and medicine
While offering many benefits, two key disadvantages mentioned above present a significant risk of a domino effect, impacting all aspects of the situation. No data flow, no users – the software is essentially dead.
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The article focuses on utilizing Big Data to solve cardiovascular diseases and mentions the challenges of practically approaching it.
# (1) Missing data: It is due to the data being omitted by clinicians, considering it unnecessary, patient refusal, disagreeing with data collection, and unsolvable missing data. As a result, there is less than 10% manageable missing data, 10-60% unmanageable missing data giving different results among methods, and 60% of missing data does not have a valid statistical solution.
The paper mentioned different solutions: (a) Complete-case analysis, (b) Available-case analysis, (c) Imputation techniques, (d) Mixed effects regression models, (e) Generalized estimating equations, (f) Pattern mixture models and selection models.
In addition to that, my suggestion for this missing issue is that data fields should be validated during the process of submitting if the data collected is aimed at further research. There should also be a beneficial program for the patients such as providing a monthly lucky draw.
# (2) Selection Bias: As the patients differ in their geographic profiles, insurance coverage, and medical history, this results in different variable distributions in different treatment groups. Consequently, a large volume of data no longer ensures a representative sample, preventing making any valid inference, and generating several false positive results.
The paper suggests (a) Propensity score analysis, (b) Instrumental variable analysis, (c) Mendelian randomization for genetic studies, (d) Considering results as hypothesis-generating, and (e) Validating through RCTs.
My opinion on this issue is the same as the Propensity score analysis which matches patients with similar characteristics across treatment groups to reduce bias.
# (3) Data Analysis / Training: Lack of formal trainings in informatics, coding, data analysis, large database handling, inefficient algorithms leads to this complexity, resulting suboptimal analysis and inefficient data processing.
In my opinion, this could be easily improved by providing formal training programs, and collaboration between clinicians and data scientists. Analyzing singly-handed could lead to doing the right thing in the wrong way.
# (4) Interpretation and Translational Applicability of Results: Studies being complex and not self-explanatory with poor variables description, subjective assumptions in analysis, questionable data quality could contribute to unclear conclusion and biased interpretation.
To improve the interpretation and translation applicability of results, firstly, the variables and metadata in the datasets should be consistently well-defined to make it easier to interpret or use across studies. Standardization will address this issue. Secondly, validating through independent studies should be established whether replicating the same studies confirms the same results.
# (5) Privacy and Ethical Issues: Medical servers can be targeted by cybercriminals and there could be a risk of identifying individual information. As a result, it compromises individual privacy.
The paper discusses (1) using broad consent models, (2) implementing a “social contract”, (3) continuous improvement of data security systems, and (4) balancing privacy protection with community benefits.
My concern is about balancing privacy protection with community benefits. If it aims for benefits primarily, it is open to abuse such as corruption and public manipulation. Even if there are no benefits, ethical standards, and privacy policies should not harm people.
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I will pick the first misinterpretation: “The P value is the probability that the test hypothesis is true” (Greenland et al., 2016, p. 340). I will elaborate on it with an example of the coin example.
The coin is fair either P(H)=0.5 or P(T)=0.5 which is H0 (null hypothesis)
But if you believe that the coin is biased towards the head, getting more heads, then P(H) ≥ 0.5 which is H1 (alternative hypothesis)
Now, you experimented 100 times and got (observed) 60 heads of 100 times.
You calculate the p-value and get ~ 0.028 (2.8%).
Here, you cannot misinterpret 2.8% as the probability that the coin is fair or the probability of getting more than 60 heads.
Instead, the p-value indicates that there is a 2.8% chance of seeing 60+ heads by random chance under the assumption that the coin is fair.
Because the p-value will randomly vary with each experiment and each flip under the assumption that the coin is fair.
Reference:
Greenland, S., Senn, S. J., Rothman, K. J., Carlin, J. B., Poole, C., Goodman, S. N., & Altman, D. G. (2016). Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. *European Journal of Epidemiology*, *31*(4), 337–350. https://doi.org/10.1007/s10654-016-0149-3
I might be wrong. Please feel free to correct me.
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Based on the four recommendations points, as a public health professional, one can participate actively in building consensus on corruption’s scope. If it does not exist yet in his organization, he can give advice to the organization he’s working at if they are open to ideas.
Second, in agreeing on the consensus, it might need to define the acceptable form of corruption because it enables dysfunctional system works, for example, bribing officials could allow to access medications for a patient with a rare disease needing affordable drugs which is available in another country, but is refused by the government due to political reasons. However, when it comes to the issues of the organization, it must be rejected. For example, a hospital has a long waitlist for a critical surgery, and paying a bride could move a patient up the list. In this case, their management team should review their operation whether it needs more technical efficiency, or hiring more high-performance surgeons to speed up the queue. As the paper suggests, it is important to concentrate on what matters most.
Third, as a public health professional, it is vital to contribute to the corruption issues in the research communities and share data on anonymized corrupt practices to build evidence for effective interventions and increase the visibility of corruption in the health research databases.
Fourth, the research should not be limited to the health sector because corruption is a systemic problem not a localized problem. Therefore, an interdisciplinary approach is necessary to enable a holistic view of the problem.
I agree with these four recommendations, however, corruption could be either a social norm or unavoidable, especially where the rules of laws are not effective and the government itself is corrupt. In this case, the boundary of corruption should be defined. On the other hand, all these recommendations can only be exercised but limited within the organization.
In addition to these recommendations, there are some suggestions I would like to propose. First and foremost, each individual should be ethical himself first and be responsible for reporting corrupt practices if the doors are open. Secondly, but of equal importance, the government should strengthen anti-corruption and enforcement mechanisms because the government affects more or less every facet of public life. Finally, public health professionals should promote external audits from a small project to a large program to be implemented across all health organizations.
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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.
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Hi everyone,
My name is Cing Sian Dal, but you can call me Cing. My background and interests are in Computer Science. I am currently working at a health tech startup focusing on developing a health information system for Myanmar, especially for underserved ethnic communities I learned statistics during my dental school, which is a part of preventive and community dentistry, and applied it from community surveys. Other than that, I have not had similar experiences in statistics since then. I look forward to learning and applying statistics through assignments and reading with you all. -
For the record,
1. My name is Cing Sian Dal. You can call me Cing.
2. My background: Bachelor of Dental Surgery + Bachelor of Computer Science
3. Related to informatics, I am responsible for developing health information systems for underserved communities in Myanmar
4. From this program, I expect to gain a depth and breadth of knowledge of health information systems and public health, as well as how to integrate them. -
Most organizations I’ve worked with had a small IT and engineering department team of less than 8 people and were budget-constrained. I will describe a disaster recovery plan based on those criteria and the on-premise information system (physical system, not cloud) and recommend suitable technologies based on the plan.
(1) Risk assessment and analysis
_ Identify potential risks and threats to the information system including natural disasters, cyber-attacks, hardware failures, theft, and fire.
_ Classify these risks based on their likelihood and impact on the operations
(2) Disaster Recovery Committee
_ Ensure that everyone understands their roles in case of disaster
(3) Notification procedures
_ Establish a clear communication to simultaneously (not a call tree) notify all team members in case of a disaster so that everyone is informed promptly.
(4) Recovery procedures
_ Outline step-by-step procedures for recovering each component and analyze prioritized critical component
(5) Reconstitution phase
_ Plan for the restoration of normal operation while/once the risks are eliminated.
(6) Ongoing maintenance and testing
_ Regularly inform the disaster recovery plan
_ Conduct mock drills to identify any weaknesses and make necessary improvements
Given the small size and budget constraints, the following technologies are recommended:
(1) Backup solutions
_ Cost-effective backup solutions like Google Drive, Dropbox, or specialized cloud backup providers can be used. For on-premise solutions, secondary RAID storage or external hard disks can be utilized.
(2) Cloud solutions
As secondary solutions for some services such as server or storage, cloud services (e.g., EC2, S3, Azure Blob) could be used.
(3) Redundant Systems
_ Implement inactive redundant systems which will be activated once the primary systems fail, in fiber optic internet, server, backup, power supply, and so on.
(4) Automation
_ Tools like Acronis, Veeam, or Windows Backup allow to back up at scheduled intervals.
_ Automate to re-route to the cloud server if a physical server fails.
_ Automate to start generators or supply with UPS if power is cut
_ Automate the inbound and outbound internet traffic
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The benefits of high availability will be evident when the system becomes unresponsive and experiences a failure. For the patients and hospitals, all operations will be stopped, which will delay treatments (in turn affecting patient outcomes), inefficient hospital workflows, and affect the quality of care (disappointing patient experience).
The benefits of high availability are:
– improved patient experience including doctor experience, allowing them to access up-to-date information and providing healthcare services seamlessly
– improved the quality of healthcare: the digital system can support their workflow/operation faster without any delay or service disruption
– reduced costs associated with system downtime and system recoveryIf the hospital relies on the digital system without a secondary solution such as a paper format or secondary server, then the High availability is not optional. In that case, as a health informatician, you must determine the level of High availability balancing with the implementation and maintaining cost.
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Your presentation offered valuable insights and expanded my knowledge of malaria and its surveillance.
A question that doubts me is:
If a patient visits a healthcare facility (e.g., hospitals, clinics) for medical attention and the consent form doesn’t explicitly mention disease surveillance, can we still use the data collected from that facility for surveillance purposes? -
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Your presentation is insightful and I’ve never thought that weak case definition would be helpful and useful in detecting potential cases earlier than confirmed cases for a more proactive response. I think that you’ve already been familiar with the flow of how a surveillance system works since the data flow diagram is impressive, I am curious to learn about how the analysis algorithms work. Regarding the weak case definition, I wonder what epidemiological factors or clinical features in identifying weak cases for dengue are.
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A company I worked for saw an employee gradually decreasing performance, affecting the team’s progress. He was then given a chance to improve it within two quarters. After two quarters, he could not meet with the goal. He was then terminated with both consensual agreements.
After two weeks, the company saw an increasing number of dummy data in the existing records. As a consequence, it affected on data of partners and their reporting mechanism, thereby harming the company’s credibility. Thanks to its backup policy, the company could recover from it easily.
Then, to mitigate such attacks in the future, the company reviewed its offboarding practices and CIA triad. Some of the CIA triad lists were as follows:
Confidentiality – (1) Updating username and password before offboarding, (2) Implementing 2FA in every authentication and authorization layer, (3) Updating access control list before offboarding, (4) Rotating SSH key (encryption key) before offboarding. The most important thing to be noticed here is to do it before offboarding.
Integrity – A background monitoring system is implemented, which triggers watching data integrity only when suspicious traffic is detected.
Availability – Although the underlying infrastructure was not affected, to ensure the availability of data and system operation, the infrastructure was further isolated and divided into different network segmentations so that unauthorized access could be prevented.
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A project plan, in the traditional way, is a paper essay written by imagination. Therefore, when reality kicks in, the plan is always constrained by time, cost, and quality. Fortunately, most projects I worked on were non-linear and progressed with the feedback loop (incremental development). In my experience, there was not even a project document to initiate a project. I like and prefer that way. However, for a big project or project proposal, it is mandatory to follow at least 12 steps of project management.
In my case, most projects are software development, and initiated by a program manager. Accountability for the project control and ownership rests with me. Usually, the project definition would be the problem statement – what problem are we trying to solve? Based on the problem statement, I gathered their expectations and transformed them into feasible digital solutions which were then broken down into an ordered list of tasks using a Gantt chart with Excel. The Gantt chart allows me to monitor the progress, productivity, and performance, and adjust priorities. The progress and quality of the project are improved by the iterative process of gathering feedback and review. Resources, risk assessment, costs, and safety margin were handled by a program manager. However, this workflow is suitable only if there are one or two people involved in plan execution.
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In my opinion, it is vital to be a team in harmony with unique personalities and characters before forming a team. For example, if a team of introverted leaders was formed for a social community, it would be detrimental to the community.
Before I was elected as the president of a civil society organization, the former leaders carefully picked up candidates based on diverse sets of personalities and characters possessed by each individual and how a team would look like in combination.
Fortunately, the general secretary I worked with was charismatic, socially attractive, friendly, and welcoming in her personality traits. As for the organization, I would be like the father and she would be like the mother of the organization. So, I was like a navigator of the team and organization while she was like a driver of the team and the organization.
For the motivation of a team, I always co-delegate to my partner and myself because she is more effective than me in that case. Yes, there are many ways to motivate the team, such as recognition and appreciation, rewards and incentives, encouraging and empowering, and paying attention and respect. It is important that, as the primary leader, I must express these even if she could articulate them perfectly. Because some people love to be praised and rewarded by people with the highest position, making them feel highly superior or motivated.
Because the leading team members must be individuals with diverse personalities and characters, it will make it a lot easier not only for motivation but also for problem-solving, conflict, and resolution, facilitating dialogue, fostering relationships, and clear communication.
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Recalling details and understanding the big picture would be listening skills that I need to improve because whenever someone told me something important, I could not grasp the context and retain important facts. I simply end such conversations, with “Okay”.
In such situations, I would rephrase the way I understand whether I miss the details or not; I would further ask and clear my misunderstandings whether I’ve accurately comprehended their message. In doing so, there could be a challenge with people who are impatient with being asked again and again, taking much time or providing more details. In that case, how do you manage it?
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Normally, my strongest component is empathy without outward display. I could recognize emotions in others, avoid judgments, and convince others to understand others’ emotions sometimes but not respond appropriately most of the time.
To express my empathy requires my expression or interaction with them appropriately when needed, like saying “hi” when someone is feeling down. However, I limit myself not to express it because my core belief is eventually people or everything will be okay whether I express it or not. Additionally, it takes a lot of energy to express myself as I am an intrinsic and introverted person. So, my action plan for expressive empathy will be limited to close relationships like family, teammates, classmates, friends, and so on.
Usually, I am weak at self-regulation when I become emotional. While I am angry at something or someone, it also affects other things or other people. Emotions expand. This also affects my health, causing hypertension.
I have no idea about this action plan. The realistic ways that work for me are playing attention-intensive games such as Mobile Legends, walking away from the source of emotion, and listening to music with headphones on.
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Generally, a government’s system and political dynamics affect the nature of its leaders’ speeches. In Singapore, with its localized politics and de facto one-party state, leaders can deliver speeches focused on a single, unified message. Conversely, in the US, with its complex, internationally engaged political system centered around diverse people, leaders often need to address multiple issues in a single speech, which was also significantly shaped by the 2020 presidential re-election.
When measured against the six principles of CERC, the Singaporean leader, Lee, is a skilled communicator while the US President Trump focused more on reassurance, optimism, nationalism, and personal branding rather than risk-focused guidance.
Be First – Both leaders addressed their nations promptly; however, Lee shared Singapore’s actions and regular updates while Trump initially addressed travel restrictions and the pandemic global spread and portrayed the crisis as under control without evidence.
Be Right – Lee explained Singapore’s response and the nature of Covid-19 including differences from SARS to set realistic expectations. However, Trump covered broadly travel restrictions and economic aid overemphasizing his government’s plans and downplaying the potential impact of the virus.
Be Credible – Lee outlined ongoing efforts and possible future steps while Trump emphasized America’s superiority and economic strength and was overly optimistic during the time of crisis.
Express Empathy – Lee addressed concerns about health and supply shortages and encouraged calmness while Trump expressed sympathy but was more focused on control over the situation.
Promotion Action – Lee shared practice steps for the public such as hygiene, and visiting the doctor when unwell while Trump emphasized national-level economic measures.
Show Respect – Lee respected his audience by highlighting the contributions of Singaporeans while Trump’s emphasis was more on national strength and leadership – this would feel less personal and less connected to individual efforts.
Based on these principles, Lee addressed the issue with transparency and empathy while Trump focused on national strength and his administration.
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As for Myanmar, following the Feb 2021 coup, at the national level, it seems impossible to have a collaborative team, build transparency and trust among ethnic groups, utilize technology for an intended purpose, provide access to information technology, embrace digital inclusion, and empower digital health transformation.
In terms of team collaboration, it can be strengthened at the ethnic level or federal-state level. However, when it comes to field operation settings, the team should be localized meaning that the members of the operation should be state residents they trust.
Trust can only be earned over decades because trust has been broken for over five decades between ethnic groups and the national government. Transparency will not work until trust is earned. In my experience at work, we have leveraged focal persons from digital literacy to the ability to handle server administration, and given the complete handover of server infrastructure (full ownership, full control, and access, therefore, full transparency), the project stakeholders are also non-state actors, even so, they abandoned it within one month after the handover.
In my experience, the underlying technology infrastructure is not something that ethnic groups or state actors lack. It is more related to their issue with continued adoption due to one main reason of feeling and belief: “Technology tools are obstacles” even after we resolved all of their feedback and experience. The internal research found that it depends not on ethnic groups or the state actors but rather on collective familiarity with technology, specifically saying, that if there are at least one or more senior focal persons familiar with technology, any digital health project will succeed.
The tech-equity is a broader topic and the underlying infrastructure (i.e., internet access, mobile access) should be provided or turned on by the state or national government. As of now, mobile networks and internet access are turned off by the national government (while the mobile network infrastructure already exists).
Digital transformation involves multiple factors. Even if the project requirement for transformation satisfies with multiple factors, it is still challenging. Although digital health is the only possible way for data collection, analysis, and research in conflict areas, the state actors themselves are not willing to continue to adopt it due to trust issues, pessimistic beliefs, and feelings even if Starlink for internet access, funds for management and human resources, required hardware and facilities such as portable power station, power bank, mobile phones, laptops for each individual, solar powered battery and inverter, custom-engineered data collection app with offline first capability, dedicated cloud servers, etc are provided.
In conclusion, as for now, to prepare for disease outbreaks, it is only possible to retrieve information from the organizations each state relies upon and trusts.
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I agree that people in rural areas do not traditionally receive quality care with being in a low priority. If basic health care is not managed to be distributed equally to the entire population (or state/region/division) of all races, health equity is a fancy term used by public health professionals.
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I like the idea of giving more incentives to work in rural areas. According to the law of economics of scale, people in rural areas are not financially viable, therefore, those places cannot scale up many resources and infrastructures. Regardless of those factors, doctors should be assigned enough for patients. If assigning doctors to where they have to work is determined by themselves, providing more incentives could be an attractive factor.
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Thank you for sharing SSS and CSMBS in Thailand. I understood that the difference between them is that they include the benefits of family members for CSMBS. However, from a different perspective, to be fair, employees working in private sectors are assumed to earn more than civil servants. With this assumption, I think that the benefits are skewed into civil servants.
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Your discussion gave me a new perspective. I think the resource challenge in medicine, particularly the demand for doctors and nurses, comes from how medical schools teach. Frankly speaking, schools treat all medical knowledge as crucial, even though much of it fades away after graduation. We need to re-evaluate both the teaching methods and the entire process of becoming a doctor. For example, instead of teaching basic sciences (biology, chemistry, physics) in the first year (which have been already taught in high school education), pre-clinical studies (anatomy, physiology, pathology) should be introduced in the first year.
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I agree that EMRs are the key drivers of healthcare. On the other hand, EMRs should be managed not to be easily accessible by everyone at healthcare provider. To prevent accessing patients’ data by senior officers or higher authorities of healthcare providers, it could be protected by implementing an Identity and Access Management policy either on-premise infrastructure or cloud or both.
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It’s interesting that I have never thought that spending office hours for personal tasks as corruption but abusing while spending office resources is indeed a corruption. Sometimes, employees may lookup information such as travel and tour, local news for personal interest, on the other hand, as per traditional company policy, everything we do on the company laptop belongs to the company, so it’s risky if we have personal photos and videos.
I agree that network analysis is useful in uncovering corruption. In banking sector, they use a graph database (a network of transaction from one person to another) to find out fraud. In health sector, I believe that if we check a network of transaction (if digital record), it will be easier to find out.
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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.
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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.
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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.
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That’s frustrating, infuriating, and very unethical. Every organization dealing with medical data must have a data sharing policy and data governance policy. Usually, at the enterprise level, data handling is automated by using enterprise software such as BlackBerry Workspace, and Microsoft Purview Information, Vera.
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It’s truly difficult to assess risks and make a contingency plan for me as well. The only way is, as you mentioned, to have a team meeting and brainstorm together because it’s never been a solo plan by nature since the beginning of the project. It also takes a pearl of wisdom to filter out useful ideas while brainstorming. In that case, the Risk Matrix introduced in the course, is truly useful in determining risks and their impact.
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We are programmed to respond since birth whenever we have conversations. Everybody can hear, but nobody can easily listen. Listening takes energy and attention. It’s more difficult when it involves non-verbal communication because it can express the opposite, for example, smiling while offering condolences. I agree that maintaining eye contact is helpful because it improves concentration to some extent but it does not work if it becomes a long conversation.
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It would be quite challenging if a doctor is unwilling to cooperate with you if it takes much time, especially with such frequent follow-up questions. To improve recall, I think memory games like listening to weather forecasts without watching and jotting down what you remember could be more effective in practice.
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Obviously, you are indeed a well-regulated person not only by emotion but also by discipline. Your promptness in discussion proves us all. And, I admire your self-discipline.
When it comes to empathy, I understand it in a different way from recognizing emotions. For me, empathy involves the experience of putting yourself in another person’s shoes. I believe that if we have a similar experience to others, we can easily recognize emotions in others quickly.
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It is interesting and thought-provoking whether HIV can be a future PHEIC. As far as I researched, although HIV seems to be met with four criteria, the virus is all based on individual behavior (i.e., multiple sex partners, shared needle injection), unlike air-borne disease. Therefore, based on the situation in Myanmar, it’s fair to say that AIDS/HIV is one of the critical public health concerns affecting around 240,000 people according to a WHO progress report and it has a high prevalence. It is a serious issue nationally.
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