Wah Wah Lwin

[Wah Wah Lwin]

If I were to develop a disaster recovery plan for my organization’s information system, I would include the following procedures. The plan should start with identifying the major risks our system could face, such as power outages, network failures, hardware issues, or natural disasters—and assessing how each one would affect our operations. After understanding the risks, the plan should outline clear steps for the three main phases of disaster recovery: activation, execution, and reconstitution.

In the activation phase, we would need procedures for quickly detecting an incident, notifying the right people, and assessing the damage. This includes having a call tree, contact list, and a process for determining whether DR should be activated.

The execution phase would describe step-by-step instructions for restoring essential systems. This includes recovering servers, applications, databases, and networking equipment in the correct order, based on their priority and downtime tolerance. These steps should be simple, practical, and easy for staff to follow during a stressful situation.

Finally, the reconstitution phase covers how we restore operations back to the main site once it is safe, including testing the original system, shutting down the temporary disaster recovery environment, and documenting lessons learned.

In terms of technology suitable for my organization, considering our budget, system size, and available people, I think regular backups and selective replication would be the most realistic. Backups are cost-effective and ensure we can recover critical data even if a major failure occurs. For systems that are essential to daily operations and cannot tolerate long downtime, having replication to an alternate location would help reduce interruptions and keep the organization functioning.

Ref: Cisco Systems, Inc. (2012). Disaster recovery: Best practices (White Paper No. C11-453495). Cisco.

[Wah Wah Lwin]

Let me share some health challenges related to climate change that the world is currently facing. Climate change is increasingly affecting global health through rising temperatures, extreme weather events, air pollution, food insecurity, and the spread of vector-borne diseases such as malaria and dengue. A joint analysis from WHO and the UN Environment Programme highlights that warming temperatures are expanding mosquito habitats into new regions, leading to outbreaks in places that previously had low transmission risk. Many countries are now adopting climate-resilient health strategies, such as early warning systems for heatwaves, improved water and sanitation systems, and public health programs that integrate climate risk assessments. A well-known example is Bangladesh’s cyclone preparedness program, which combines community training, improved shelters, and early alerts, resulting in a major reduction in cyclone-related deaths over recent decades.

References:
https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
https://bdrcs.org/cyclone-preparedness-programm-cpp/?

[Wah Wah Lwin]

One change I was directly involved in within my previous organization was the introduction of Integra, a real-time project management system. Before Integra, we relied on fragmented processes that often caused delays and made it difficult to track budgeting, supply chain activities, human resources, and administrative tasks in a streamlined way. To address these challenges, the organization decided to adopt Integra, which integrates all these functions and provides real-time reporting to improve transparency for donors and stakeholders, especially in showing budgets versus deliverables and overall outcomes.

As one of the staff responsible for rolling out the system in our project field, I took an approach to support this change. I began by raising awareness among staff and end users, explaining the purpose of the system and the benefits it would bring, such as improved efficiency and clearer reporting.

As expected, many staff were initially hesitant. They were used to traditional methods and worried that the new system would be complicated, time-consuming, or increase their workload. To address these concerns, we provided hands-on training using simulation exercises, which helped build both confidence and knowledge. We also actively collected feedback from users and worked with the technical team to adjust the system based on their needs, which helped reduce resistance and build trust.

To ensure everyone understood their specific role in the system, I delivered tailored training sessions. For instance, program staff focused on program activities, while finance staff received training on budgeting functions. Later, we brought everyone together so they could see how the full system worked as an integrated whole.

Even after the rollout, we continued monitoring the system’s use through regular communication, follow-up sessions, and ongoing feedback collection across departments for a certain period. This helped us identify challenges early, support staff who needed more guidance, and continuously improve the adoption of the system.

[Wah Wah Lwin]

If we implement High Availability technology in the hospital information system (HIS), both patients and the hospital will gain significant, long-lasting benefits.

For patients, HA ensures they receive quality care with less waiting time because the system stays responsive even during busy periods or unexpected technical issues. It also improves the overall patient experience: fewer delays, smoother service flow, and higher satisfaction. Their personal health data is better protected, reducing risks of data loss or unauthorized access. Patients also benefit from more accurate and timely information, such as updated lab results, medication records, and appointment schedules. In emergency situations, HA can make a real difference by ensuring clinicians can immediately access critical patient information without interruption.

For hospitals, the benefits extend across operations and service delivery. HA reduces downtime and keeps essential systems running, even in cases of hardware failure, network problems, or maintenance activities. This supports fast, uninterrupted health services and improves the quality of care delivered. It also enhances accountability and reduces the risk of medical errors caused by unavailable information. Additionally, HA helps optimize resource use, lowers operational costs related to system outages, and increases staff productivity because clinicians and administrative teams can work without disruption. Over time, maintaining consistent system performance enhances the hospital’s reputation, strengthens trust among patients, and supports compliance with health information standards and regulations.

[Wah Wah Lwin]

In my previous work, I experienced a situation where the confidentiality of staff information was not properly protected. There were no clear IT protocols in place, so personal details such as personal information, salary data, and other HR records—were kept in shared folders that everyone in the organization could access. This meant that any staff member could see information that should have been private. It made many of us feel uncomfortable and raised concerns about trust and data misuse.

The situation could have been avoided/prevented with some basic security measures. For example, setting up role-based access so only authorized HR staff could view sensitive files, encrypting important documents, and having a secure HR information system. Clear guidelines on data handling, along with regular staff training and proper monitoring, would also help ensure that confidentiality and integrity are maintained.

[Wah Wah Lwin]

Thanks for an informative and comprehensive presentation about TB surveillance system for Myanmar. Your surveillance system is practical and appropriate for the MM context. Data flow and utilization is also logical. I only have one comment; regarding cross-border surveillance, that you mentioned in your presentation. It would be great if you could add ‘how it will be collaboratively work with neighboring countries for cross-border surveillance’.

[Wah Wah Lwin]

For effective communication, I always value and respect each team member’s opinion by carefully listening to their inputs, thoughts, and perspectives whenever we need to discuss specific tasks.
For example, when I was working as a Regional M&E Officer collaborating closely with country-based M&E officers and managers, I was responsible for several reporting and monitoring activities with them. Since we were from different countries, most of our communication took place online. Without effective communication, we would not have been able to achieve the desired outcomes for our project.
To address this, I developed a clear communication strategy to ensure mutual understanding of what needed to be done. As each country’s M&E team had its own principles and guidelines, I created a standardized protocol for the project’s specific outputs. To establish this, I initiated online meetings with clear objectives, listened carefully to their feedback, and assessed whether those objectives were achievable. When we could not reach a general consensus, I openly asked about their challenges and worked with the team to redefine the objectives together.
Through this experience, I realized that being a good listener is a vital part of effective communication. It ensures that everyone’s voice is heard and helps the team make well-informed, collective decisions that lead to successful outcomes.

[Wah Wah Lwin]

Hi Phyoe! Thanks for your presentation, it’s good to know the malaria situation in Shan State. It would be good if you could highlight the key stakeholders instead of dividing the data/HIS team, program coordinator, and manager separately, as they could all be grouped under one key stakeholder category, such as implementers. Also, it would be good if national bodies include in one of key stakeholders.

[Wah Wah Lwin]

Thanks for your great presentation, Jenny! It’s informative and I could learn the system from your country. Your presentation is quite clear, particularly in data flow, data utilization and how the data has positive impact on national-level decision making.

[Wah Wah Lwin]

Hi New! Thanks for your presentation! It’s a nice visual presentation and has a logical flow! I have just one clarification: do the percentages shown for each indicator refer to the targets for system evaluation?

[Wah Wah Lwin]

Hi Kevin! It’s a great and detailed presentation! really informative! I could see so much efforts were made to respond C19, that integrates multiple surveillance approaches.

[Wah Wah Lwin]

Hi Hteik Htar!

Thank you for your detailed, great and comprehensive presentation! And yes, AWD is one of consequences after the natural disaster, that needs to be tackled as a public and environmental health concerns.
Regarding my comment, I would agree with Ko Aung that using one reporting platform would be easier to collect the data and integrate to the system for real-time monitoring and analysis for quick response. Another comment: since the system requires timely reporting, how will it handle cases where users are unable to report within the provided timeframe due to internet connectivity issues? Are there any alternative channels available for reporting? For example, via messenger, telephone, etc.

[Wah Wah Lwin]

Hi Khun Salin!

It’s a great presentation! Thank you for sharing your experience and knowledge on CKD. I think your presentation covers all the required components for the surveillance system, and you presented them in chronological order. I have also noticed that Thai population have faced CKD burden due to underlying metabolic diseases, and yes, it requires an effective government health system to address the burden.
Regarding your presentation, I only have one comment, it would be a great idea if you add how evaluation results can benefit to transform the better health care system and support the decision makers for long-term impact.

[Wah Wah Lwin]

Thank you so much for your great presentation, Khun Sirithep!

Your presentation provides good information regarding RSV and its surveillance system. You mentioned well on rationale, objectives, stakeholders, data flow and data utilization. Just one comment from my end. Since the system will be evaluated by several indicators, it would be great if you include how those indicators will be collected (from what kind of sources), and why all those indicators are relevant for the system. I am just wondering how these all indicators will have impact on the RSV surveillance system and support the better decision making process.

Thank you very much!

[Wah Wah Lwin]

Hi Ko Aung!

Thanks for your informative presentation, it’s a great one! I learned good points about the SIDES platform components you mentioned in your slides. Also, the SIDES data flow appears logical and practical for the system.
Just one comment — it would be great to include who the key stakeholders are and what their roles will be within the system.
Regarding the indicators, I noticed that many will be used to evaluate the system. I’m curious to know how these indicators will be collected in order to assess the system’s effectiveness.

[Wah Wah Lwin]

Let me share a non–work related story that demonstrates emotional leadership. It’s about how my partner and I have been building mutual respect, trust, and negotiation through our different leadership styles.
As we all know, no single leadership style works for every situation. Even within a single situation, we may need to apply different styles of leadership to accomplish our tasks or reach our goals.

Throughout our relationship or what I like to call our family journey, we have made many major decisions that shaped our future direction. We always bring our ideas together, carefully consider the consequences, and make joint decisions.
For example, when we decided to relocate from Myanmar to Thailand five years ago, we faced many challenges, including safety concerns, financial constraints, and legal residency issues. However, through emotional support, bonding, and trust, we managed to overcome these challenges and successfully make that transition. I think this reflects a shared affiliative leadership style, where emotional connection and harmony play a key role.
On other occasions, such as when we began thinking about starting a family (kids), we took a visionary approach. I would say, we first discussed financial matters and potential investments, setting a new direction for our long-term goals. We talked about how we envisioned our future, a picture different from our current situation, and then identified possible challenges and what we hoped to achieve in both the short and long term. Those discussions often brought emotional stress, largely from the subconscious fear of uncertainty. Yet, we continued to learn, explore, and adapt to new situations as we moved forward.

Sometimes, we also use a democratic leadership style. For instance, when planning a vacation, we make decisions together about where we want to go, share responsibilities such as booking flights and hotels or managing the budget, and plan ahead for possible obstacles so that our trip goes smoothly with minimal disruption.
That’s my story of non–work-related leadership styles, which shows how emotional leadership can shape trust, collaboration, and shared growth in personal life 🙂

[Wah Wah Lwin]

PM Lee Hsien Loong (Singapore)

In his speech, he establishes leadership, shows that he acknowledges external shifts and is setting a direction rather than reacting. For example, he begins by addressing “My fellow Singaporeans” and immediately references the broader context: the changed world, Singapore at a crossroads.”, showing “BE FIRST”. His framing reflects realistic assessment of both internal strengths and external threats. In his speech, he acknowledges real global risks: “New conflicts have broken out. Geopolitical tensions have deepened. Barriers to trade are hardening”, showing strong “BE RIGHT”. In his speech, he leverages institutional trust and narrative of past success; personal commitment, by saying “I will serve you with all my heart”, positioning his leadership as part of continuity, enhancing his strong “BE CREDIBLE”. In his speech, he shows the inclusive language and recognition of collective experience help create empathy, by saying “Not everyone will find the transition easy” and “no one will face these challenges alone”, expressing deep “EMPATHY”. In his speech, he effectively promotes action and motivates the audience to participate, by saying ‘We must move faster, adapt quicker and innovate smarter’, showing strong “PROMOTE ACTION”. Finally, his speech shows respect through inclusive language and recognition of diversity and shared responsibility, by saying “We may come from different races, speak different languages, and hold different beliefs. But we are bound by something deeper, shared commitment..”, showing “DEEP RESPECT” to the audience.

Overall, PM Lee’s speech is well-crafted, communicates a clear vision, invites participation, fully respects the audience, and builds trust, showing strong 6-principles of CREC view. Hence, he is a good communicator.

President Trump (United States)

In his speech, he opens by addressing “my fellow Americans” and immediately frames the topic “our nation’s unprecedented response to the coronavirus outbreak”. He sets himself up as the first voice in the matter, which helps frame the issue as urgent and his role as central. Although he takes the lead in framing the crisis scenario, the speech was on 12 March 2020, led to weaken “BE FIRST” principle, compared to the PM Lee.
He gives statements about the outbreak, about actions being taken, etc. For instance: “the outbreak that started in China and is now spreading throughout the world.” He tried to be fact-based, but the complexity of the issue and broad statements limit “BE RIGHT”. He references his role, mentions emergency actions, acknowledge the seriousness. For example, “I will soon be taking emergency action to provide financial relief.” He maintains a credible posture, though the depth of evidence, giving full “BE CREDIBLE”. In his speech, he recognizes the seriousness and addresses all Americans, which helps create a sense of shared experience, expressing EMPATHY. In his speech, he provides clear instructions on hygiene and behavior, which makes audience participants rather than passive.Hence, he gives good actionable guidance for the public, fully “PROMOTE ACTION”. Finally, He shows respect at a basic level, but the depth of respect is somewhat limited because his speech addresses “Americans” broadly, includes mention of roles everyone must play, but there is less acknowledgement of vulnerable populations, limiting “DEEP RESPECT”.

In summary, President Trump’s speech shows good communication, particularly for setting agenda and mobilizing action.However, from a 6-principles of CREC view, it lacks in deeper empathy and respect for all audiences, and the “BE RIGHT” principle is left behind in a fast-moving crisis.

[Wah Wah Lwin]

Based on the themes proposed in the article, I think all five themes still need improvement to strengthen emergency preparedness in my country, Myanmar.

Theme 1. Team:
The country should build strong, multi-sectoral teams that connect ministries, local authorities, academia, private sectors, and local communities. Limited collaboration and fragmented data flow during emergencies weaken national response capacity. Clear roles, shared data systems, and community participation can enhance preparedness.
Theme 2. Transparency and Trust:
A transparent approach to data collection and use is essential. The country needs clear data governance, ethical standards, and communication strategies to ensure that the public trust digital tools and government responses. Trust is crucial in emergency situations when misinformation spreads quickly.
Theme 3. Technology:
Outdated systems and low interoperability hinder timely data sharing. Investing in interoperable platforms, real-time surveillance tools, and training health workers in data literacy can help the country prepare and respond faster to health emergencies.
Theme 4. Techquity:
Access to digital health tools varies widely across my country, especially in rural and conflict-affected areas. Expanding internet connectivity, affordable mobile services, and digital literacy programs will ensure that all regions benefit from digital health innovations.
Theme 5. Transformation:
Digital transformation should be seen as a long-term investment, not just an emergency measure. Integrating digital health into the country’s health policies can create resilient systems that support prevention, early detection, and coordinated response in future health emergencies.

[Wah Wah Lwin]

List of the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)? Why do these outbreaks raise such concerns?

Since 2005, eight disease outbreaks have been declared as Public Health Emergencies of International Concern (PHEIC) under the IHR 2005. These include:
1. H1N1 Influenza Pandemic (Swine Flu): Declared on April 25, 2009, and ended in August 2010. This outbreak rasied concern by a rapidly spreading novel influenza virus that infected millions worldwide, raising fears of severe global impact.
2. Wild Poliovirus (Polio): Declared on May 5, 2014, but it’s still ongoing as of 2025. This outbreak raised concern by due to the re-emergence and international spread of wild poliovirus in areas thought to be near eradication, threatening global progress toward elimination.
3. Ebola Virus Disease (West Africa outbreak): Declared on August 8, 2014, and ended on March 29, 2016. This outbreak raised concern by devastating epidemic in Guinea, Liberia, and Sierra Leone that caused over 11,000 deaths and exposed weaknesses in international outbreak response systems.
4. Zika Virus Epidemic: Declared on February 1, 2016, and ended on November 18, 2016. This outbreak raised concern because of its association with severe birth defects, including microcephaly, and its rapid spread across the Americas.
5. Ebola Virus Disease (Democratic Republic of Congo – Kivu outbreak): Declared on July 17, 2019, and ended on June 26, 2020. This outbreak raised concern due to high case fatality rates, ongoing conflict in affected areas, and risk of cross-border transmission.
6. Coronavirus Disease 2019 (COVID-19) Pandemic: Declared on January 30, 2020, and ended on May 5, 2023. The outbreak raised concerb by leading to widespread morbidity, mortality, and socioeconomic disruption.
7. Monkeypox (Mpox) Outbreak: Declared on July 23, 2022, and ended on May 11, 2023. The outbreak raised concern due to emergence in multiple non-endemic countries, highlighting global vulnerability to zoonotic infections.
8. Monkeypox (Mpox) Re-emergence: Declared again on August 14, 2024, following new outbreaks in Central and East Africa. This outbreak raised concern due to the rising number of cases across several regions, reflecting persistent transmission and the need for coordinated control efforts.

Overall, these outbreaks raised global concern because they met the core PHEIC criteria: they posed a public health risk, had the significant risk for international spread, international trade and travel restrictions, as well as required a coordinated international response.

In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?

In my opinion, any disease that is highly infectious, difficult to detect in its early stages, and capable of spreading across borders has the potential to trigger a Public Health Emergency of International Concern (PHEIC) in the future. One example is avian influenza, which remains a major concern due to its ongoing mutations (strains adaptations) and increasing presence among both animal and human populations. These changes raise the risk of the virus adapting to spread more easily between humans, which could create conditions for another global health emergency. Therefore, I would say that it is essential to recognize the interconnection between humans, animals, and the environment, One Health approach, as a key perspective in anticipating and preventing future PHEICs.

[Wah Wah Lwin]

1. Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?

The single design limitation that most threatens valid estimates of sensitivity and representativeness of the AEFI surveillance system is the limited geographic and facility coverage, specifically the under-reporting from private and rural health facilities. This may lead to weak data collection, incomplete data reporting, and a lack of representativeness for the coverage.

To address this within six weeks, we need to focus on integration and collaboration with private and rural health facilities for the AEFI surveillance system. Firstly, we need to organize short compulsory training sessions (1-2 days in week one) for key staff from the above health facilities that offer vaccinations. This training will ensure everyone understands the AEFI case definitions and knows exactly how to fill out the required reporting forms, addressing critical knowledge gaps. Secondly, we need to establish clear guidelines that every confirmed adverse event must be reported immediately. This will create a clear, fast channel for data flow and speed up the response (within the timeframe). Finally, we need to conduct review meetings on AEFI reporting, along with acknowledgment of the health facilities that report AEFI cases timely and consistently with good data quality (in week six). This would help the AEFI frontline staff stay motivated, feel recognized, and gain a sense of ownership.

2. Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.

Since sensitivity is sub-optimal due to high under-reporting, delayed transmission, and low community awareness about AEFI and its reporting, a low-cost intervention would be to increase community awareness by conducting education and outreach activities using communication tools such as pamphlets, flyers, and community talks. This aims to empower the community to initiate passive reporting. At the same time, immunization staff will provide education during their visist for immunization, on how to report AEFI cases through simple method such as sending SMS messages for AEFI cases.

Expected trade-offs: Improved data quality and greater acceptability of the system by the community which will help address under-reporting, delayed transmission, and low public awareness.

Indicators to detect the impact of the intervention (based on simplicity and generalizability):
• Increased reported AEFI cases: This will be calculated as the ratio of AEFI reports per 100,000 surviving infants per year. Reported cases will be collected from all data sources. This indicator contributes to global AEFI reporting as part of the Global Vaccine Action Plan.
Source: WHO Global Advisory Committee on Vaccine Safety – Indicators
• Proportion of community-reported AEFI cases: This will be calculated as the ratio of AEFI cases reported by the community to the total AEFI cases reported. This indicator will track the percentage of total AEFI reports that come directly via SMS or community alerts compared to the overall AEFI cases reported.

3. For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
– If yes, what trigger would you use to revert to the prior definition?
– If no, why should this change not be implemented?

Yes, the AEFI case definition should be temporarily broadened to maximize early signal detection for a newly introduced vaccine since it described that the AEFI surveillance system in Northern Nigeria is recognized as not robust enough to generate sufficient and convincing vaccine safety data, especially for new vaccines and those under emergency authorization use.

The trigger to revert to the prior definition would be used once the National Expert Committee confirms that the AEFI surveillance system has successfully generated sufficient vaccine safety data. This means the data must be robust enough to support accurate causality assessments with consistent reporting.

[Wah Wah Lwin]

How IT could assist Outbreak Investigation Process?

Verification and Preparation

1. Establish the existence of an outbreak: by developing real-time dashboards to display case trends over time and place, as well as notifying authorities about unusual surges in cases.

2. Verify the diagnosis: through electronic laboratory reporting to public health authorities and relevant stakeholders, enabling timely data exchange across healthcare settings and supporting decision-making processes.

3. Prepare for field work: by using digital tools to collect field data and integrating GIS mapping to identify hotspots, allowing fast and secure information sharing.

Describe the outbreak

4. Construct a working case definition: by using collaborative digital tools to draft, review, and revise case definitions, which can then be easily shared with the technical working group without requiring in-person meetings.

5. Find cases systematically and record information: by using digital case investigation forms on mobile phones, tablets, or computers for faster reporting, synchronized with a central database so that public health officials can promptly review and make further decisions.

6. Perform descriptive epidemiology: by creating data visualizations and GIS maps to identify case patterns, trends, and clusters through interactive dashboards.

Hypothesis & Testing

7. Develop hypotheses and analytical studies: by applying digital data analysis and statistical tools to explore correlations or associations between cases and possible contributing factors. In addition, IT can support data collection through digital surveys and assessment forms for further analysis.

Response & action

8. Implementation of control measures and follow-up: by using automated communication systems such as SMS alerts and emails to inform affected communities about control and preventive measures. IT can also help create dashboards to monitor the progress of interventions and follow-up actions.

9. Communication including outbreak report: by generating automated data summaries and dashboards for stakeholders, and sharing accurate information with the public via social media platforms. At the same time, IT can assist in monitoring social media behavior to detect and address misinformation in real time.

In addition, IT can support the overall outbreak investigation process by enabling efficient data exchange among stakeholders and decision-makers, minimizing data errors, enhancing efficiency, ensuring scalability, and strengthening data security and control.

[Wah Wah Lwin]

I would choose social media platforms that played an important role COVID-19 response by serving as tools for rapid communication, public engagement, and real-time data monitoring. As described by Budd et al. (2020), social media platforms enabled health authorities to share timely updates, preventive measures, and risk communication messages directly with the public. These platforms work by allowing users to exchange information and interact instantly, creating a two-way communication channel that helps address public concerns and tackle misinformation. Social media data can also be analyzed using machine learning and natural language processing to track public sentiment, identify misinformation trends, and detect early signs of outbreaks. For example, during the early stages of COVID-19, patterns in social media activity provided early warnings of increasing infection rates even before official reports emerged. Despite challenges related to misinformation and data privacy, social media platforms are important for delivering health messages, promoting behavioral change, and strengthening community engagement.

[Wah Wah Lwin]

1. How can surveillance help to detect and control the disease (Dengue)?

Surveillance plays an essential role in detecting and controlling dengue outbreak by enabling early identification of unusual increases in dengue cases, allowing health authorities to respond quickly (by collaboration with different sectors such as clinical setting, public health setting, environmental health setting) before the disease spreads widely. Through continuous monitoring of disease patterns, surveillance system can track trends in dengue incidence, identify high-risk areas, and detect clusters of infection that signal potential outbreaks.

2. Should we conduct active or passive surveillance or both for the disease (Dengue), why?

We should conduct both passive and active surveillance for Dengue. Passive surveillance collect reports from health facilities, while active surveillance involves targeted investigation and case finding in communities. Conducting both would provide early detection and timely responses on Dengue outbreaks.

3. Which method should be best to identify cases (Dengue), why?
3.1: Cases in medical facilities VS community

Identifying dengue cases through both medical facilities and the community is the best option. However, in resource limited setting, community-based surveillance is more effective for dengue detection. This is because mild dengue cases may not reach hospitals or clinics, and some symptoms may disappear without severe clinical signs and symptoms. Community surveillance helps detect these unreported infections, giving the transmission trend in the area. However, data from health facilities are also important for confirming severe cases and guiding medical response. Therefore, a combined approach ensures early detection and better control of dengue outbreaks.

3.2: Sentinel VS population-based surveillance

For dengue, sentinel surveillance, using selected health facilities or locations, works best in many settings, especially where resources are limited. Sentinel surveillance can provide detailed, high-quality data on trends of the disease without requiring the large effort of population-based surveillance. Although population-based systems give broader coverage, they are costly and need to use extra human resources. Sentinel surveillance, when well chosen in high-risk areas, can offer timely response that helps target prevention and vector control measures more effectively.

3.3: Case-based VS aggregated surveillance

A case-based surveillance is better for dengue detection and control. Collecting data for each individual case, including personal, and geographical information, allows for rapid investigation of clusters, understanding transmission trend, and implementing targeted interventions. Aggregated data, while simpler to manage, lacks the detail needed to trace outbreaks or identify hotspots accurately. As Murray and Cohen (2017) note, case-based surveillance is particularly useful for disease outbreak and require quick public health responses.

3.4: Syndromic VS laboratory-confirmed surveillance

In dengue surveillance, both are important. Syndromic surveillance provides early detection and laboratory confirmation provides disease verification. Since dengue often presents with fever and flu-like symptoms, monitoring these symptoms can provide an early warning before lab confirmation is available. As per Murray & Cohen (2017), combined approach (Syndromic for early detection followed by lab-confirmed surveillance) provides fast and accurate response in managing dengue outbreak.

4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?

For disseminating monkeypox surveillance information, I would choose real-time online platforms, along with regular epidemiological reports (such as weekly, bi-weekly, etc.) and communication channel (such as social media, SMS) to the general public. Real-time tools are very important because monkeypox can spread quickly through travel and close contact, so immediate sharing of verified information helps health authorities and the public respond quickly to prevent further transmission. At the same time, regular epidemiological reports provide detailed updates (such as trend analysis, disease data, future plan for disease control, research purpose, etc.) for policymakers and health professionals for decision making. Dissemininating the disease status and alerts to the general public is also essential for their awareness and preventive measures.

[Wah Wah Lwin]

Based on the given scenario:

Should you give the data out?
No, we should not give individual-level data such as home addresses, geolocation, and contact numbers. If we do this, we will violate the principles of information privacy, security, and least intrusive alternative, as well as accountability on ethical duties to protect confidentiality and prevent harm of individual information.

How do you not violate the General Principles of Informatics Ethics?
Principle of Information Privacy and Disposition: we must respect patients’ right to control over their own health data, identifiable data must not be shared without patients’ consent.
Principle of Security: we must ensure strong safeguards for data storage and transfer. Sharing individual-level data increases risks of misuse.
Principle of Legitimate Infringement & Least Intrusive Alternative : If data must be shared, it should be done in the least intrusive way such as providing de-identified or aggregated data.
Principle of Accountability: Any decision must be justified transparently, with documentation of why and how data is shared, and used.

If you want to provide the data, what and how will you do it?
If I want to provide the data, I will do the following in accordance with information ethics:
• Seeking for approval and transparency by informing and getting approval from the relevant officials or managers or decision makers as well as beneficiaries/data owners about data sharing and usage, before proceeding data sharing process.
• Asking for ethical approval for the research conducted from the research team to make sure the research will be conducted under the approval of ethical comitte, before research implementation.
• Data aggregation by providing geograhical level or provincial level data instead of individual level data to maintain data confidentiality.
• If individual level data need to be shared, de-identification of patients’ information by removing patients’ identifiable information such as name, address, contact numbers.
• Transparency on data use agreements by documenting how and why the data will be shared and used for the benefits of country disease control. Then, both parties must be signed and agreed accordingly to protect data security and confidentiality.

[Wah Wah Lwin]

Based on the provided scenario:

• As a health information professional, I should not disclose the patient’s information to my close friend, even if she may face consequences, because we must uphold the ethical principle of patient confidentiality and respect the patient’s right to control access to their own health information. The information channels must be in the appropriate process such as proper counseling session for the patient. The patient has the right to self-determination in deciding whether or not to disclose their condition to his family. Breaching this would harm the patient and violate serious ethical codes. In addition, interfering with family matters could undermine professional integrity and trust, as well as lead to legal consequences.

We must follow the fundamental principles by
• Right to self-determination: We must respect the patient’s right to make decisions about disclosure of their health condition.
• Doing good: We must ensure that the health information system is safe and protective for patients, while providing accurate health information through secure processes.
• Doing no Harm: We must protect patient confidentiality and safeguard their personal health information.
• At all times, we must follow ethical standards when handling patient information to maintain professional integrity.

[Wah Wah Lwin]

I’d like to share another example of a successful system that was used in my previous organization. The system, called Integra, is a real-time project management tool that integrates operations and program activities such as budgeting, supply chain management, human resources, and administration. The main purpose of Integra is to provide transparency to donors and stakeholders through real-time reporting. For example, showing budgets versus deliverables, as well as outcomes.

From my perspective, the system worked well because the organization managed the change process effectively as follows:

• Awareness for change: The senior management team (SMT) began by raising awareness among end users/staff. They introduced the system, explained its purpose, and emphasized the benefits of using it.
• Desire to support change: At first, end users/staff were reluctant to move away from traditional methods, fearing that the system would be complicated, time-consuming, and add to their workload. However, SMT provided proper training through simulation exercises, which increased both awareness and knowledge. They also gathered feedback from users and made system adjustments based on that feedback, which helped reduce resistance.
• Knowledge of how to change: Training was tailored to staff roles and responsibilities. For example, program staff were trained on program-related modules, while finance staff received training on the budget system. At the end of the process, all staff members participated in a collective training session to better understand how the entire system worked.
• Ability to use knowledge for change: At the beginning of system implementation, end users/staff faced unfamiliar and time-consuming using the system. However, SMT and IT staff were always on-board to coach end-users depending on their barriers of using the system. This allowed the end-users to be familiar and comfortable with the system.
• Reinforcement to make the change stick: Organization leaders and SMT continued to monitor the system’s use via regular communication with the staff/users, and collect feedback from staff across departments to ensure the system was being effectively adopted and improved over time.

[Wah Wah Lwin]

Background of the system

I’d like to share an example of a system failure from my previous work, focusing on One Health education. The One Health Workforce Academy (OHWA) was created as a global online hub for training and certification in One Health, which recognizes the interconnectedness of human, animal, and environmental health, and the need to work across these boundaries to address today’s challenges. It grew out of the USAID-funded One Health Workforce–Next Generation (OHW-NG) project, led by the University of California, Davis (One Health Institute), which followed the earlier One Health Workforce initiative launched in 2014. The University of Minnesota and Tufts University coordinated the work in partnership with two regional university networks: the Africa One Health University Network (AFROHUN) and the Southeast Asia One Health University Network (SEAOHUN).
The purpose of OHWA is to build the key skills needed for One Health practice. It also aims to establish a credentialing system that employers, governments, and universities can recognize as proof of One Health competency.

What made the system successful?
• Operation/Leadership: OHWA was supported by strong leadership across the Global One Health consortium. Courses were designed to be compatible, accessible, and relevant, user-friendly design, particularly for academics from member countries, enabling them to collectively address One Health issues.
• People/User Satisfaction: Since its launch, OHWA grew quickly. By 2025, more than 6,200 learners from 95 countries had enrolled. Most participants came from Africa and Southeast Asia, where OHWA worked closely with AFROHUN and SEAOHUN.

What made the system failed?
• Cost/Funding: After USAID funding ended, continuous IT support and system maintenance became very difficult to sustain. This eventually led to suspension of the platform in September, 2025.
• People: Recognition of OHWA credentials by employers, governments, universities remain a challenge, and course content should be updated regularly to meet the needs of diverse learners.

[Wah Wah Lwin]

Thanks for your presentation on OpenMRS for ART patients, Ko Aung. I’m glad to see how patients benefit from this system in achieving better health outcomes!

[Wah Wah Lwin]

Hi William!
Thanks for your presentation on eHealth Africa, that was really interesting! I can imagine how this eHealth project improves access to health care, especially for people living in remote areas. It would help make health care services more equitable and accessible for the community. I’m just wondering how does the project address cold chain management? Since vaccination programs need to prioritize cold chain management, right? Or, it might be the same scenario with EPI program in Myanmar, I guess.

[Wah Wah Lwin]

Hi Phyoe! Thank you so much for your comments! Regarding data sharing with neighboring countries, based on my knowledge and previous experience, there is an annual meeting or workshop held in Mae Sot, Tak Province, with implementing partners along the borders. It is organized by the Thailand VBDU/MoPH/DDC to share updates on the malaria situation. However, I am not sure whether real-time data sharing occurs among neighboring countries, as this could be challenging due to various barriers such as technical limitations and internet connectivity issues.

[Wah Wah Lwin]

Hi New! Thank you so much for your feedback and suggestions. And yes, I agree that visual dashboard and GIS mapping is really helpful to show the hotspots in high endemic areas.

[Wah Wah Lwin]

Thank you so much for your response, Ko Aung! It’s perfect now.

[Wah Wah Lwin]

Thank you for your comment, Soe :)! Yes, malaria elimination cannot be achieved by a stand-alone country. It requires collective and collaborative efforts among neighboring countries. And yes, we still have a lot to do within our own country to contain disease outbreaks.

[Wah Wah Lwin]

Hi Hteik Htar! thank you for your comments and questions. For VHV, yes, they are trained for malaria surveillance (both passive and active case detection) and they are already volunteering for their community. Similarly, for refugees and migrants along Thai-Myanmar borders, including refugees camps, there will be camp-based workers/migrant workers who are trained for malaria surveillance, including using mobile app. for case records and reporting. At the community level, they will be reporting the cases via mobile app (paper-based in case where there are limited resources). For eMIS, responsible implementing partners/government levels will be keying-in for synchronization.
For usability and adaptability indicators, frequency of data collection is suggested for annual basis, since the calculation is based on semi-structured interviews/survey and time analysis. So, it’s worth to access the system quality with annual basis to get feedback and insights from the users/respondents.

[Wah Wah Lwin]

Thanks for sharing Jenny!

[Wah Wah Lwin]

It’s interesting that you choose the indicator “Median time from event to report” 🙂

[Wah Wah Lwin]

Hi Kevin! Yup, Chatbots are really helpful for automated information sharing, and it’s convenient way to communicate with the users who need prompt responses. Also, we can collect the data from the system faster and analyze the users’ behavior, from there, we could refine/improve strategies in health emergencies for better public communication.

[Wah Wah Lwin]

Hi K’ Salin! Yup, I agree with your point. Continuous delivering of correct information is crucial for the long-run. At the same time, educating people is the complimentary to tackle the misinformation issues.

[Wah Wah Lwin]

To my knowledge, during the COVID-19 era, Facebook sought to minimize the spread of misinformation by using automated systems to detect and remove suspicious content that repeatedly shared information not aligned with updates, news, and guidelines from the World Health Organization (WHO). In addition, to promote accurate information and public education, Facebook boosted posts from trusted health organizations such as the WHO, ensuring that reliable updates on COVID-19 trends, notifications, and precautions appeared in users’ news feeds. I think other platforms, such as YouTube, use similar technology to minimize misinformation. However, it is sometimes difficult to determine which sources of information are truly reliable and what criteria social media platforms use to check and balance the delivery of accurate information to users. This can be complicated further by potential influences from political interests and decision-makers. For example, political leaders are nowadays using social media platforms to gain public trust.

[Wah Wah Lwin]

Agreed!Hope such tool would be useful for future pandenmic.

[Wah Wah Lwin]

This tool played a critical role in COVID-19 contact tracing!

[Wah Wah Lwin]

Yeah! Operational and people factors matter when disseminating the system. Without proper change management, awareness, and training, the system would be less effective, even if the technology is designed to improve outcomes. I think support from leadership is also critical for this kind of system, as it enhances user satisfaction and encourages people’s involvement.

[Wah Wah Lwin]

Thanks Ko Aung for the information!

[Wah Wah Lwin]

Hi Kevin! Thanks for sharing DHIS2 practices in MM.

[Wah Wah Lwin]

Hi Kevin! I heard that DHIS2 works quite well on HIV and TB programs, however, I haven’t heard about Malaria yet. Hope, it’s working now.

[Wah Wah Lwin]

Agreed! Cost is a crucial for sustainable project. Also, government spending/budget allocation on such systems plays an important role for the success.

[Wah Wah Lwin]

Hi William! I agree with the factor “lack of enough data” for making decision is important for the organization. In addition, data quality also supports the right decision. Otherwise, there will be like ‘garbage in, garbage out’. 😀

[Wah Wah Lwin]

Agreed! inconsistency/no ICD standard would cause issues for further processes as you mentioned.

[Wah Wah Lwin]

Thanks Kevin for sharing your experience with FUCHIA. Yeah, I think we also need to think options like MSF to tackle physician’s burnout, while maintaining strict data privacy and integrity.

[Wah Wah Lwin]

Thanks for sharing Ko Aung!It’s good to learn about OpenMRS for HIV care in MM. Is it integrated with national HIV system or, stand alone for the organization?

[Author]

Posts