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Primary health care (PHC) in Myanmar has expanded over the past decade, particularly in response to the growing burden of non-communicable diseases (NCDs). Here, I would like to present a case study that examined the readiness, availability, and utilization of PHC services for NCDs in Shan State, Myanmar, from January 2020 to January 2021. The study was conducted across 242 primary health care facilities in urban (Taunggyi), semi-urban (Loilem), and rural (Linkhae) districts. It assessed the readiness, availability, and utilization of PHC facilities for NCD services and compared the results among the three districts.
The findings showed that PHC services for NCDs in rural Shan State (Linkhae) face significant challenges that limit their effectiveness compared to urban areas such as Taunggyi and Loilem. Although many facilities met basic readiness standards, the rural district of Linkhae had the lowest screening rates and the highest new patient rates, suggesting difficulties in effectively managing the NCD burden.
Several factors contribute to this situation in rural Shan State (Linkhae):
1. Significant Gaps in Financing and Governance
• Financing: The mean score for financial readiness was only 38.20%, far below the 70% adequacy threshold. This was largely due to the absence of community health fund policies, which are important for reducing out-of-pocket expenses and improving access to care.
• Governance: Rural facilities experienced low levels of community participation and engagement, limited cooperation with community organizations, and insufficient local resource mobilization for essential services such as ambulance transport. Preventive services, including screening for hypertension and diabetes, were also underutilized.
2. Disparities in Human Resources and Training
• In the urban district of Taunggyi, 89.6% of health workforce positions were filled, whereas only 64.4% were filled in the rural district of Linkhae.
• Historically, PHC in Myanmar focused more on communicable diseases, meaning many Basic Health Staff (BHS) lacked specific training in NCD prevention and control. Although training has improved, the lower number of appointed staff in rural areas continues to hinder service delivery.
3. Limited Availability of Specific NCD Services
• Mean scores for assessment and referral of suspected cancer cases and management of respiratory diseases were considerably lower across all districts, including rural Linkhae.
4. Higher Prevalence of Risk Factors in Rural Areas
The limited success of PHC services is also linked to higher risk factor prevalence in rural populations. Rural communities often have higher levels of behavioral risk factors, such as alcohol consumption and low fruit and vegetable intake. This contributes to the high new patient rate in Linkhae, placing additional pressure on a PHC system that already has lower readiness and availability compared to urban districts.
5. Infrastructure and Supply Chain Challenges
Utilization of NCD services is constrained by infrastructure limitations and inconsistent medicine supplies. Even when essential medicines were officially available, frequent stockouts made it difficult for rural patients to rely on PHC facilities for continuous chronic disease management.Reference:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9659547/ -
What Works for Myanmar’s UHC Scheme
Myanmar has taken some important steps toward UHC. The National Health Plan (2017–2021) laid out a clear policy to expand access to a Basic Essential Package of Health Services and strengthen health system foundations such as workforce, infrastructure, and financing strategies. This plan reflects stakeholder engagement, including government, civil society (CSOs), and ethnic health organizations (EHOs), which helps make health policy more inclusive and responsive. Prioritizing primary health care (PHC) has also been recognized as essential because it focuses on prevention and early treatment, which are cost-effective and improve equity. Community-level approaches and partnerships with civil society have helped to engage local voices in planning and monitoring health services. These policy commitments and collaborative structures provide a foundation on which to build further progress.What Needs to Be Done for Myanmar’s UHC Scheme
Despite these positive steps, Myanmar still faces major barriers on the path to UHC. Financial protection remains weak. Many people pay large out-of-pocket costs for care, risking poverty when they get sick. Reducing these financial barriers through stronger public financing, social protection mechanisms, and health insurance will be crucial. There are also deep inequities in access to services, with poorer and rural regions having much lower coverage of essential care compared with wealthier/urban areas. This is driven by shortages of trained health workers, limited infrastructure, Civil Disobidient Movement (CDM) after the military coup, and limited health facilities, which are the problems that need targeted investment and workforce planning. Strengthening health system capacity and security, especially in remote, underserved, and conflict affected areas, will be essential to provide equitable services across the country. Moreover, continued engagement with communities, civil society, EHOs, and local/international partners can support accountability, ensure services meet the country needs.References
1. Nikoloski, Z., McGuire, A., & Mossialos, E. (2021). Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis. PLoS Medicine, 18(10), e1003811. https://doi.org/10.1371/journal.pmed.1003811
2. Ministry of Health, Myanmar. (2021). Universal health coverage. Retrieved from https://moh.nugmyanmar.org/universal-health-coverage/
3. Universal health coverage in Myanmar: The way forward. (n.d.). Community Partners International. Retrieved from https://cpintl.org/type/impact-story/universal-health-coverage-in-myanmar-the-way-forward
4. Strengthening financial protection and advancing UHC in Myanmar. (2025, December 12). Myanmar Digital News. Retrieved from https://www.mdn.gov.mm/en/strengthening-financial-protection-and-advancing-uhc-myanmar -
In Myanmar, there is a large gap between health care in urban and rural areas. People in cities usually have better access to hospitals, trained health workers, medical tests, and quality services. In contrast, rural and conflict-affected areas have limited access to care, shortages of health workers, weak referral systems, and lower quality services. Because of this, rural communities have worse health outcomes, especially for mothers and children, infectious diseases, and preventable illnesses.
Political instability and ongoing conflict have made the situation worse. Many skilled health workers have left, health services have been disrupted, and communities now depend more on NGOs, ethnic health organizations (EHOs), and community-based providers.
To improve the situation, Myanmar needs to move away from a hospital-focused system and invest more in prevention and community-based primary health care. Strengthening community health workers, sharing tasks among health staff, promoting healthy behaviors, detecting diseases early, using mobile clinics, and working closely with local and EHOs can improve access to care and fairness. It is also important to protect health workers, encourage them to stay in rural areas, and reduce financial barriers for patients.
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Myanmar’s health workforce is under severe strain and has become increasingly labour-intensive due to a serious imbalance between the number of patients and available health workers across all levels of the health system. In many public hospitals, a small number of doctors and nurses are expected to care for large patient volumes, which leads to long waiting times, staff burnout, and reduced quality of care. The situation is even worse in conflict-affected and hard-to-reach areas, where insecurity, displacement, and damaged infrastructure have driven many health workers away, leaving communities with very limited access to basic services.
The shortage of health workers has also affected the quality and safety of care. Limited availability and tight control of medicines and medical equipment reduce clinicians’ ability to diagnose and treat patients properly. After the coup, many skilled professionals, including doctors, nurses, specialists, and hospital management teams, are no longer in the formal system because of their involvement in the Civil Disobedience Movement (CDM), safety concerns, or migration. As a result, remaining staff (non-CDM) are overstretched and often forced to work beyond their capacity, increasing the risk of errors and poor patient outcomes.
In addition, corruption at different levels of the health system creates further barriers for patients. People may need to pay informal fees to receive services, or access hospital care. This increases out-of-pocket spending and makes healthcare unaffordable for many families, especially vulnerable populations. At the same time, ongoing conflict disrupts health facilities through damage, and insecurity, further reducing service availability.
To improve the above situation, it requires both political stability and strong support from the (?) government and international community to rebuild trust and functionality in the health system. With a more stable environment, the country can increase recruitment of skilled health workers and offer fair salaries that meet basic living needs, helping retain doctors, nurses, and specialists. Continuous training is also essential to ensure staff remain competent and motivated. At the system level, strengthening logistics, administration, and supply chains will improve access to medicines and equipment, while clear protection mechanisms are needed to keep healthcare workers safe, especially in conflict-affected areas. Providing incentives for high-performing staff can boost morale, and reducing unnecessary paperwork through better systems can free up time for patient care. At the same time, systematic hospital management and effective budget allocation to the health sector are important for quality health care.
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From my experience in humanitarian health, using electronic medical records (EMR) in migrant and humanitarian settings offers clear benefits (good points) over paper records, but it also brings important risks (bad points) that must be carefully managed.
Advantages/Good points are
1.Improved Continuity of Care for Mobile and Displaced Populations
One major benefit of EMR in humanitarian and migrant health is improved continuity of care for highly mobile populations. Refugees, migrants, and internally displaced persons often move between clinics, regions, or even countries, making it difficult to maintain complete medical histories using paper records, which are frequently lost or damaged. EMRs allow healthcare providers to retrieve previous consultations, laboratory results, vaccination histories, and treatment plans across sites, which is particularly important for managing chronic conditions such as tuberculosis, HIV, non-communicable diseases, mental health conditions, and antenatal care.
2.Timely Access to Information for Safer Clinical Decisions
EMRs can improve efficiency and clinical decision-making in high-volume or emergency settings. Compared to paper files, electronic systems reduce time spent searching for records, re-registering patients, and repeating investigations. Faster access to patient information can enhance patient safety by reducing medication errors and improving clinical continuity, which is especially critical during outbreaks, mass influxes, or emergency responses where time and accuracy are essential.
3.Supporting Evidence-Based Program Management, Surveillance and Humanitarian Coordination
From a program management and public health perspective, EMRs provide stronger data for surveillance, monitoring, and accountability. Electronic systems enable real-time aggregation of data for disease surveillance, early outbreak detection, and reporting to donors and coordination mechanisms. This is particularly valuable in humanitarian operations where reporting requirements are complex and timelines are tight. EMRs can also reduce transcription errors that often occur when transferring data from paper registers into electronic reporting platforms.Risks/Bad points are:
1.Infrastructure and System Reliability Issues
EMR implementation in humanitarian and migrant health settings is constrained by infrastructure limitations. Electronic systems depend on reliable electricity, hardware, and often internet connectivity, all of which may be unstable or absent in emergency or remote settings. Power outages, system failures, or lack of technical support can disrupt clinical services and delay care, especially if no functional paper backup system is in place.
2.Risks to Data Privacy and Patient Confidentiality
Data protection and confidentiality pose one of the most serious risks of EMR use in migrant health. Medical records in these settings may include highly sensitive information related to legal status, migration routes, sexual and reproductive health, HIV status, mental health, or experiences of violence. In contexts with weak data protection laws and governance, electronic data may be vulnerable to unauthorized access, misuse, or external pressure from authorities, potentially placing patients at risk. Poorly secured EMRs can therefore do more harm than paper records if privacy safeguards are inadequate.
3.Increased Workload and Staff Burden During Transition
The transition from paper-based systems to EMR often increases workload in the short term. During rollout phases, healthcare workers may be required to maintain both paper and electronic records, leading to longer consultation times and staff fatigue. In already overstretched humanitarian teams, this additional burden can reduce productivity and contribute to resistance against the new system, particularly if staff do not clearly perceive immediate benefits.
4.Digital Literacy Gaps Among Frontline Health Workers
Limited digital literacy among frontline health workers is another challenge. Many staff in humanitarian settings have basic computer skills and are more comfortable with handwritten documentation. Complex or poorly designed EMR interfaces can slow clinical workflows, increase errors, and cause frustration. Without adequate training and ongoing support, EMRs may undermine rather than improve quality of care.
5.Patient–Provider Relationships in the Context of EMR Use
There is also concern that EMR use may negatively affect the patient–provider relationship. Screen-focused consultations can reduce eye contact and interpersonal communication, which is particularly problematic in services that rely heavily on trust and rapport, such as mental health care, gender-based violence services, and trauma-informed care.
6.Donor Dependency and the Sustainability of EMRs
Sustainability remains a critical concern. Many EMR systems in humanitarian contexts are introduced through short-term donor funding and fail once financial or technical support ends. Without long-term planning for maintenance, updates, and local capacity building, EMR projects risk becoming unsustainable pilot initiatives rather than durable health system improvements. -
Ways to cope with challenges in big health data/EHRs:
1.Minimizing Data Inconsistency: Database Management Systems should include interchange and translation mechanisms to standardize data across hospitals and platforms. Furthermore, machine learning algorithms should be leveraged to extract meaningful diagnoses and investigation results from unstructured clinical text. This allows important information to become usable for analysis and decision-making.2.Improving Data Quality: EHRs should require mandatory completion of key CVD fields such as blood pressure, lipid profiles, ECG findings, and diagnosis codes before a record can be closed. This helps ensure clinicians capture essential information during routine care. In practice, smart alerts can gently remind clinicians when essential data are missing, making data quality part of daily workflow rather than an extra burden.
3.Building the culture of data ownership: a culture where clinicians and relevant persons feel ownership of the data. For instance, showing clinicians dashboards of their own patient outcomes or service performance can help them see that the data benefits their work, not just publications and research purposes.
4.Enhancing Translational Applicability: Utilization of machine learning can help standardize image interpretation, such as echocardiography, ECGs, and radiology images. This supports clinicians with consistent assessments. In addition, researchers should improve transparency by clearly describing dataset variables. When clinicians understand what the data mean, research findings become usable.
5.Reducing Selection Bias: In clinical research, stronger statistical methods should be applied, including hypothesis testing and appropriate sampling techniques. When possible, randomized controlled trials and population-based datasets should be combined with routine clinical data to reduce bias. This helps ensure that findings reflect real-world situation.
6.Investment in Training: Investment should be considered in formal training curricula in informatics, coding, data management, and advanced statistical tools. Training should not only target researchers but also clinicians who enter data daily. When staff understand how data are used, they become more motivated to collect high-quality information and apply research results in practice.
7.Solving Privacy and Ethical Issues: Updated cybersecurity and encryption systems are needed to implement ahead of cyber threats. Clear governance frameworks, consent procedures, and role-based access control help protect patient confidentiality.
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-I agree with the first recommendation. Corruption in health systems is difficult to define because it is often hidden in everyday practices and described as “gifts,” “tokens of gratitude,” or “facilitation.” Power differences between health care providers and patients make these behaviors easy to accept and hard to challenge, as patients may fear receiving poor care if they do not pay extra. Public health professionals should recognize that corruption is not only direct bribery. It also includes informal payments, absenteeism, incentives from pharmaceutical companies, and abuse of authority. These practices are often normalized and ignored. I agree with using clear examples instead of one rigid definition, because strict legal terms miss how corruption actually happens in real health systems. In developing countries including Myanmar’s public health system, corruption does not happen at only one level. It can occur from central budgeting and procurement down to facility management and frontline service delivery. The most harmful corruption lies in the “grey zone,” such as paying for faster care or staff being absent from duty. These practices mainly harm poor and vulnerable people. In Myanmar, for example, some patients feel pressured to give money to get quicker attention in public hospitals, while absenteeism in rural health centers (for example) can leave communities without services. Even if staff do not see this as corruption, it denies patients access to care and risks lives.
-I partially agree with the second recommendation because understanding the background of corruption and prioritizing action by public health impact is important, but not enough on its own. Corruption is more than bribery. It includes absenteeism, and favoritism in postings and promotions, all of which reduce efficiency and equity. In Myanmar, for example, low salaries, weak accountability, political instability, and fragile governance allow these practices to persist. However, recognizing these causes does not automatically protect health outcomes. As an example, a high-level official once misused Myanmar’s vaccination budget, yet no effective action followed. This shows that awareness without effective enforcement allows corruption to continue. Some corrupt behaviors also emerge because the health system is weak and under-resourced. In fragile settings, bribing officials to obtain approvals or using informal payments to keep facilities functioning may be seen as survival strategies rather than personal wrongdoing. Frontline workers sometimes face a choice between strictly following rules and meeting urgent patient needs. While these actions may be understandable, they should not become normal. Survival-driven corruption increases inequality, weakens trust, and keeps the system fragile.
-I strongly agree with the third recommendation because fighting corruption needs a holistic and multidisciplinary approach. The article describes that research on corruption is often published in anthropology and political economy journals rather than health literature, which makes it hard for health professionals to access and use. Important knowledge therefore stays outside everyday public health practice. Studying corruption is also difficult because powerful officials/individuals may shift blame to frontline workers, limit access to information, or present themselves as reformers while protecting their own interests. Researchers often have to choose between keeping access and telling the truth. If public health looks only at rules and audits, it misses the human behaviors and power relations that allow corruption to survive. A holistic, multi-disciplinary view helps explain why corruption happens and leads to solutions that are more realistic.
-I agree with the fourth recommendation because fighting corruption needs evidence, not just good intentions or moral arguments. The article points out that we still do not have enough strong evidence on what really works to reduce corruption in health systems. Without evidence, actions against corruption would not be effective. When research clearly shows how corruption affects mortality, access to care, and public trust, it becomes much easier to persuade policymakers and stakeholders to take action. Additionally, the evidence helps turn it into a practical public health problem. Alternatively, studying corruption can help strengthen public institutions, improve services, and build trust. The key issue is how corruption is framed. When seen as a system problem rather than individual moral failure, corruption research supports equity, and better health outcomes.
-In addition to the four recommendations, (1)Digitalization can minimize chances for corruption. Investing in technology that connects the whole public health system with accountability and real-time monitoring such as e-procurement, stock management, and payroll systems can reduce medicine diversion. Today, mobile phone applications make it easier for staff and communities to report problems, track services, and improve transparency. When activities are recorded and traceable, it becomes harder to hide corrupt practices. (2) Independent third-party monitoring/audit: Corruption can be detected by comparing different sources of information, such as service records, drug stocks, and spending reports. When these do not match, it may signal a problem. Independent or third-party monitoring is especially useful in donor-funded humanitarian programs because it reduces conflicts of interest and increases trust in the findings (3) Strengthening community engagement can also be effective. Empowering communities, local CSOs, and ethnic health groups to monitor public health services can help uncover corruption that officials may overlook. Creating safe and simple channels for reporting problems allows communities to participate in protecting health services. When people are involved, corruption becomes more visible.
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In Myanmar, one of the major public health challenges is tuberculosis (TB), especially in urban slums, migrant communities, and conflict-affected areas. An example of health system improvement is scaling up of community-based TB screening and proper treatment support through national TB program, township health hospitals and basic health staff. Mobile teams and community volunteers can actively screen high-risk groups such as household contacts, factory workers, migrants, and internally displaced persons (IDP) using symptom checklists and rapid diagnostic tests such as chest X-ray, sputum AFB. This improves access and coverage by delivering TB services to people who may not visit health facilities because of cost, distance, or stigma. It also improves quality and safety by enabling early diagnosis, proper infection control, and standardized treatment using the national TB guidelines, reducing transmission and minimizing risks of drug resistance TB. In terms of efficiency, it increases technical efficiency by detecting and treating more TB cases with the same workforce through outreach and rapid diagnostic testing; improves productive efficiency by combining the efforts of health staff and trained community volunteers to lower the cost per case detected and treated; and enhances allocative efficiency by prioritizing resources for high-burden areas such as Yangon’s peri-urban townships such as Hlaing Thar Yar and border regions rather than spreading funds across low-risk populations. This also promotes equity. Horizontal equity ensures that people with similar TB symptoms receive the same diagnostic and treatment services regardless of geography, while vertical equity provides additional support, such as nutrition, transportation, and treatment supervision, to groups with greater needs, including the poor, migrants, and people living with HIV.
Despite these benefits, barriers remain, including stigma that discourages testing, long treatment duration leading to poor adherence, limited laboratory capacity, workforce shortages, funding constraints, and access issues in conflict-affected regions. Addressing these challenges through community engagement, patient support, and system strengthening is essential to improve TB control in Myanmar. -
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.
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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/? -
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.
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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.
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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.
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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’.
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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. -
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.
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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. -
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. -
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!
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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. -
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 🙂 -
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.
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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. -
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.
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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.
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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.
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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.
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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 communityIdentifying 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.
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To use EMR smoothly in humanitarian and migrant health settings, health care workers/digital staff need basic digital skills and practical training on the system. Health workers should feel comfortable registering patients, entering data, retrieving records, and protecting confidentiality. Ongoing support and simple, user-friendly interfaces help reduce frustration and prevent errors, especially for staff who are more used to paper-based work.
Reliable infrastructure and technical support are also important for EMR system operations. EMR systems require reliable electricity, appropriate hardware, and either stable internet or offline functions for remote areas. Backup power, and secure servers should be in place to ensure that health care is not interrupted though technology fails.
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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.
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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. -
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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.
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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.
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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.
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