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Primary health care (PHC) in Myanmar
PHC in Myanmar is mainly delivered through township hospitals, station hospitals, rural health centers, and sub-rural health centers under the Ministry of Health. Basic Health Staff such as health assistants, lady health visitors, midwives, and public health supervisors provide preventive and basic curative services at community level. PHC focuses on maternal and child health, immunization, communicable diseases (such as HIV, TB and malaria), and increasingly non-communicable diseases (NCDs). In many ethnic and conflict-affected areas, Ethnic Health Organizations (EHOs) also provide similar primary care services.
A successful example of primary care intervention in Myanmar is the community-based malaria control program in Myanmar. In this program, community health workers were trained to use rapid diagnostic tests and provide early treatment within villages. This reduced delays in treatment and helped lower malaria transmission in remote areas.
Several factors contributed to this success. First, services were delivered by local community members, which increased trust and access. Second, there was strong collaboration between government health authorities, EHOs, and international partners. Third, there was reliable supply of medicines and diagnostic tools. Finally, the intervention focused on early detection and prevention, which are key principles of primary health care.
However, challenges remain. Political instability, workforce shortages, supply chain disruptions, and reliance on donor funding affect sustainability. This shows that while PHC interventions in Myanmar can be effective, long-term success depends on stable governance, strong financing, and continuous support to frontline health workers.Reference
Smithuis, F., Kyaw, M. K., Phe, U. O., Aye, K. Z., Htet, L., Barends, M., & White, N. J. (2013). Effectiveness of artemisinin combination therapy in Myanmar. The Lancet Infectious Diseases, 13(3), 211–218. https://doi.org/10.1016/S1473-3099(12)70301-4 -
UHC in Myanmar
Myanmar developed the National Health Plan (2017–2021) to guide the country toward UHC. The plan focused on:
Strengthening Primary Health Care (PHC)
Expanding basic health services
Working with civil society organizations (CSOs) and ethnic health organizations (EHOs)
Improving health services for poor and rural communities
Primary health care is a strong point because it focuses on prevention, maternal and child health, immunization, and early treatment. Community-based health workers also help reach remote and conflict-affected areas.
Initially, the NIMU (National Health Plan Implementation Monitoring Unit) had 2 more 5-year-plans expanding services and coverage population from 2021 to 2030 but military coup happened and the plan was halted.However, many challenges remain at large.
High out-of-pocket payment: Many people still pay directly for treatment and medicines. This can push families into poverty.
Inequality between urban and rural areas: Cities have better hospitals and more doctors. Rural and conflict areas often lack staff, medicines, and facilities.
Health workforce shortage: After the 2021 political crisis and Civil Disobedience Movement (CDM), many health workers left public facilities. This weakened the already insufficient healthcare workforce.
Political instability and conflict: Ongoing conflict affects health service delivery, supply chains, and access in many areas.To make UHC work in Myanmar:
Increase public health funding
Reduce out-of-pocket costs
Develop stronger health financing or insurance systems
Invest in training and retaining health workers
Strengthen primary health care in rural and conflict areas
Continue working with EHOs, CSOs, and communities -
Of course, there are big differences between rural and urban health in Myanmar.
Access and quality of care are much better in urban areas where most health facilities, specialists, equipment, and trained professionals are located. In contrast, rural areas have far fewer facilities, long travel distances, poor transport, fewer skilled staff, and lower service quality.
This leads to delayed care, poorer health outcomes, and higher risk of complications especially in maternal and child health gaps.Access: Most hospitals and specialists are in Yangon/Mandalay; rural villages often lack local clinics or have only basic centres with minimal staff and equipment.
Workforce: Doctors, nurses, and midwives tend to work in urban settings; rural areas suffer human resource shortages.
Quality: Even when rural residents reach care, quality (e.g., maternal/newborn services) is generally lower due to limited trained staff and supplies.
Costs & travel: Long journeys and travel costs delay care-seeking in rural communities.Examples of Innovative Approaches
Community Health Workers (CHWs) & Auxiliary Midwives: Trained volunteers in rural areas support basic primary health services, health education, immunization support and manage common conditions where doctors are scarce.
Integrated Community Malaria Volunteer (ICMV): Projects training malaria volunteers to diagnose and treat malaria and other illnesses have increased access in hard-to-reach areas.
Ethnic and community-based health organizations: In underserved regions (especially conflict-affected areas), local health systems and organizations deliver essential care and build trust within communities.Other Innovative Ideas to Close the Gaps
1. Expand and support ICMV — with training, supervision, supplies, and modest incentives
2. Mobile clinics and outreach teams that regularly visit remote villages
3. Telehealth for remote consultation and referral support
4. Incentives for rural retention of skilled staff (housing, allowances, career paths)
5. Stronger linkages between government, NGOs, and community support groups to coordinate services and resources -
Are you aware of the health workforce situation in your country? Can you share with your peers and Can you suggest what can be done to improve the situation?
Yes. Myanmar is facing a serious health workforce crisis. Many doctors, nurses, and health workers have left the public system due to insecurity, low pay, limited training opportunities, and unsafe working conditions. This has reduced access to essential health services, especially in rural and conflict-affected areas.
To improve the situation:
1. Protect health workers and ensure safe working conditions
2. Provide fair salaries and incentives, especially for rural areas
3. Support training, mentoring, and task-shifting to community health workers
4. Strengthen partnerships with NGOs, ethnic health organizations, and local providers
These steps can help maintain basic services and rebuild the health workforce over time. -
Good things about using EMR in Myanmar
Saves time: Staff can find patient records quickly without searching through many paper cards.
Less duplication: Patients often lose record booklets. EMR reduces repeated registrations and repeated data.
Better information access: Patient history, treatment plans, and lab results can be easily retrieved.
Improved quality of care: Doctors, nurses, lab staff, and admin staff can share accurate and updated information.
Better coordination: Different departments can update the same patient record.
More secure than paper (if well managed): EMR can protect records from loss, fire, or physical damage.
Remote access: Head office and managers can review patient data to support better decision-making.
Long-term efficiency: Over time, EMR can reduce workload and improve clinic workflow.Bad things / challenges of using EMR in Myanmar
Unstable electricity: Power cuts are common and can stop the system from working.
Technical support problems: When computers break down, technicians may not be available quickly.
Training needs: Many staff only have basic computer skills and need proper training.
Extra workload during transition: Staff may need to use both paper and EMR at the same time.
Patient confidentiality risks: Electronic data can be accessed or hacked if security is weak.
High initial cost: Computers, software, power backup, and internet are expensive.
Sustainability concerns: Without long-term funding, infrastructure, and ICT staff, the system may fail.
Less patient interaction: Some staff worry that typing on computers reduces face-to-face time with patients. -
Coping With Big Health Data Challenges
1. Missing Data
Accept that missing data are common due to paper records, displacement, and weak follow-up.
Define minimum essential data for key programs (NCDs, TB, MCH).
Use simple methods always and apply complex, multiple imputation, and mixed models only when needed.
Improve data collection using simple digital tools (DHIS2, Kobo, ODK).2. Selection Bias
Large datasets might not be representative of the whole population due to selection bias.
Clearly state who is included and excluded in analyses.
Use triangulation (routine data + surveys + qualitative data).
Treat findings as hypothesis-generating, not practice-changing.3. Data Analysis & Skills
Limited local skills are a major challenge.
Train clinicians and public health staff in basic data analysis and interpretation.
Use standard analysis templates to reduce errors.
Avoid advanced AI or machine learning unless data quality is strong.4. Interpretation & Use of Results
Translate results into simple, actionable messages for decision-makers.
Involve program staff in interpreting findings.
Use big data to identify trends and gaps, not to dictate clinical care.5. Privacy & Ethics
Build trust through clear explanations of how data are used.
Collect only necessary data and limit access.
Use broad consent models suitable for conflict-affected settings. -
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3. Significant result (P ≤ 0.05)
A P value ≤ 0.05 does not mean the test hypothesis is false. It only means the data would be unlikely if the hypothesis and all assumptions were true. The small P value could be due to chance, random error, or problems with the assumptions. It simply shows that the observed difference would happen by chance in 5% or fewer cases.4. Non-significant result (P > 0.05)
A P value > 0.05 does not mean the test hypothesis is true. It only means the data are not unusual if the hypothesis and assumptions are true. The hypothesis could still be wrong, but the result may look non-significant because of chance, random error, or other problems. It shows that the observed difference could happen by chance more than 5% of the time. -
My personal view on the four actions to fight corruption is as below.
1. Convene stakeholders and talk openly about corruption
Agree. Corruption cannot be reduced if it is not acknowledged. In Myanmar, open discussion is difficult, so health workers, especially junior staff, need support and protection to speak safely.2. Prioritize actions with high impact and feasible solutions
Agree. Public health professionals should focus on corrupt practices that harm vulnerable groups most, such as informal payments and drug diversion, and where solutions are realistic.3. Take a holistic and multi-disciplinary approach
Agree. Corruption is not only a health problem. In Myanmar, involving communities, civil society, and other sectors helps to understand causes and find practical solutions.4. Clarify the role of research
Agree. Simple, practical research such as audits, community feedback mechanism, and basic data report, is more useful than complex studies in the Myanmar context.Additional suggestions for Myanmar might include
Promoting community engagement and accountability
Improving transparency in recruitment and procurement
Improving health worker pay and working conditions
Using simple digital tools for reporting and stock managementIn conclusion, the four actions might be appropriate for Myanmar if they are applied carefully, using practical, and community-based approaches.
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One example of health system improvement in Myanmar is strengthening Primary Health Care (PHC) in rural areas by improving the capacity of Basic Health Staff (BHS) such as health assistants and midwives. This includes training BHS to provide integrated services (maternal and child health, nutrition, immunization, TB and malaria), improving referral systems, ensuring essential medicines, and involving communities in health activities. This helps increase access to basic health services and improves early detection and treatment at community level.
Possible barriers
– Shortage and high workload of health workers in rural and conflict areas
– Limited and unstable funding for primary health care
– Shortages of medicines, equipment, and poor transportation
– Weak health information and reporting systems
– Poor coordination among government, NGOs, and ethnic health organizations
– Low health awareness and socio-cultural barriers in communities
– Security and access problems due to conflict
While PHC strengthening is effective in improving health system of Myanmar, many system-level challenges can affect implementation. -
Hello classmates,
I am Zam Lian Kham and you can call me Kevin. I had academic background of M.B.,B.S and Master of Arts in Community Development. I am mostly working in humanitarian and public health organization and in these sectors, I have to conduct multiple analyses and assessments using both quantitative and qualitative research methods. Even though I attended some courses in basic or applied statistics, I had little experiences on quantitative research which use statiscal softwares. My thesis in MACD is mainly qualitative as the analysis for my topic needs depth rather than width.
I hope to learn a lot from this course from esteemed experienced teacher as well as colleagues. -
Disaster Recovery Plan (DRP)
Procedures to Include in the DRP
a. Risk Assessment
Identify possible problems: power failure, fire, theft, cyberattacks, natural disasters.
Decide which systems are most important for daily work.
b. Backup Procedures
Back up important data every day (emails, finance, HR, shared folders).
Keep one backup in the office and one backup outside the office or in the cloud.
c. Disaster Response
Steps to follow immediately after a disaster (inform staff, protect equipment, activate backup systems).
d. Recovery Steps
How to restore servers, systems, and data. How to switch to backup equipment if needed.
e. Communication Plan
Who to inform (management, staff, partners). Simple message templates for emergencies.
f. Roles and Responsibilities
IT Manager leads the DR process. DR Team restores systems. Country Director approves plan activation.
g. Testing the Plan
Practice the DR plan once or twice a year. Fix any weak points after each test.Suitable Technology for an INGO
a. Cloud Backup using Google Workspace, and Microsoft 365. (Recommended)
b. Local + Offsite Backups using small NAS devices in the office for daily backup and a copy device is kept in different location.(Use as Hybrid with cloud backup)
c. Power Protection with UPS for servers and network devices which protects equipment from power cuts and surges.
d. Basic Security Tools such as Anti-virus, firewall, VPN, and multi-factor authentication. -
Many developing countries, including Myanmar, still face similar health challenges.
– One big problem is the lack of money to build and maintain good health systems initially and in current situation with collapse of USAID, the funding of public health is more scarce and difficult.
– Many hospitals and clinics also do not have trained staff who know how to use health technologies even some owners might not know those technologies exist.
– Even when systems exist, some health workers do not use them because they are difficult or do not fit their daily work due to electricity cutoff, poor internet and telecommunication or not user-friendly systems.
– Poor data quality, interoperability and worries about privacy by patients also make the situation harder.People are trying to solve these problems by learning through institutions and consultants, giving more training to organizations and staff, improving system design, protecting patient information, and trying to connect different health systems together (the interoperability).
I hope exploring with new funding other than USAID, better technical, administrative support and teamwork, these challenges can slowly be reduced within organizations and the health systems of the developing countries can improve.
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When we implement the High Availablity technology in hospital information system (HIS),
Benefits for Patients
1. No delays in care — the system is always working, so doctors can access your records anytime.
2. Faster service — shorter waiting time for tests, results, and treatment.
3. Safer treatment — less chance of mistakes because information is always available and up-to-date.
4. Better emergency care — staff can see patient history immediately during emergencies.Benefits for the Hospital
1. Less downtime — hospital services keep running even if one server fails.
2. More efficient work — doctors, nurses, and staff can work smoothly without system interruptions.
3. Better data protection — patient information is safely stored and not easily lost.
4. Good reputation — patients trust a hospital with reliable systems.
5. Saves money — avoids costly shutdowns and system repairs. -
During my time as a Field Coordinator of WHO with the National AIDS Program, our team observed that the existing HIV/TB reporting indicators were unclear and often caused confusion for staff in the field. This challenge prompted me to engage with program coordinators in Central Myanmar to review and revise the indicators. Over the course of three to four months, we carried out a series of discussions and workshops involving both the HIV and TB programs.
Through these bilateral and collaborative meetings, we were able to agree on new and clearer definitions for the HIV/TB indicators. This revision was considered a bottom-up initiative because it originated from the practical challenges faced during field implementation. Although the change required updating reporting forms, registers, and indicator definitions, the transition was completed smoothly. This success was largely due to strong teamwork, consistent communication, and collective perseverance.
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Yes, I experienced a situation where Availability was affected in a health system strengthening project in Myanmar.
What happened?
As the internet connection in some townships of Myanmar was cut off due to conflicts/politics, our reporting system could not be accessed by teams from those townships.How did it affect the system or users?
Field staff could not submit monthly and quarterly reports on time.
Workload increased because staff had to collect data in other ways of communication like phone.
Decision-making was delayed.How to prevent it?
Use offline data collection tools (ODK, Kobo).
Go to where internet is available (to other nearby townships) and report.
Create a simple offline reporting plan. -
To have effective communication in my team, I focus on three things:
Be open: I encourage everyone to share their ideas and feelings freely. I listen carefully and make sure all voices are heard.
Be honest: I speak clearly and truthfully, even when the topic is difficult (although there might be a limit of transparency level by rank and position of staff). I also expect others to do the same.
Be respectful: I respect different opinions and never interrupt when someone is talking. I use kind words and stay calm during discussions.
These simple habits help build trust and teamwork in my work. -
Throughout a decade of my career, I had overcome many professional challenges. While I worked for the Chin State Health Department in Myanmar to improve the health system, one of my jobs was to draft state health plan of Chin State including voices from the lowest level of the health system, the Rural Health Centers. During that time, it was nearly impossible and quite challenging to gather the health budget data as well as the health infrastructure plan for the whole State. For the budget data, I had to work with the State Finance Officer and for the infrastructure plan, with a state engineer in addition to my challenging tasks. I also had to work on public holidays, while solving some misunderstanding between Township Medical Officer which meant more workload.
Finally, due to the relentless effort of our team, we could publish the Chin State Health Report 2018 which is the only health plan drawn from a bottom-up approach different from other top-down approach plans.
Leadership means bringing people together for a common goal. My journey in public health had taught me the importance of visionary leadership and teamwork which is needed to improve the Myanmar health system. -
Dear Sirithep,
I agree with Salin that you might need further explanation on how active surveillance will be implemented. For the case definition, it is quite challenging to narrow down to RSV among other respiratory illnesses of COVID 19 and flu too that you might need to increase your data accuracy somehow to work efficiently. Thanks for interesting surveillance system. -
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In Singapore, Prime Minister Lee Hsien Loong demonstrated strong alignment with all six CERC principles. He communicated promptly and consistently (Be First), providing accurate, science-based information supported by health authorities (Be Right). His calm, transparent demeanor enhanced credibility and public confidence (Be Credible). Lee also expressed empathy toward citizens’ anxieties, acknowledged frontline workers’ efforts, and called for social unity (Express Empathy). His messages included clear behavioral guidance, such as hygiene practices and social distancing (Promote Action), and were delivered respectfully in multiple languages to reach all communities (Show Respect). Consequently, Singapore’s communication strategy fostered public trust and compliance.
In contrast, U.S. President Donald Trump’s public addresses showed partial adherence to the CERC principles. Although he communicated early in the pandemic (Be First), his messages were often inconsistent or factually disputed (Be Right), which weakened public trust (Be Credible). Empathy and respect were inconsistently conveyed, with politicized rhetoric overshadowing reassurance (Express Empathy, Show Respect). Furthermore, conflicting statements regarding preventive measures, such as mask use and testing, undermined public understanding and compliance (Promote Action). These gaps reflected limited integration of the CERC framework into national communication efforts.
Overall, Singapore’s leadership demonstrated a comprehensive application of CERC principles, resulting in clear, credible, and empathetic communication. The United States’ approach, by contrast, suffered from inconsistency and diminished credibility, which weakened public confidence and adherence to health measures. This comparison highlights the importance of consistent, transparent, and empathetic communication in managing public behavior and trust during health emergencies.
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Based on Al Knawy et al. (2022), the five themes for strong digital health systems are team, transparency and trust, technology, techquity, and transformation. In my country, Myanmar, some progress has been made, but several areas still need improvement:
Team: There is weak coordination among ministries, NGOs, and ethnic health organizations. Health workers also need more training in digital tools and data use.
Transparency and trust: Myanmar lacks clear data protection laws. People have low trust in how health data are collected and shared.
Technology: Many rural areas have poor internet and limited electronic systems, making it hard to collect and share health information quickly.
Techquity: There is a big digital gap between urban and rural areas. Some communities have little access to mobile or online health services.
Transformation: Digital health activities are small and scattered. There is no strong national digital health strategy linked to pandemic preparedness. -
Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
The Seven PHEIC according to IHR are as belows;
1. In 2009, H1N1 Influenza (Swine Flu) Declared May 2009 and ended Aug 2010. It originated in Mexico/USA region.
2. In 2014, Poliomyelitis (Polio Resurgence) Declared May 2014 and ended May 2023. It originated in Pakistan, Afghanistan, Nigeria.
3. In 2014, Ebola Virus Disease (West Africa) Declared Aug 2014 and ended Mar 2016. It originated in Guinea, Liberia, and Sierra Leone.
4. In 2016, Zika Virus, Declared Feb 2016 and ended Nov 2016. It originated in Brazil.
5. In 2018–2020, Ebola Virus Disease Declared Jul 2019 and ended Jun 2020. It originated in Democratic Republic of the Congo.
6. In 2020, COVID-19 (SARS-CoV-2), Declared Jan 2020 and ended May 2023. It originated in China.
7. In 2022, Monkeypox (now “Mpox”), Declared Jul 2022 and ended May 2023. It originated in Multiple countries.Why do these outbreaks raise such concerns?
There outbreaks raise such concerns because of
-Rapid international spread (e.g., H1N1, COVID-19, Mpox).
-Severe health impact and high fatality rates (e.g., Ebola).
-Weak health systems unable to contain transmission (e.g., West Africa Ebola outbreak).
-Potential for mutation or vaccine escape (e.g., Polio resurgence, Influenza).
-Social and economic disruption, including travel and trade restrictions.
-Uncertainty about the disease’s nature, transmission, or control (e.g., Zika’s link to microcephaly).In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
In my opinion, the following conditions are strong candidates that could trigger a PHEIC in the future:
a. Avian Influenza (H5N1, H5N6, H7N9 variants)
Sporadic human infections with very high case fatality (>50% in some strains).
Increasing reports of infection in mammals (e.g., sea lions, cats, cattle).
If sustained human-to-human transmission occurs, it could spark a global pandemic.
b. Antimicrobial Resistance (AMR)
While not an “outbreak” in the traditional sense, the rise of drug-resistant infections (e.g., carbapenem-resistant Klebsiella, resistant gonorrhea, XDR-TB) could cause uncontrollable international health crises.
It fits the criteria of a PHEIC due to its global spread, lack of treatment options, and impact on healthcare systems. -
1. Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
The biggest problem is that the AEFI system depends mostly on passive facility reporting, which misses many cases in the community and private clinics. This affects sensitivity and representativeness.
How to address it in six weeks:
Train community health workers (CHWs) and private clinics to report AEFIs using WhatsApp, SMS, or a simple online form. Collect reports from at least two sources (e.g., clinics and CHWs) and compare them using a simple capture–recapture method to estimate missing cases. Combine all data in one Excel or Google Sheet and analyze weekly.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.
Intervention: Let CHWs send reports of any health problems after vaccination through SMS or WhatsApp.
Trade-offs: We will get more reports, but many might not be true AEFIs (more work to verify).
Indicators to measure impact:
Number of AEFIs reported per 10,000 doses (should increase).
Median time from event to report (should decrease).
Percentage of reports verified within 48 hours (shows improved response).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 can be temporarily broadened when a new vaccine is introduced. This helps catch more possible reactions early.
When to return to the old definition: After 8–12 weeks, or when confirmed serious AEFIs stay stable for a month, and the verification workload becomes manageable.
If not broadened: The system may miss early safety signals. However, if the team cannot handle many reports, it’s better to strengthen capacity first before broadening. -
Verification and Preparation
Establish the existence of an outbreak: IT systems such as electronic health records (EHRs), and real-time dashboards help detect unusual rises in case numbers, triggering early warnings for potential outbreaks.
Verify the diagnosis: Digital Laboratory Systems, and teleconsultation facilitate rapid confirmation of the pathogen.
Prepare for field work: Mobile data collection apps, and Geographic Information Systems (GIS) assist in mapping affected areas, organizing field teams, and planning logistics efficiently.Describe the Outbreak
Construct a working case definition: Shared online documents and digital collaboration platforms (e.g., Google Workspace, Microsoft Teams) ensure clear understanding and updates of case definitions across all team members.
Find cases systematically and record information: Integration of digital data collection tools, mobile survey systems (e.g., ODK, KoBoToolbox), and EMRs enables efficient case finding, and data entry.
Perform descriptive epidemiology: Data analysis and visualization tools (e.g., R, Epi Info, Power BI) generate epidemic curves, distribution maps, and summary of statistics, helping investigators describe the outbreak in terms of time, place, and person.Hypothesis and Testing
Develop hypotheses: Data mining, statistical analysis, and machine learning tools (e.g., R, Python) help identify patterns of exposure and potential sources, leading to the formulation of preliminary hypotheses.
Conduct analytical studies to test hypotheses: Analytical software such as SPSS, Stata, and R allows investigators to compare data between affected and unaffected groups, testing associations statistically to validate hypotheses.
Conduct special studies (e.g., environmental or laboratory): Environmental monitoring systems, and bioinformatics tools link environmental and genetic data to understand the source, mode, and spread of the pathogen.Response and Action
Implement control measures and follow-up: IT facilitates communication of interventions through mobile alerts, supports contact tracing through digital tracking systems, and monitors the effectiveness of control measures using real-time dashboards.
Communicate findings and prepare reports: Digital reporting platforms, online dashboards, and visualization tools enable timely dissemination of findings to policymakers, health professionals, and the public, ensuring transparency and coordinated response. -
One digital technology I like most apart from contact tracing app from Budd et al. (2020) is the chatbot used in the COVID-19 public health response. Chatbots are computer programs that can talk with people through websites, apps, or messaging platforms. They use artificial intelligence to answer questions, give advice, and guide people on what to do if they have symptoms.
During the COVID-19 pandemic, chatbots were used by the World Health Organization (WHO) and many national health agencies to provide accurate and timely information to the public. They helped people check their symptoms, learn about testing and vaccination, and avoid misinformation.
This technology is very important because it allows health authorities to reach millions of people quickly, even when healthcare workers are busy or when movement restrictions are in place. Chatbots are available 24 hours a day and can respond in different languages, making them a useful and low-cost tool for improving public communication and surveillance during health emergencies -
For dengue…
1. How can surveillance help to detect and control the disease?
It can detect outbreaks early and triggers rapid response (vector control, awareness campaigns) and monitor trends, seasonality, and geographic spread of dengue. Surveillance can help describe burden and risk groups (age, sex, area). It can evaluate the effectiveness of mosquito-control measures and also provide data for policy, planning, and advocacy.2. Should we conduct active or passive surveillance or both for the disease, why?
Both are needed. While passive surveillance by routine reporting from health facilities continues, active surveillance by public health teams for active cases in schools or communities during dengue outbreaks ensures timely detection and response.3. Which method should be best to identify cases, why?
a. Cases in medical facilities VS community (Cases in community because it can capture mild or unreported cases.)
b. Sentinel VS population-based surveillance (Sentinel because it can provide detailed, high-quality data)
c. Case-based VS aggregated surveillance (Case-based to analyze person, place, time and source)
d. Syndromic VS laboratory-confirmed surveillance (Syndromic because it allows early detection)4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Ministry of Health Dashboard including a hotline number: the best official transparant way to reach communities and raise public awareness of disease including case count, trends and epi data together with social media platform like facebook and tiktok.
Routine periodic tools: are useful for official updates and global reporting with interoperability between clinical and public health data system.
These tools are chosen because monkeypox needs fast and accurate information sharing. Using online and real-time platforms ensures that health professionals and the public receive timely alerts, helping prevent the spread of the disease and improving international coordination. -
In the given scenario, a Western research team is asking data in detail at individual level for each disease case.
1. Should you give the data out?
No, I should not give out detailed personal data directly. It would break data privacy and confidentiality rules.2. How do you not violate any of the General Principles of Informatics Ethics?
I must protect people’s privacy, get proper permission, and share data only in an ethical and legal way. I should make sure the data cannot identify any individual person.3. If you want to provide the data to them, what and how will you do it?
I will first ask approval from the Ministry of Health or relevant authority. Then, I will share only anonymized or aggregated data (without names, addresses, phone numbers, or exact locations). I will also sign a data-sharing agreement that limits how the researchers can use the data. -
According to the given scenario, my close friend’s husband has HIV and she did not know about that.
1. What should I do?
I should keep the patient’s information private and not tell anyone. My duty is to protect confidentiality.2. As a health information professional – can you tell your friend?
No, I cannot tell my friend. It would break patient confidentiality and professional ethics.3. Can you interfere with other people or family issue?
No, I cannot interfere in their personal or family matters. My role is only to manage patient information safely.4. But, should your friend not know about this because she might be at risk?
Even though she might be at risk, I still cannot tell her directly. I can encourage the patient to tell his wife or inform the doctor or counselor to handle it properly.5. How will you follow the fundamental principles about right to self-determination, doing good and doing no harm to others?
I respect the patient’s right to privacy (self-determination), I do good by protecting his trust, and I do no harm by avoiding gossip or breach of confidentiality.6. Isn’t it your obligation and the right of the subject to hold the information?
Yes. It is my obligation to keep the information confidential, and it is the patient’s right to decide who can know about his health condition. -
Using the same HMIS (DHIS-2) of Myanmar Public Health;
1. Awareness: Many staff are used to paper-based reporting and lack understanding of DHIS2 benefits. Communication meetings, orientation, and demonstrations were needed to explain why the change wass ncessary emphasizing improved data-driven decision-making.2. Desire: Resistance arose from fear of extra workload or job insecurity. To build motivation, recognize and reward early adopters as “DHIS2 Champions.”
3. Knowledge: Limited digital literacy and inconsistent training hindered adoption. Conducted many practical, step-by-step training in local languages, supported by user manuals and job aids, which was known as “ToT” “Training of Trainers” to cascade the training locally.
4. Ability: Challenges included poor internet, lack of devices, and double work during transition. Providing necessary equipment, on-site coaching to strengthen the application locally.
5. Reinforcement: To sustain change, integrated DHIS2 reports into routine supervision and performance reviews. Providing annual refresher training, ensuring leadership used DHIS2 data in decision-making, and allocating a stable budget for system maintenance from central government.
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Please give an example of a system in your organization (either successful or fail). What are main factors that make the system successful or failure (Data, Cost, Operation, Design, and People)?
I would like to analyse the HMIS (DHIS2) of government for partially successful factors.
Data : even though the coverage was not all, HMIS could cover most of the implementing partners and areas in the country.
Cost : Open Access Software, cost effective
Operation and Design : The system could be customized for user friendly features and easy to use with little to no technical knowledge
People : The training to input HMIS is not long even though the register in fields and reports from health facilities might need longer training on data definitiona and report system. -
One example of the decision support system for almost all organization I worked for, is checklist marking scale of recruitment. When we recruit a candidate, we transparently use predefined checklist of position we want with marking scale and during interview, we add or substract marks according to candidate’s answers.
The factors influencing the DSS might include the mental conditions of candidate, and interviewers as well as language barrier and understanding the questions or preparedness of the candidate.
However, the hiring manager had the final decision to make when the result of the individual interviews was not significant. -
If the hospitals in a country do not use the ICD Standard, we need to ask if they are using other Standard first.
If no standard is used, each hospital will write diseases differently making it hard to collect, compile, and compare in the national health information system or internationally (like in WHO system) which will cause obstacles in insurance claims, research, policy planning leading to health system failures and patients’ deaths. -
According to the article by Muhiyaddin R, et al., the six main problems causing Physicians’ Burnout are EHRs’ documentation and related tasks such as note taking and electronic communication in EHRs, EHRs’ poor design, workload, work overtime, inbox alerts, and alert fatigue.
Yes, I’ve heard similar complaints. Many health officers say that using EMR takes more time than expected, especially when the system is slow or complicated. Some prefer paper records because they feel faster during busy clinic hours. In Myanmar, where internet and electricity can be unstable, EMR use can add several extra stress instead of helping, it create extra workload addition to papar records.
Suggestions might include using offline EHR with simplified user-friendly design (maybe using a lot of drop-down lists), providing training prior to physicians, and hiring data-entry assistants for physicians. -
Dear Sayar Aung,
Thanks for your comprehensive response. PHC is like the most basic health care in a health system and as we could not fulfill this gap in Myanmar now and the service gap is increasing as the conflicts escalating.
Current quick fixed will not endure long and we might alternative solutions for porviding PHC in Myanmar.
Respectfully,
Dr. Kevin Zam -
Thanks for mentioning the NHP, Ma Wah.
I had worked with NIMU (NHP implementation monitoring unit) of MoH after the launch of NHP. The initial plan was to produce 3 NHPs covering 5 years duration each up to 2030, the second NHP will cover from 2021-2025 and third/final NHP will cover 2026-2030. But, sadly, the plan was halted in 2021. -
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Hello Nang Phyoe Thiri,
Thanks for your interest in data interoperability. As fellow Myanmar, we might need initial survey and analysis on what data standard and system are using by our service providers in Myanmar. According to my knowledge, the government hospital part might not be a problem while the involvement of different data system by private hospitals might need detail solution.
In short, we will need data scientists for this data interoperability analysis I think. -
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Dear Ma Wah,
Thanks for your comprehensive and excellent response.
During my work in MSF, we, MD, had to fill up the FUCHIA forms which take around 3 to 5 minutes by hands on paper excluding the patient consultation and examination time (which altogether last around 15 to 30 mins per patients). However, the MD did not fill the EHR to system and there were data assistants who filled up the FUCHIA Form into the EHR system. The MD used the offline-paper-based FUCHIA files only. I could read other MD handwritings as well as mine to go through the medical records of patients without the stree caused by the EHR in the paper.
As in Myanmar, offline EHR with help of data assistant might be solution for physicians’ burnout related to EHR.
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