The financial basis for continued malaria control. 1.2 Healthcare

The Ministry of Health and Sports is
the major player in the health sector as a governing agency as well as a
provider of comprehensive health care. The health system comprises a
pluralistic mix of public and private systems both in financing and provision..
In such rapid and continuous changing environment, effective management of
patient data become the critical factor in upgrading the country health system
to reach the ultimate target of universal health coverage. Internet and mobile
technology has been significantly improving in relation with past years which
could be the leveraging factor to build up the countrywide network of patient
data monitoring system Health Management Information System is one of twelve
programs under the National Health Plan (2006–2011). The Department of Health,
one of the seven departments of MoHS, is the service provider and also takes
the regulatory functions of the Ministry in bringing health of the people. Myanmar
is now entering the elimination phase of Malaria and various government and
non-government organizations are implementing to achieve this goal in
2030.Mobile technology become the essential role in this historic period mainly
in the patient data collection, reporting and surveillance. In this journey of
Malaria elimination Mobile phone technology was found to be an efficient and
effective method for rapidly detecting and treating patients with malaria in
this remote area. This technology, when combined with local knowledge and field
support, may be applicable to other hard-to-reach areas.





1.    Introduction

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1.1  Country

Malaria remains a leading cause of
morbidity and mortality in the Republic of the Union of Myanmar. Considerable
progress has been made over the past 10-15 years in reducing the burden.
However, the disease is still a priority public health problem in the country.
It occurs mainly in or near forests, but also in some coastal areas and
plantations. Because of these environmental determinants, the malaria burden is
particularly high among national races in remote areas and migrants, who seek
economic opportunities in rural economic frontier areas, and the economic
development activities such as forestry, mining, plantations and roadbuilding.
The significant reduction of malaria morbidity and mortality so far made in
Myanmar is threatened by evolving complexity of the problem, especially
multiple resistance of the parasites to antimalarial medications and the
uncertainty about the financial basis for continued malaria control.


1.2  Healthcare


The Ministry of Health and Sports
(MoHS) is the focal in planning and implementation health and also other
ministries are involving in improving health of the population by establishing social
security scheme and producing medicines and therapeutic agents. The Ministry of
Health (MOH) is the lead in the health sector as a governing agency and a
provider of comprehensive health care towards citizens. Many other key stakeholders
played improving roles in the evolving political and administrative
circumstances. The current Health Information System comprises hospital,
public-health, human-resources and logistic information. The Central Epidemiology
Unit of the DOH is a national focal point for communicable-disease surveillance
and response, responsible for disease surveillance. (Myanmar Health Policy
Mapping, 2017).Health technology assessment is an area in which the health
sector needs capacity development. The DOH is the main organization designated
to regulate health-care providers, pharmaceuticals, medical devices and aids,
and capital investment. Previous political situations and restrictions made patient
empowerment more of a concept than practice.(Myanmar Health Plan,2014).


Risk Management

Risk management is the process of
identifying, assessing and controlling threats to an organization. These risks
are financial hardship, legal liabilities, management problems, IT security
threats and data-related risks. Risk management standards have been developed
by several organizations to help organizations by identifying specific threats,
assess unique solutions to overcome their risks and challenges and then
implementing risk reduction efforts according to organizational strategy
(SearchCompliance, 2016). Business Process Reengineering (BPR) aims at cutting
down enterprise costs and process redundancies. Business Process Reengineering
(BPR) – also known as process innovation and core process redesign – attempts
to restructure or obliterate unproductive management layers, wipe out
redundancies, and remodel processes differently.( KiSSFLOW.2018).


2.    Analysis

2.1  Usage
of mobile technology in Malaria Programs


is an article by Meankaew et al. (Malaria Journal.2010) named “Application of
mobile-technology for disease and treatment monitoring of malaria in the
“Better Border Healthcare Programme” presents assess the effectiveness of
integrating the use of cell-phones into the malaria prevention and control
programme, for improving management of malaria cases among the under-served
population in a border area. The module for disease and treatment monitoring of
malaria (DTMM) is targeted of case investigation and case follow-up for
treatment compliance and patients’ symptoms.


module involving web-based and mobile technologies developed as a proof of
concept, to replace the existing manual, paper-based activities that malaria
village health volunteers used in treating and caring malaria patients in the
villages for which they were responsible. After a patient was detected and
registered onto the system, case-investigation and treatment details are
recorded into the malaria database. A follow-up schedule is generated, and the
patient’s status was updated when the malaria village health volunteer
conducted during home visits, using mobile phones loaded with the follow-up
application module. The module generated text and graph messages for a summary
of malaria cases and basic statistics, and automatically fed to predetermined
malaria personnel for situation analysis. (Prue et al. Malaria Journal


is also good evidence that using mobile increases the case detection and
management in rural areas of Bangladesh, which is presenting in the article by Prue
et al. (Malaria Journal 2013) in which Based on phone calls, field workers
visited the homes with ill persons, and collected blood samples for malaria.
Mobile phone technology was found to be an efficient and effective method for
rapidly diagnosing and treating patients with malaria especially in the remote
areas. The technology, in combination with local knowledge and field support,
may be applicable to other hard-to-reach areas to improve malaria control. (Meankaew
et al. Malaria Journal 2010)



Risk Management of using mobile technology


Since approximately two third of the
country are in covered with mobile network, there might be some areas still the
mobile Internet network is unreliable at best and often inexistent or unusable.
Planning on connections in villages that would allow a daily data
synchronization seems like a risky bet. Servers needs to be bought, installed,
backup and managed. On top of the equipment costs, these tasks require a
competent, experienced, IT system administrator. (Githinji et al. Malaria
Journal 2014). The prediction of use of the application also a matters, in
which some beneficiaries face barriers in the use of the relevant application
for data gathering and reporting. In relation to application majority of Malaria
programs in other countries use CommCare application to collect, analyze and
reporting. According to the experienced from neighboring south east Asian
countries, running a CommCare project requires various skills, the main one
remaining computer literacy. Other skills are however needed: exposure to
M&E tools and procedures, hands-on mobile phone management, capabilities to
train users. Training the village health volunteers to

CommCare related roles matching their
expertise may expose the projects to different challenges and risks.
Stakeholders inclusion, Real demand for electronic tools, Random applications,
Education level, Follow-up feedback, Starting from end user needs and
Successful training strategies are factors to be make prior comprehensive preparation
for incorporating mobile technology into malaria elimination process. (Githinji et al. Malaria Journal 2014)





      Benefits and Threats of using Mobile


This study “Using mobile phone text
messaging for malaria surveillance in rural Kenya” by Githinji et al. (Malaria
Journal 2014) also  demonstrated the
feasibility of using mobile phone based SMS text messages in Kenyan rural
setting as a tool for improving timeliness and reporting of malaria surveillance
data from facility level. The mobile technology made malaria data gathering easier
at the local clinic, and additional data were collected on the mobile phone
during routine home visits. With more information collected systematically in
the database, this module has allowed the exploration of clinical outcomes and
the generation of new hypotheses about transmission, and prevention and control
measures. It would also be a useful tool for intervention studies, since it can
collect reliable and timely variables, and identify cases in study areas. It
has the potential to help determine vulnerable predictors of malaria outbreak.


The major challenge for success of the
mobile data collection in Malaria program is data quality, including data
integrity, completeness, and timeliness. Since the system is designed to
collect data, including migrants and hard-to-reach populations, it should be
acknowledged that some malaria infections may not be contracted at the place of
reporting. The key to successful use of mobile phones in Malaria programs will
rely not only on the mobile phone technology, but on pairing the technology
with the on-the-ground knowledge of the area and the people.




and ways for Developing Malaria Mobile Data Collection


training and supporting is the integral part in the bringing the foundation and
effective implementation of patient data management with mobile technology in
nationwide Malaria Programs. National Malaria Control Program (NMCP) should be
the lead and communication hub for this process whereas international
organizations and institutions need to collaborate to fulfil this vision.The
program and technical support and technical body like World Health Organization
(WHO) and funding body such as Global Fund (GF) ,USAID and EU are essential. Improving the management,
processing and analysis of malaria data where first step under this objective
is identifying a suitable sampling framework for piloting the database system.
In developing this implementation plan a number of options were discussed with
NMCP staff.Adding to that, appropriate network at NMCP and associated IT
infrastructure and staff capacity at all levels to manage, secure and share
data. For harmonizing VHV reporting systems to maximize data quality, it is
mandatory that Standardized volunteer reporting systems, SOPs and accurate list
of all volunteers within the NMCP coverage and completeness. A range of activities will
be carried out to develop, test and evaluate appropriate Mobile data collection
tools based on established best practice within the region. Within the time frame
of this implementation plan the focus will be on carrying out small-scale, proof
of concept activities in a limited number of sites where there is existing
mobile phone coverage. NMCP will determine the scope and purpose of malaria
data collection activities and work closely with a suitably experienced
external partner to develop trial and evaluate appropriate solutions.




It can be concluded that
this report reflects the usage and feasibility of using mobile technology in
Malaria programs in the developing countries with similar IT infrastructure
with Myanmar. With the visible improvement in the
information technology system in Myanmar, mainly the broader mobile network
coverage areas comparing with the recent years, is the precious opportunity for
healthcare service provision mainly with the patient database system. Assessment
of the Health Information System in 2006 indicated that the System has the
potential to generate adequate indicators of an acceptable quality. The current
Health Information System is based on that system, having the concept of a
minimum essential data set to reduce the workload related to data management by
the Basic Health Staff (BHS).Data are collected manually by individual BHS
using standardized forms on monthly, quarterly and annual bases (depending on
the nature of the data collected), and collated at the local facility. All the
consolidated data are then sent through the Township Health Department to the
DHP and respective Region or State Health Department. Compilation and analysis
are done at the DHP. Dissemination of statistics is through publication of an
annual public health statistics report. (Malariaconsortium.2018) The System
still needs to have adequate policy support and resources, and the information
generated needs to be disseminated and used more. Myanmar
has an opportunity to leapfrog its development trajectory, and effectively
manage its geographical spread and socio-economic diversity using e-Governance
and e-Health. To improve the better healthcare services especially developing
countries, there should success in the acceptance of the patients, health care
professionals and the security of the health information technology by ensuring
the safety and reliability of technology systems using decision making and
policy making. Concise and systematic reporting starting from the village level
from the national sector is integral portion the country goal of Malaria free
status in 2030.Upgrading the data collection process from traditional paper
based ways to mobile data collection, in reflection with currently developing
stage of mobile network coverage of the county, is the system that inevitably
need to be developed sooner.