Questions/Answers

The Ministry of Health and Sports has been exerting an enormous effort to reform the decade-long neglected public health care and health service delivery in Myanmar. Myanmar comprises of 135 ethnic groups, speaking different languages and dialects and 70% of people live in rural areas. The ministry has been promoting effective utilization of information and communication technologies for community health promotion, robust health information system establishment and prompt response in public health emergencies, especially for those living in rural areas. One of the focus areas is health literacy and promotion as the health knowledge, attitude and practice of the people can be effectively improved if health education activities are simple, interesting, effective, and widespread all over the country. In this regard, delivering standardized health messages for people living in far reaching, vulnerable and hard-to-reach areas of Myanmar becomes critical for the Ministry. E-Health division under the department of public health leads the Ministry’s initiative to launch the Information and Communication Technology (ICT) supported community health promotion targeting basic health staffs through the distribution of electronic mobile tablets installing applications to equip the staffs in rural areas with ICT for community health promotion. These mobile tablets will provide timely and updated information to basic health professionals for health literacy promotions in the community regarding pressing public health issues including maternal, newborn and child health, reproductive and sexual health, communicable and non communicable disease control and surveillance at primary health care level in Myanmar.

Geographic and language barriers, transportation and poor health literacy hinder delivery of health care and public health services in the rural and ethnic areas in Myanmar. Basic Health Professionals are the essential health care providers at the primary health care level in the rural and ethnic communities in Myanmar. Basic health professionals equipped with mobile tablets and technology will effectively deliver quality community health care services to the rural communities in prompt manners. Therefore, it will consequently help alleviating health inequalities especially among rural and vulnerable populations in Myanmar and move forwards achieving SDG 2030.

The initiative " Promoting Community Health through Mobile Technology" in Myanmar ensures healthy lives and promote well-being for all at all ages (SDG- Goal 3). The mobile tables equipped with Mobile Device Management System have been distributed to all basic health professionals who are providing primary health care services at grass root levels and have been continuously updated with health related mobile applications for health literacy and promotion, disease surveillance, health information, data collection and electronic based community surveys. Therefore, the initiative enables the basic health professionals to conduct community health promotion activities ranging from maternal, newborn and children health, sexual and reproductive health services, health literacy and promotion, communicable and non-communicable diseases control capacity through empowering training of those staffs through mobile learning platforms via use of tablets.

Investing in health is essential not only to improving health outcomes but also to supporting social, economic and environmental growth and development in Myanmar. With the rapidly increasing mobile network coverage and internet connectivity, the initiative has equipped the basic health professionals with basic infrastructure and innovation to expand access to affordable and quality community health care services for millions of people in Myanmar. Through more effective health promotion, disease surveillance and health care management through mobile tablets, the Ministry becomes more efficient in health care provision to people in rural and remote areas of Myanmar.

The health care and community health provision have been challenged by accessibility to quality of health care especially in rural remote and ethnic areas in Myanmar. In Myanmar, Township and Station medical officers and Basic Health Staff are major health care givers in rural and remote area, where 70% of population including ethnics group reside. MoHS has launched Information Technology (IT) supported capacity building program through distribution of mobile tablets to those health care givers, with the objectives of enhancing their ability, promoting health literacy of community and providing effective and efficient health care to public. It is served as a knowledge sharing platform and also provides ICT support services for health facilities. The tablet contains standardized health messages, essential manuals, guidelines and standard operating procedures (SOPs) for health professionals regarding public health care, medical care, laboratory, food and drug administration, planning, budgeting and staff affairs and research. Therefore, imbuing Basic Health Staff with Information Technology would accelerate the momentum of our efforts for improving overall health status of the population, leaving no one behind.

Through mobile tablets, the health professionals can access many health applications that promote women and reproductive health in Myanmar, including Safe Delivery application for maternal and newborn care, Love Question Life Answers for adolescent reproductive health, both on line and off line. Further, the mobile tablets updated with latest guidelines, manuals and standardized health messages for women and reproductive health care services targeted for those living in rural, remote and ethnic areas in Myanmar.

The initiative aims to promote the health of communities living in rural, remote and ethnic areas in Myanmar through mHealth. With the leadership of the Ministry of Health and Sports Myanmar, eHealth division has been working relentlessly to install ICT infrastructure for the initiative "promoting community health through mobile technology" and linking its components for effective health care deliveries. Since 2018, when the project has been initiated, eHealth led the distribution of 30,098 tables to 25,868 basic health professionals in 17 states and regions in Myanmar. By using those mobile tablets, basic health workers have conducted health education sessions, maternal, newborn and reproductive health activities, disease surveillance and public health emergency response including ongoing COVID-19 pandemic in Myanmar. In addition to routine community and public health activities, those mobile tablets are being used for case based data collection and electronic recoding, reporting and contact tracing of COVID-19 cases in Myanmar.

The initiative was implemented in August 2018 with the initiation of distribution of mobile tablets one state after another. Till November 2020, eHealth division has distributed 30,098 tables to 25,868 in all states and regions in Myanmar. The eHealth division developed a Enterprise Architecture and robust IT infrastructure for development, maintenance and monitoring of mHealth based Health care services through mobile tablets. Training of Trainers and Multiplier trainings on effective use of mobile tablets were conducted before distribution. IT and Administration support team was established at Central (eHealth division) and State and Regional MOHS level for maintenance, technical and administrative support for basic health professionals for effective use of mobile tablets for community use. Continuous assessment of their application, feasibility and challenges are monitored by Mobile Device Management System and periodic assessment surveys through internet and software.

The major challenges were digital literacy of basic health professionals who utilized mobile tablets for community health promotion. The logistic of distribution and maintenance of mobile tablets and development of mobile applications, software and tools for support of community health activities at primary health care level. The capacity building trainings in person, via video conferencing, webinars and tutorial video lectures were conducted to improve digital literacy of users. The central and regional level management and support teams are formed at ministerial central and state/regional level to provide digital and technical support for the initiative to overcome challenges.

The initiative is the first comprehensive mHealth project compiling health promotion, capacity building and mobile based applications for promotion of community health through distribution of mobile tablets and development of nationwide IT architecture and infrastructure in Myanmar. This project also targets the rural and ethnic communities who had suffered poor access to quality health care in Myanmar. The project enables the basic health professions working in the rural remote areas to provide health promotion and community health care services effectively and efficiently by means of mHealth application.

The emergency of mHealth is occurring in many countries through experimentation with different technologies in many health settings. This initiative has provided an innovative and instantaneous ways of communication and support from the central level to the grassroot level health care workers for community health promotion in the resource limited developing country. Therefore, it would set a remarkable model for many other resource limited settings for health promotion and community health.

The significance of the initiative is use of mobile device management which serves as a tool for instantaneous and effective way of providing technical support and communication from the central level management and policy making level to primary health care level of implementation and community through mHealth. It is also an effective digital solution to overcome the challenges of access to quality health care and health inequalities encountered by the government.

The initiative was originally implemented in 7 states and regions in 2018 and 2019, expanding to all (17) states and regions in 2020. The establishment of IT architectural blueprint and infrastructure enabled the rapid expansion of the initiative in almost all states and regions in Myanmar. The Mobile Device Management System is the key to overall IT structure of promotion of community health through mobile tables in Myanmar. The initiative has become the fundamental framework for developing " COVID-19 Database Management System" when the pandemic occurred in Myanmar in 2020. The tablets are currently utilized for databased entry, reporting and management for COVID-19 cases at clinics, field hospitals, quarantine sites, testing and treatment centers in Myanmar since October 2020. It highlights the successful adoption of established mHealth activity for prompt and effective response for public health emergencies and pandemics.

It has been transferred to all states and regions in Myanmar. The regional and state level ministry of health and sports also takes part in the coordination and technical support for the initiative in terms of organizing health information and messages, hardware maintenance and distribution. The central eHealth division oversees and monitors the activities conducted through mobile tablets and application and share it with the central, state and regional MoHS for further improvement and adjustment of the public health programs at primary health care levels.

The initiative is supported financially mainly by the Ministry of Health and Sports . The core users of the initiative are basic health professionals who are working for community health and public health preventive services at primary health care level in Myanmar. IT blueprint infrastructure and framework has been designed, implemented and maintained by eHealth division of the Ministry of Health and Sports, Myanmar.

The initiative requires minimal financial for maintenance of IT infrastructure and mobile application. The mobile tablets last minimum of 7-10 years for usage. As eHealth division of the Ministry of Health and Sports leads the technical support, the capacity has been institutionalized within the ministry and it also ensures the sustainability at central as well as state and regional levels through access to administration and maintenance of the initiative at different levels of MoHS.

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The effective use of mobile tables by basic health professionals are evaluated with the use of Mobile Device Management (MDM) System by eHealth division of Ministry of Health and Sports. MDM System provides data on how and what mobile applications are used for non-communicable disease control and prevention, maternal and reproductive health, health education, health information and reporting.

Mobile Device Management System is used to evaluate the time of usage of mobile tablets and application installed for public health promotion and the data are analayzed by eHealth division for effective use of mobile tablets for community health promotion by basic health professionals at primary health care level. The data are fed into different public health programs for the progress of the programs at grass root level.

The maintenance of hardware after five to seven years of initiative will be a challenge. There has bee a development of plan for maintenance of hardware devices. The quality of community health services provided by the basic health professionals through mobile devices is still a challenge too. However, the usage data on mobile device and applications has been analyzed for more effective use of data for effective implementation of community health promotion and mHealth related activities n Myanmar in the upcoming years.

The initiative was launched by the leadership of eHealth Division of the Ministry of Health and Sports. The eHealth division at central MoHS coordinates with different public health programs under the Ministry, which are non-communicable diseases control division, communicable diseases control divisions, maternal and child health division, occupational and environmental health division, health literacy and promotion unit, nutrition and school health division of department of public health, and medical services and food and drug administration department to update and manage community health related health messages and materials to the basic health professionals and then to the community in rural and ethnic areas in Myanmar. The initiative strengthens the existing public health and community health services in Myanmar, especially in rural and remote areas in Myanmar through innovative mobile health infrastructure development and maintenance. The initiative also links with the existing health information management system and enhances electronic based routine health information and periodic survey data collection in Myanmar.

The community at rural, remote and ethnic areas in Myanmar is the largest and crucial stakeholders of the initiative. The main focus of the initiative is promotion of health literacy in the rural remote communities in Myanmar through innovative mHealth approach. The existing standardized health messages related to non-communicable diseases, communicable diseases, maternal and child health, reproductive health, occupational and environmental health are converted into electronic version and continuously updated through mobile application and use of mobile tablets between central level MoHS and Basic Health Professionals at primary health care level. It also engages various public health implementers on a single platform of mHealth developed on mobile tablets distributed by the Ministry. It also dramatically reduces the overburden of different tasks of basic health professionals as they can organize and compile all of their administrative documents, routine reporting, health information and health literacy services targeted on different public health problems and their own capacity building through innovative mHealth approach. Further, central level MoHS can easily modify, disseminate the health information and administrative messages to the primary health care works and obtain feedbacks from them in prompt and effective manners. It in turn improves public health in the community.

The mHealth approach has become popular and beneficial in public health especially in the low and middle income countries like Myanmar. The rapid expansion of mobile network and ubiquitous presence of mobile phones and internet in Myanmar has increased the potential of use of mobile technology in community health promotion dramatically in the recent years. The Ministry of Health and Sports has grasped this opportunity to alleviate the inequality in health in Myanmar, especially for people in rural and remote areas. The eHealth division of MoHS has become the main architect of the initiative " community health promotion through mobile tablets " in Myanmar. The initiative has created the crucial infrastructure of data collection, case identification and contact tracing, clinic management and data informed decision making when the COVID-19 pandemic hit Myanmar in August. The COVID-19 Database Management System via distributed mobile tablets through this initiative, has been developed recently and has applied in COVID-19 quarantine, diagnostic and treatment centers in all states and regions in Myanmar since November 2020. This highlights that this established initiative enabled the Ministry to develop and apply the crucial health information and management system in the time of public health emergencies.