Myanmar

Projects

Project for Improving Reproductive Health at Primary and Community Level
Program for Improving Female Personal Hygiene through School Health Education among Young Girls (Phase II)
Feasibility Study on Improvement of Maternal Health in Rural Areas in Central Myanmar by Using the Remote Medical Care System “XMIX”.

Project for Improving Reproductive Health at Primary and Community Level

Country	Myanmar
Project Strengths	Working together by all community for mother’s health Promoting maternal and reproductive health status of women
Implementing Partners	Ministry of Health and Sports (School Health, Health Literacy Promotion and Maternal and Reproductive Health from Department of Public Health)
Supporting Agencies	Japan International Cooperation Agency (JICA)
Project Period	3 years (September 2017 – August 2020)

Description of SRHR Needs

In Myanmar, SRH related indicators are still high compared with neighboring countries in ASEAN. Ex. MMR (Maternal Mortality Rate) is 282, Neonatal Mortality Rate 25 and IMR (Infant Mortality Rate) 61.8 (Source: 2014 Census).
Bago Region is one of the areas which shows lower RH/MCH indicators, such as 316 for MMR, 43 for neonates, and 61.9 for IMR (Source: 2014 Census).
In Thegone and Phaukhaung Townships, Bago West Region, where the above-Project will be implemented, one of the major reproductive health issues is low rate of deliveries attended by skilled birth attendants (SBA) (approx. 20)

JOICFP’s Intervention

Overall Goal	The Maternal and Reproductive health status of women is improved in the project area.
Project Purpose	Women’s access to better quality services increases in the project area.
Target Area and Population	People living in Thegone and Phaukaung Townships, Bago West Region (Total Population 255,800), especially women during pregnancy, delivery and post-delivery (Total 3380) and women in reproductive age (15-49) (Total 73.080) are among the target scope.
Uniqueness in the Approach	In order to improve access to quality health services by rural women, JOICFP recruits “MCHPs” (Maternal and Child Health Promoters). MCHPs are female volunteers from the village, with each covering 30 households. MCHPs support government health workers (so called Basic Health Staff / BHS) in providing health education and awareness-raising, and serves as a cultural bridge between community women and BHS. The MCHP system was originally jointly developed by JOICFP and Ministry of Health and Sports of Myanmar, with support from JICA, based on the similar existing volunteer system in Japan. MOHS took over the MCHP system in 2010.
Activities	Conduct training on community participation targeted for government health staff called BHS (Basic Health Staff) and community representatives Develop Community Action Plan (CAP) through annual participatory workshop by BHS and community representatives, and undertake activities according to CAPs Conduct refresher training for MCHPs, including mutual-observatory visits by some MCHPs selected as “out-standing” Conduct health education / promotion activities by MCHPs Conduct skill training for BHS, especially for midwives. Organize dissemination workshop to share achievements, outcomes, good practices and lessons learned to the other areas in Myanmar.

Project Outcomes

Community capacity is enhanced to create an environment in which women and women during pregnancy, delivery and post-delivery have easier access to reproductive health services.
Activities conducted by Maternal and Child Health Promotors (MCHPs) are sustained and strengthened.
Services and information on RH provided in the project area are improved.

Projects

Program for Improving Female Personal Hygiene through School Health Education among Young Girls (Phase II)

Country	Myanmar
Project Strengths	Promoting Menstrual Hygiene Management Education through Public-Private Partnership
Implementing Partners	Ministry of Health and Sports (School Health, Health Literacy Promotion and Maternal and Reproductive Health)
Supporting Agencies	Unicharm Co,. Ltd and MYCARE Unicharm Co,. Ltd
Project Period	1 year (April 2017 – March 2018)

Description of SRHR Needs

There are few adolescent health education models in the country that targets female students in their early teens, even though the government of Myanmar has strong focus on adolescent health.
Receiving information and services, for especially young girls regarding changes of the body through adolescence seems to be available but still considered as a taboo.
A large gap exists between urban and rural areas regarding access to health-related information and services. For example, the usage rate of sanitary napkins in the urban areas are as high as 90%, whereas the rate is around 30% in the rural areas.

JOICFP’s Intervention

Goal	Through personal hygiene education, young girls in Myanmar will learn appropriate knowledge regarding their physical growth during puberty, and how to use the knowledge correctly.
Target Area and Population:	Total 300 schools and 90,000 people from 3 regions (15 townships) of Ayeyarwady Region, Bago Region, Nay Pyi Taw Union Territory.
Uniqueness in the Approach	The first female personal hygiene education materials were developed with approval by the Ministry of Health and Sports, Myanmar, which were test-used in the School Health Program of the Government Schools by applying the education materials developed by Unicharm Co. Ltd., one of the top share companies of feminine care products.
Activities	Create core team and organize state/regional advisors meeting for capacity enhancement of core trainers both at central government and state/regional levels In the each 3 project Regions, conduct Regional trainings for trainers of female personal hygiene education including from the 5 previous project townships In the 3 project areas, conduct female personal hygiene education activities at the township level targeting girl students in 5-9 grades(15 Townships) Periodical Monitoring of utilization of the education materials

Project Outcomes

Knowledge on their own body and changes during puberty increased, focusing on menstruation and care during this period among young girls
Appropriate care and utilization of disposable sanitary napkins promoted among young girls and their guardians
In line with the Myanmar National School Health Strategy (2017-2021), contribute to the enlargement of personal hygiene education for female students in collaboration with the School Health Division, Department of Public Health, Ministry of Health and Sports

Projects

Feasibility Study on Improvement of Maternal Health in Rural Areas in Central Myanmar by Using the Remote Medical Care System “XMIX”.

Country	Myanmar
Project Strengths	Introduction of “XMIX”, a remote medical care system to reduce disparities between urban and rural areas in Myanmar in providing MNCH services, aiming at Universal Health Coverage (UHC)
Implementing Partners	TRIART (a Japanese IT development company which has developed XMIX: Remote Medical Care System through a smart phone application, http://triart.co.jp/ ) Ministry of Health and Sports (MOHS), Myanmar
Supporting Agencies	Japan International Cooperation Agency (JICA)
Project Period	Oct. 2016 – Sep. 2017

Description of SRHR Needs

In Myanmar, around 70% of the population reside in rural areas. The Ministry of Health and Sports (MOHS) of Myanmar has decided in centering resources and interventions to beneficiaries residing in rural areas; specifically, mothers, newborn babies, and children under the age of five. MOHS is also committed in reducing the gap of access to health care between those who live in the urban and rural areas, with a vision to realize Universal Health Coverage (UHC) by 2030.
Studies and researches by UN agencies have revealed that the Maternal Mortality Rate (MMR) in the country is 178 per 100,000 live births, and the Infant Mortality Rate (IMR) is 40 per 1000 live births (2015). This is second worst among the 10 ASEAN countries, only after Laos. These figures need to be improved immediately.
According to studies, most of the deaths of pregnant women have occurred at home or on their way to health facilities. The MOHS recognizes the needs of a well-organizedsystem to ensure timely access to emergency health care.

JOICFP’s Intervention

Goal	To establish a remote medical care system covering the rural areas of Myanmar. This will help improve statistics such as maternal, neonatal, child mortality, as well as morbidity.
Survey Area	Selected four (4) townships, namely, Natmauk, Taungtwingyi, Myo Thit, and Sinbaungwel in Magway Region of central Myanmar (Population of Magway Region : 4,093,406 according to the 2014 Census with 25 townships. This is one of the regions where the MMR and IMR levels are highest in Myanmar)
Uniqueness in the Approach	XMIX, a remote medical care system implemented through a smart phone or tablet application, does not require to a server, and ensures high security levels. JOICFP’s senior official will join the study mission as a specialist on MNCH, to make assessments of the effectiveness of XMIX, and advise on how XMIX could be utilized to to improve the MNCH conditions in Myanmar.
Activities	Interviewing, exchanging opinions, and collecting information at various UN agencies including the WHO, UNICEF, etc. Interviewing, exchanging opinions, and collecting information at various MOHS offices including the Central, Regional and District offices as well as selected 4 Townships. Visits will be conducted at Station Hospitals, Rural Health Centers (RHC), and Sub-Rural Health Centers (SRHC), with interviews scheduled with medical professionals and co-medical staff. Interviewing, exchanging opinions, and collecting information at IT related organizations and private companies 4-Discussion and exchange of opinions related to remote medical care system with senior officials of MOHS, Japanese experts, and so on.

Project Outcomes

A feasibility study team was dispatched to the Magway Region five times to conduct above mentioned activities. Although the team recognizes some technical development is needed on releasing the Android version of the original application, the project was given a green light. Some of the findings and recommendations as of interim report in June are copied below. The final report will be prepared by the end of September 2017:
　
Necessity for MOHS to have her own secured communication application in the near future.
To protect personal medical information and confidential information among health personnel, it is not recommended to use so-called commercial applications in the near future. Applications such as Facebook and Viber are widely used among health care personnel as a daily communication tool, but it is essential to avoid professional use of such SNS tools. What XMIX is proposing is to implement the application to be used as a hotline with high security between the MOHS and medical personnel. Soon enough, the heavy reliance on existing commercial applications will become a great risk from the “security perspective”. Confidentiality between the Ministry of Health and health personnel are a major risk factor, with severe medical and ethical consequences expected to rise in the near future. Therefore, we propose the introduction of an exclusive communication application such as XMIX to ensure data security and confidentiality at the MOHS.
　
Cost-effectiveness of not requiring a server to use XMIX will become immeasurable in the future.
Currently, the recommended XMIX configuration has the advantage of not requiring a fixed server, which the end-user will not be aware of. Using a dedicated communication application such as XMIX, which does not need a server, will result in large reduction of potential infrastructure costs.

XMIX being a highly versatile application,connecting with other medical examination equipment
One strength of XMIX is its ability to connect with other medical examination equipment. It will greatly improve the ability to remotely diagnose patients if it becomes possible to connect XMIX with crucial equipment for providing medical diagnosis such as X-ray or ultrasonic diagnostic equipment, if they were connected between medical facilities in a timely manner. Once the network is established, it is expected to spread the application as a remote medical system to conduct diagnoses quickly and accurately. Examination results, images, and information of the patient’s overall physical condition such as his/her facial expressions and complexions can be sent as a picture or video to experts or senior doctors, thereby making the diagnosis more accurate.

From the provider’s point of view, using XMIX as a remote medical care system that connects experienced or specialized doctors with younger or more inexperienced doctors is highly beneficial
It was clarified in this interview survey that young doctors working at station hospitals in rural areas felt a lot of “anxiety” associated with solitude and isolation in the operating room. It was also found that how reassuring it was if they could receive advice from specialists and experienced doctors via XMIX. In another aspect, it will also be effective in enhancing mentorship between junior and senior doctors. XMIX will be an effective tool for specialists / experienced doctors and young doctors who are located apart to connect and consult for or provide advice. XMIX can provide live footage during surgery, so the remote doctor can check the operative field and condition of the patient through the camera to advise on surgery policy and procedures. Receiving real-time advice will be reassuring to junior doctors, and will enhance effective skill-transfer.

Using XMIX as an educational tool for public health
As in hospitals, XMIX can be used in townships to provide remote medical services with a doctor providing advice and diagnosis to local nurses/midwives. However, it is recommend to the use XMIX as an education and leadership support system in the public health field. A Township Medical Officer (TMO) could use XMIX to provide general health information and educational guidance to co-medical staff. Content could vary from emergency procedures, seasonal infections and health conditions, managing infectious diseases and using the emergency medical system. The host can broadcast multiple content to various end-users at the same time, so the end-users can use the system whenever they like. For example, the township medical officer (TMO) can record and send video messages for co-medical staff scheduled to be aired 3 times a day, so everybody can see the video at their convenience. As XMIX is a secured application, any content provided online will only be available for those who have access.

XMIX as a tool to gather epidemiological information to improve public health, nationwide medical service
Currently, per estimates by UN agencies, the 2,800 mothers die during pregnancy or childbirth in Myanmar in one year. While the cause and situation of each person be different, it would be helpful to collect scientific data to reduce maternal mortality. Midwives can use XMIX combined with GPS location tracking system to record maternal mortalities on the spot, which will be collected to be used for mapping and analysis by MOHS. This kind of demographic data collection could also be done for other epidemics and diseases. This data will help the MOHS to build comprehensive policies and provide insight for effective decision-making. With the participation of 22,000 midwives (Health in Myanmar 2014) deployed nationwide, would make these epidemiological surveys credible. The almost real-time data collected by midwives would contribute not only in improving the HMIS (Health Information Management System), but also in ensuring more robust public health and medical services in the future.

XMIX will be the go-to device for achieving Universal Health Coverage (UHC) by 2030
MOHS is diligently working on achieving UHC through the delivery of medical services to all citizens of Myanmar. This should be realized through due handling of personal information. A dedicated and secure application like XMIX will be very helpful in making this goal.

Additional Information: Attachments, Links, etc.

Refer to the MOHS website for further health and medical information.
http://mohs.gov.mm/home