MyanmarMedicalEmpowermentProject:
2016FinalReport
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SummaryTheinternationalcollaborationbetweenMananTrust,theShinKongLifeFoundation(SKLF),theMyanmarAcademyofFamilyPhysicians(MAFP),GlobalHealththroughEducation,Training,andService(GHETS),andtheBostonUniversity(BU)GlobalHealthCollaborativehelpedexpandupontheachievementsoftheTaiwan-MyanmarMedicalEmpowermentProject(TMMEP)pilotphase,whichwasinitiatedin2015.In2016,thecommencementofphasetwooftheTMMEPhasbeensuccessfulatextendingtheproject’sfirstphaseinthefollowingareas:
• PrimaryCareHumanResourceCapacityBuildingthroughcompletionofarigoroussecondleveltraining-of-trainersprogram
• UniversityEngagementandRelationshipBuildinginaseriesofongoingdiscussionswithuniversityleaders
• CreatingClinicalInfrastructurethroughsupportforadditionalclinicaltrainingsites• Organizationaladministrativestrengtheningthroughfurtherinstitutionaldevelopmentofthe
MAFP• PolicyReform&AdvocacycontinuedoutreachandsupportforFamilyMedicineinitiatives
ThemomentumfromtheactivitiesinitiatedinphaseoneoftheprojectcarriedintophasetwoastheprojecthascontinuedtoadvanceFamilyMedicinedevelopmentinMyanmar.TocontinuepreparationoffacultytoadministerafutureFamilyMedicinepost-graduatetrainingprogramforallgeneralpractitioners,theMAFPandGHETS/BUCollaborativejointlydesignedandimplementedthesecondTrainingofFaculty(TOF)course.The8-weekintensiveTOFLevel2courseemphasizeddevelopingandimplementingcompetency-basedevaluationandincludedPowerPointpresentations,lectures,groupandindividualassignmentsandaudio-recordings.ParticipantsbuiltonthecurriculumstheydesignedinTOFLevel1byselectingspecificevaluationmethodsforalloftheteachingcompetencies.Eachparticipantalsodesignedanactualevaluationtooltobeusedinclinicaltrainingandpresentedtheirworktofacultyandtheirpeers.Another“super-trainer”wasidentifiedamongthegroupoftheMAFPparticipantswhowillleadthedeliveryofTOFcoursesinthefutureandthusassistinsustainingcontinuedeffortsofFamilyMedicinedevelopmentinMyanmar.Throughout2016,theMAFPgainedsignificantrecognitionlocallyandglobally.TheprojectorganizationsentamembertorepresentMyanmarattheglobalmeetingoftheWorldOrganizationofFamilyDoctors(WONCA)inBrazil.Dr.KyawThurepresentedtheMyanmarGeneralPracticeSocietyandMAFPatWONCACongressandspokeonapanelshowcasingtheachievementsoftheMAFPtoaglobalFamilyMedicineaudience.Inadditiontopromotingtheproject’sprogressabroad,thisyeartheMAFPmadesignificantstepsforwardinitsmarketingandbrandingstrategies.Anofficiallogohasbeenestablishedtorepresentthebrandinamodernanduniquedesign,andanewwebsiteisscheduledtolaunchinearly2017.Finally,theprojecthasincreaseditsoutreachandsupportforFamilyMedicineinitiativesthroughexpandingthecollaborationbetweenkeypolitical,medicalandacademicfiguresinMyanmar.GreatprogresswasmadeinbuildingagrowingrelationshipwiththeUniversityofMedicine1andtheMAFP.Inaremarkablestepforward,theMAFPhasbeenabletoengagedirectlywiththenewMinistryofHealthaspartoftheirworkonachievingUniversalHealthCoverage,andaseriesofmeetingshavebeeninitiatedwiththeUniversityofMedicine1inYangontodevelopthefirstformalDepartmentofFamilyMedicineinMyanmar.
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Results/OutcomesThisfirstyear(ofthree)ofthesecondphaseoftheprojectfocusedoncontinuingorexpandingupontheworkinitiatedinthepilotphaseoftheTMMEPinordertoaccomplishtheproject’sgoalswhicharelistedbelowalongwithadetaileddescriptionoftheprogressmadeandthespecificoutputs.
1. StrengthentheprimarycarehumanresourceinfrastructureinMyanmarbypreparingprimarycareleaders,trainersandprovidersfordevelopingnewtrainingprogramsinFamilyMedicinedesignedtoimproveaccess,equityandqualityofcareforthepopulation
TwentydedicatedparticipantswhoattendedthefirstTrainingofFaculty(TOF)coursesuccessfullycompletedtheTOFLevel2coursethisyear.Thecoursemettwiceaweekforthree-hoursessionsoveran8-weekperiod.Theyfulfilledtherigorouscourserequirementsandincorporatedwhattheylearnedthroughthecompletionofthecurriculumevaluationfinalprojectsinadditiontofamilyobligationsandfull-timeclinicresponsibilities.TheirpersistentdriveandenthusiasmtocontinueimprovingupontheirteachingmethodswasremarkablethroughouttheentiredurationoftheTOF2course.UponcompletionofTOF2,participantscompleteda40-questionself-assessmentsurvey,ratedon4and5-pointLikertscales,with4open-endedquestions.Overall,themajorityofthesurveyrespondentsshowedapositivereviewoftheTOF2course.All17participantssurveyedagreedorstronglyagreedthattheyfeelcomfortablepreparingcurriculummaterialssuchaswritinggoalsandobjectivesandchoosingteachingmethods.AlloftheparticipantssurveyedagreedorstronglyagreedthattheywillusetheTOF2teachingtechniquesintheirworkattheMAFPandareexcitedtocontinuetheirtrainingintheupcomingTOF3course.
SomeattendeesattheTOF2closingceremonyonDecember12,2016
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Outputs:• SuccessfuldesignandimplementationoftheTOFLevel2coursewithaMAFPmember,Dr.
AungPyiSoebecomingthesecond“super-trainer”forfuturecoursesastheprojectexpands• 20locallytrainedMAFPleadersinFamilyMedicineeducation• Collationofcoursesyllabus,presentations,assignments,andrecordedaudio-lecturesto
serveasresourcesforfuturecourses• TOFLevel2ClosingCeremonyheldonMonday,December12th,2016andwasattendedby
MAFPmembershipandtheGHETS/BUCollaborativeExecutiveDirectorandMyanmarProgramManager
• Exceldocumentofthecompiledself-assessmentsurveyresultscompletedby17participants
2. ContinuingthedevelopmentofMAFPplanningandpreparingforthedevelopmentof
FamilyMedicineinMyanmarasacompletemedicalspecialtyThisyeartheMAFPfocusedonthepromotionoftheorganizationbysolidifyingitsmarketingandbrandingstrategies.TheprojectgainedglobalrecognitionattheWONCAWorld2016ConferenceheldinRiodeJaneiro,Brazil.Dr.KyawThurepresentedMyanmarattheWorldCouncilMeetingandspokeonapaneldiscussingFamilyMedicinecurriculumdevelopment.
Dr.KyawThuatthe2016WorldCouncilMeetingrepresentingMyanmar
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Outputs:• PowerPointpresentationfromDr.KyawThu’spanelattheWONCAWorldConferencefrom
October31st–November6th,2016• PromotionalmaterialsincludinganewMAFPlogoandlayoutfortheMAFPwebsitethatwill
offer:o AnoverviewofthebenefitsofFamilyMedicinetodoctors,patients,andMyanmar
medicalsystemo AnintroductiontoMAFPanditsMissionStatement,aswellasamessagefromthe
Chairman(Dr.TinAye)o AninvitationandapplicationforGPstojointheMAFPAssociateProgramo ANewsandEventssectiontoprovideupdatesofactivitieso AnoverviewofMAFPfaculty,administration,andinternationalpartners
3. Expandingthepromotionofpublic-privatepartnershipincollaborationbetweenprimarycareleadershipandinstitutionsandgovernmentalandacademicleadersandinstitutionsinanefforttocontinuetransformingprimarycaresystems
RecentyearshavebeenaturbulentandexcitingtimeinMyanmar,withrapideconomicandpoliticalchange.Ashasbeenestablishedpreviously,therearehistoricalpoliticalandstructuralchallengesthathaveactedassubstantialbarrierstosuccessfulcooperationbetweentheprivateandpublicsectorsinMyanmar.Whilethishasbeenayearofuncertaintyfollowingthehistoricelectionsof2015,theMAFPhasworkedaggressivelytomaintainandstrengthenitsrelationshipwiththeMinistryofHealthandSports(MOHS)andthelocaluniversitiesdespitesomeapprehensionamongthemembership.
GroundbreakingmeetingwithMAFPmembersandUM1leadershipinDecember,2016
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Notallinitialinteractionswereoptimallysuccessful,forinstanceastheUniversityofMedicine2expressedareluctanceorinabilitytoengageinagrantpartnershipwiththeMMEP.Morerecently,however,theMOHShasexpressedinterestindevelopingformaldepartmentsofFamilyMedicineintheuniversities–afirstandessentialsteptoembeddingmeaningfulprimarycareinfrastructurewithintheexistinggovernment-sponsoredhumanresourcecapacitybuildingsystemforhealth.Subsequently,theUniversityofMedicine1hasreachedouttotheMAFPforassistanceindevelopingthefirstdepartmentofFamilyMedicineinthecountry,andbothorganizationsarenowworkingonastrategicplanforpartnershipandjointactvities.Outputs:
• OngoingpositivemeetingsofMAFPandtheGHETS/BUCollaborativewithkeypolitical,medicalandacademicfiguresincluding:
o RectorsoftheUniversityofMedicine1toexploreMAFPcollaborationwiththeUniversityindevelopingadepartmentofFamilyMedicine
o MinisterofHealth,MyintHtwe• ProposalforFamilyMedicinetrainingsubmittedtoHealthMinisterMyintHtwe.
o ApprovalofthisproposalwouldallowtheMAFPtomoveforwardwithofficialjointplanningoftrainingsandseminarswiththeuniversity
• InvitationsandattendanceofMAFPleadershipatkeynationalmeetingsaddressingplansforUniversalHealthCoverageinMyanmar
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2016TravelScheduleoftheGHETS/BUCollaborative
TheMAFP/GHETS/BUCollaborativetookthefollowingtripsin2016inordertohelpguideandsupportin-personcollaborationwiththeMAFPandsupportotherprojectactivities:Dates:June1st,2016–June5th,2016Traveler:JeffMarkunsActivities:
• Strategydevelopmentwithentrepreneursfrom7DayMediatodiscusswebsitedevelopmentfortheMAFP
• MeetingwithMandalayMAFPrepresentativeMieMieHtayinYangontodiscussfuturepossiblesupportsforMandalay
• ShareprojectinformationwithMananTrustrepresentativesHeatherBrandandAndrewMcKeeinhopesofpotentialfuturefunding
• MeetingwithUniversityofMedicine2RectortoproposeanMOUandcollaborationwithMAFPandexploreoptionsforNIHgrant
Dates:October1st,2016–October3rd,2016Traveler:JeffMarkunsActivities:
• StrategydevelopmentwithMAMS,Prof.MaungMaungWint,advisortoMinisterMaungNayWinforadvocacywiththeMinistryofHealth
Dates:November11th,2016–November13th,2016Traveler:JeffMarkunsActivities:
• MidtermworkshopfortheTOFLevel2courseincludingcontentdeliveryandreviewofprojectwork
• StrategicplanningwiththeMAFPfororganizationaldevelopmentandpolicyandadvocacyplanningwithuniversitiesandgovernment
Dates:December11th,2016–December15th,2016Traveler:JeffMarkunsActivities:
• TeachingoffinalclassofTOFLevel2course• Planningoffuturetrainingprograms• TOF2ClosingCeremony• MeetingwithUniversityofMedicine1departmentheads,UniversityofMedicine2Rector,Head
ofMAMS,PresidentofMMA,VicePresidentofMMCandBurmeseMedicalAssociationofNorthAmericamembertodiscussstrategiestoestablishaFamilyMedicinedepartmentatUniversityofMedicine1
• MeetingwithMananTrustrepresentativesAndrewMcKee,QuanqiangXian,LilyTseandJoNhantodiscussmorefundingopportunitiesfortheproject
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LessonsLearnedAsmomentumfromthepilotphase’saccomplishmentscontinuedintotheopeningyearofPhase2,theprojecthasgeneratedlessonstobelearnedandappliedtoextendeddevelopmentsinMyanmar.
• TheTOFapproachoverallcontinuestobeasuccessfulmodelfordevelopingneweducationalskillsinalongitudinalformatwhilesimultaneouslydevelopingadditionalcurricularmaterials.
• AccordingtotheTOF2participantsurveyanswers:
o moreclear,specificexamplesshouldbeincludedinfutureworkshops.o moreopportunitiesforfeedbackonevaluationtooldevelopmentwouldbebeneficialo additionaltimeshouldbeallottedtoTOFworkshopsandgroupworkactivities
• TheprojectneedstocontinuetoworkondevelopingmechanismstocompensatetheMAFP
doctorssothattheycancontinuetoparticipateintheorganizationwithoutanypersonalfinanciallosses
• Initiatingprivatepracticesasformalclinicalteachingsiteshasbeenmorechallengingthan
anticipated,astheseactivitiespotentiallyinterferewiththefinancialsuccessofclinicoperations
• Someinitiallyplannedactivitieshavebeensomewhatdelayedandpushingintothenextcalendaryearasotherinternationalsupportandtrainingactivitiesresultedincompetitionforlocaltimeandresources:
o WhiletheGHETS/BUCollaborativehasmaintainedengagementwiththeRCGPastheyhaveindependentlyworkedwiththeMAFPandGeneralPracticeSociety,activitieshaveyettobeoptimallyaligned
o TheUniversityofSydneyinvitedmultipleMAFPmemberstoattendatwoweekimmersionprograminAustraliarequiringadelayintheinitiationoftheTOF2program
o TheMAFPhasnowdevelopedandreleasedanorganizationalstatementregardingengagementwithinternationalpartnersinanefforttobetteraligntheeffortsofallpartiesandshouldcontinuetobuildtheirleadershipinguidingtheintentionsofinternationalpartnersanddevelopanorganizedprimarycaretaskforce
• MaintainingfocusontheorganizationalinfrastructureoftheMAFPisvitaltothelongevityof
theorganization.Additionaltimeneedstobeallottedtofinalizingthecharter,approvingthegovernancestructureandrepresentation,onlinepresence,andongoingstrategicplanning.
• TheorganizationalsuccessoftheMAFPwilldependonbothmaintainingconsensusamongthe
membershipontheorganizationalgoalsaswellasworkingaggressivelytoexpandthepoolofmembers.
• Engaginginatruecollaborativepartnershipwithgovernmententitiesnowseemsrealisticand
possiblethankstothehardworkoftheMAFPwithsupportfromtheirinternationalpartners,whenonlyafewmonthsagoaformalpartnershipseemedmanyyearsaway.ItisimperativethattheMAFPcontinuetocapitalizeonthegoodwillandopennessofgovernmententitiestocontinuetoadvancetheiragendaandincreasetheirstaturewithinthecountry.
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ConclusionsandFuturePlansTheMAFPandtheGHETS/BUCollaborativecontinuetomakegreatstridesinaccomplishingthefollowingcorecomponentswhichwillremainkeyelementsthroughthenextyear:
1) StrengthenprimarycarehumanresourceinfrastructureinMyanmarbypreparingprimarycareleaders,trainersandproviders
2) Buildclinicalinfrastructuretosupporttrainingandclinicalservicedeliveryreforms3) FurthersolidifytheorganizationaladministrativecapacityoftheMAFPtosupportprogram
expansionthroughoutMyanmar4) Fortifyrelationshipswithgovernmental,academic,andprivateentitiesinanefforttopromote
primarycareandsubsequentpublicpolicyreformsinMyanmarTheMAFPinconjunctionwiththeGHETS/BUCollaborativewillcontinuetoenhancethecompetency-basedcurriculumandevaluationtrainingssothatlocalfacultywillbefullypreparedtobeginFamilyMedicinetrainingsinthenextphaseoftheproject.WiththerecentadditionofsupportfromtheMananTrust,theMAFPwillengagewiththeGHETS/BUCollaborativeaswellastheRoyalCollegeofGeneralPractitioners(RCGP)fromtheUnitedKingdomtoinitiateathirdphaseoftheTrainingofFacultyprogramthisspring,focusedondirectclinicalteachingintheoutpatientsetting.Thetrainingswillincludeapreceptorshipcomponentheldatthreeidentifiedclinicaltrainingsitesandtheparticipationofmultipleinternationalprimarydoctorsasfacilitators.Whileinitialeffortsatdevelopingprivatepracticesasoutpatientsiteshavebeensomewhatslowtodevelop,wewilllearnmoreasweinitiatemoreintensivetrainingactivitieswithintheprivateclinicsduringtheTOF3program.Havingfacedsomeofthepotentialchallengesininitiatingtheseclinics,coupledwiththenewopportunitytoengagewithUM1,webelieveachangeinstrategymaybewarranted.Ratherthanrelyingsolelyonindividualprivatepracticesastrainingsites,webelievealocalflagshiptrainingclinicmaybebeneficialandpotentiallynecessarytocreateasustainablemechanismfordeliveringformalprimarycaretraining.Wearecurrentlydevelopingpotentialplansforsuchaclinic,andexploringavarietyofmechanismsforfinancingtheinitialdevelopmentofsuchaclinic.Mostimportantly,theMAFPhasmadegreatinroadsinbuildingacollaborativerelationshipwithgovernment.Whiletheintensityofotheractivitiesdidnotallowforaformaladvocacyconferencewithinthiscalendaryear,weanticipatehostingsuchaprograminthecomingfewmonthsincollaborationwithgovernmententities.TheMAFPrecognizesthetremendousopportunityapotentialnewopportunitywithUM1provides,andspecificactivitiesinsupportoftheabovecomponentsmayneedtoberedesignedtotakemaximumadvantageofthisnewpartnershipandensuremutualbenefittobothparties.WearegratefulforSKLF’ssupportinfindingnewpartnerships,andtheadditionoftheMananTrustbringsanotherimportantpartnertothetable,allowingustoaccelerateourpaceofprogress.Wecontinuetoworkhard,withthesupportofbothSKLFandtheMananTrust,toidentifyadditionalfundingpartnerswhocanallowustocontinuetogrowtheprojectandourvisionwithanoverallcohesiveplanforprimarycaresystemstrengtheninginMyanmar.
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Budget
ThefollowingistheapprovedbudgetfromthepilotphaseoftheTMMEPprogram,withonemodification,andrepresentsfinancesasspentbyGHETS.BecausetheMyanmaruniversitieswereunabletoacceptfinancingthisyear,thismoneywasreappliedtoorganizationaloperationsfortheMAFP.TheMAFPandBUassubcontractorstoGHETSmaystillretainsomefundsascarryoverincalendaryear2017stilldedicatedtotheactivitiesasoutlinedbelowbutplannedforcompletionin2017.Notethe$171remainingintravelisnotactuallyintheGHETS/BUaccountsbutrathersimplyrepresentsfundsneverprovidedfromSKLFtoGHETSasaresultofthetotaltravelreceiptsbeingbelowthe$15000.originalbudgeted.