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.