Feasibility Study on Improvement of Maternal Health in Rural Areas in Central Myanmar by Using the Remote Medical Care System "XMIX". | JOICFP - Japanese Organization for International Cooperation in Family Planning

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

Projects

Overcoming socio-cultural and decision-making barriers to family planning and maternal health services in rural areas of Myanmar
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”.