The RCGP Myanmar Volunteers have been actively working with Myanmar since 2013 to improve the quality of Myanmar General Practice. Each year we like to share our progress and some of the successes and challenges our colleagues in Myanmar are experiencing.
We received funding from Myanmar Emergency Fund
The Myanmar Emergency Fund (MEF) is an FCDO-funded programme which aims to help Myanmar build a stronger, more resilient health system and make progress towards universal health coverage (UHC) through improved health service performance for poor and vulnerable populations, ultimately contributing to ending preventable deaths.
The RCGP has been awarded funding for our work in Myanmar, specifically for the project “Improving Health Outcomes in Myanmar through Strengthening Myanmar GP Capacity”, which runs from 1 May 2022 to November 2023.
Continuing Professional Development of Myanmar GPs
We continue to provide twice monthly Zoom webinars on a wide variety of medical topics orientated to general practice - in addition to Myanmar diaspora GPs and hospital specialists, these have also included other non-Myanmar NHS hospital consultants. The topics include Managing and Diagnosing Thyroid Disease (Consultant Physician, Norfolk and Norwich NHS Trust), Managing Giddiness (GP Trainer Leicester), Management of Venous Thrombosis in Primary Care (Consultant Haematologist, Plymouth NHS Trust).
Between 100-250 Myanmar doctors and GPs from all over Myanmar attend the webinars.
Providing education resources for Myanmar GPs
Learning needs survey of Myanmar GPs
Although we have asked for feedback from the Myanmar GPs through regular meetings with our partner, Myanmar GP Education, and following webinars, it remains a challenge understanding how they learn and what are their learning needs. A survey of Myanmar GPs was carried out by the International Global Health Fellow working together with colleagues from Myanmar GP Education.
Here are some interesting points from the survey:
- Doctors use books/guidelines/websites mostly from the UK, US and Myanmar
- They would like to know more about a wide range of topics - a few that came up most often were child health, elderly care, mental health, dermatology and orthopaedics
- A wide range of specific resources used - UpToDate, Medscape and Z-waka were mentioned
- The majority learn best from formal short courses, webinars, lectures or interactive sessions/group discussions
- Time and internet access are the main barriers to accessing CME - only 52.6% of respondents have reliable internet at all times
Developing a Myanmar GP Education website
At present, the recorded webinars and education resources such as guidelines are uploaded onto the Myanmar GP Education Facebook page for Myanmar GPs to access at their leisure. However, we're finding that resources on Facebook are not that easy to find especially after a few months. The RCGP has also been provided with access to major UK GP education resources such as Red Whale GP CPD.
To make the best use of such excellent resources we felt that a Myanmar GP Education website would be the most effective way to upload the resources and for Myanmar GPs to access.
The Quality Improvement (QI) Programme
- Progress continues despite the uncertainties and trauma in Myanmar
- Two new QI Intro-courses have started in February, one with a quality assurance pilot project. Each course has 15 participants in each course x2 =30 Myanmar GPs.
- There continues to be very good engagement from Myanmar GPs
- Enthusiasm seems to be increasing rather than dropping off which we're delighted by
Organisational Development Course
Organisational Development training started in March 2022 in response to a request by 20 GPs in Myanmar who had formed themselves into a group sharing the commitment to change. They recognised that they needed help to develop the leadership skills they needed to establish and run their new organisation, Myanmar GP Education (previously Myanmar Association of General Practice, MAGP) to support GPs in Myanmar.
Monthly workshop topics include, Leadership & Organisational Development Introduction, Covey Habits of Highly Effective People, Teamwork: Creating goals & Effective Teams, Motivation & Change Management.
The RCGP Myanmar Trainer Group is reviewing the courses offered and in future much of this material as well as 'training the trainers' will be incorporated into a course for Quality Champions.
The overall aim is to build a cohort of GPs in Myanmar who can deliver QI training to their colleagues. A stand-alone Organizational development course will also be offered, so we're looking forward to bringing that to life.
Challenges faced by our partner organisation in Myanmar: Myanmar GP Education
As well as all the positive outcomes and successful projects that we're part of, it's fair to say that we're still up against some difficult challenges.
Access to healthcare
- Martial law, violence, and internally displaced people (especially in NW & SE, ethnic states, rural areas, and hard-to-reach areas)
- Reduced affordability (high cost of medication-double price, policy changes in drugs import, hyperinflation, exchange rate fluctuations, rocketing commodity price)
- Challenges in getting drugs for TV, HIV, and Malaria cases
- Poor access to secondary care (limited human resources, CDMers, some are not-operationalized) and private hospitals (expensive)
GP healthcare provision
- Acute, chronic, and preventive cares are immense challenges, especially for pregnant women, elderly, and other vulnerable groups
- Rising cases of Covid-19
- Lack of Covid-19 Immunizations
- Lack of Childhood Immunizations
- Lack of support from the hospitals for both patients and GPs
- Increased workload for GPs
- Sustainability of GPs' clinics, and setting up of clinics in new places due to high rental cost of clinic space
- Local people are having difficulty consulting with their GPs from declining socio-economic status
Lack of space for medical organisation
- Restriction, scrutiny and under surveillance and group work at risk - New Association Registration Law, compulsory registration of all organisations
- Difficulty with accessing project funding
- Shortage of electricity supply and internet connectivity (Online networking, electronic medical record process)
Despite the challenges our volunteers face in Myanmar and the risks under which we often practice, we're very proud to see steady improvements and positive outcomes where we operate. We have a longstanding relationship with GPs in Myanmar and our commitment to improving family medicine for our international colleagues and patients continues.
About the writer
Dr Sonny Aung is a member of the RCGP Myanmar Volunteer Group