Evaluation of primary health care system in Yangon Region, Myanmar: a mixed-method approach

Abstract Background Many low- and middle-income countries and international organizations have invested resources to strengthen primary health care services. Despite efforts from the Ministry of Health on primary health care, barriers to accessing health care services and health inequality in Myanmar still exist. This study aimed to identify the challenges and unmet needs in the current primary health care services by assessing the experiences and perceptions of healthcare workers and local leaders in three townships (Htantabin, Hmawbi, and Taikkyi) in Yangon, Myanmar. Methods The study was conducted among healthcare professionals and community leaders in three townships. By adopting a mixed-method approach, a cross-sectional health needs assessment survey was conducted for quantitative data (n = 66), and focus group discussions (15 group discussions) were conducted online for qualitative data. Results As a result of the survey regarding six domains; hygiene, primary medical care, maternal and child health, infectious diseases, non-communicable diseases, and leadership, enhancing the management and leadership capacity had the lowest average score on the current achievement (2.81 out of 5), while strengthening infectious disease control service and accessibility was perceived as the highest mean on the priority of intervention (4.28 out of 5) and the impact of the intervention (4.7). The focus group discussions revealed that while specific infrastructures and equipment necessary for the category were addressed, the need for financial support has been the recurrent theme throughout the discussions. Conclusions Utilizing the World Health Organization’s six-building block framework, our findings suggest that a long-term targeted financial investment in the primary health care system is critical in Myanmar by increasing health care expenditure per capita. At the same time, related barriers and facilitators should be considered to optimize the effectiveness of prioritized interventions. Key messages • Health care providers and local leaders perceived the management and leadership capacity as the lowest current achievement. • A long-term targeted financial investment in the primary health care system is critical in Myanmar.


Background:
According to the NCDC (Tbilisi, Georgia), in 2015-2019, thyroid cancer ranked second in the cancer structure of cancer in Georgia. Additional studies are needed to identify the thyroid cancer incidence by regions and municipalities of Georgia.

Results:
Ranking and proportion of thyroid cancer in female population of Georgia in 2015-2019 according to the regions and municipalities, its age specifics and dynamics were determined. Incidence of thyroid cancer in women in Tbilisi (ASR = 52.4%000; AAR = 64.1%000), compared to Georgia (ASR = 34.4%000; AAR = 41.0%000), indicates that Tbilisi is the geographically highest prevalence zone for this site cancer and the highest levels were observed in the 25-69 age group (TASR25-69 -Georgia = 110.8%000, Tbilisi = 190.1%000). In dynamics, the incidence of thyroid cancer in the 27-year period (2015-2019 vs 1988-1992) according to the SIR, increased by 66.4%. According to the cumulative risk index (CR64, CR74), the municipalities, where the risk of developing thyroid cancer is almost 1.5 times higher than the total rate in Georgia, were identified. According to the PIR, the ratio of thyroid cancer to the share of thyroid cancer in the structure of cancer in the regions of Georgia (including Tbilisi) showed that the proportion of thyroid cancer in Tbilisi (PIR = 117.7) is 17.7% higher compared to proportion of total thyroid cancer in Georgia.

Conclusions:
It is recommended that the epidemiological map of thyroid cancer incidence be used in planning national, regional, and municipal preventive programs. Key messages: It is recommended to continue study in this direction: retrospective review of histological and histochemical features of each case of thyroid cancer. It is recommended: to conduct molecular (oncogenes) studies in conjunction with histological and histochemical studies.

Background:
Many low-and middle-income countries and international organizations have invested resources to strengthen primary health care services. Despite efforts from the Ministry of Health on primary health care, barriers to accessing health care services and health inequality in Myanmar still exist. This study aimed to identify the challenges and unmet needs in the current primary health care services by assessing the experiences and perceptions of healthcare workers and local leaders in three townships (Htantabin, Hmawbi, and Taikkyi) in Yangon, Myanmar.

Methods:
The study was conducted among healthcare professionals and community leaders in three townships. By adopting a mixedmethod approach, a cross-sectional health needs assessment survey was conducted for quantitative data (n = 66), and focus group discussions (15 group discussions) were conducted online for qualitative data.

Results:
As a result of the survey regarding six domains; hygiene, primary medical care, maternal and child health, infectious diseases, non-communicable diseases, and leadership, enhancing the management and leadership capacity had the lowest average score on the current achievement (2.81 out of 5), while strengthening infectious disease control service and accessibility was perceived as the highest mean on the priority of intervention (4.28 out of 5) and the impact of the intervention (4.7). The focus group discussions revealed that while specific infrastructures and equipment necessary for the category were addressed, the need for financial support has been the recurrent theme throughout the discussions.

Conclusions:
Utilizing the World Health Organization's six-building block framework, our findings suggest that a long-term targeted financial investment in the primary health care system is critical in Myanmar by increasing health care expenditure per capita. At the same time, related barriers and facilitators should be considered to optimize the effectiveness of prioritized interventions. Key messages: Health care providers and local leaders perceived the management and leadership capacity as the lowest current achievement.

Background:
The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs).

Methods:
Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis.

Results:
Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge.
(2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels.
(3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC.
(4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy.

Conclusions:
Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients.

Key messages:
Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. Tailored SC support should be an integral part of comprehensive cancer care.

Background:
Health education for promoting healthy lifestyle from early ages is considered to be important. However, this issue has not been thoroughly examined in Georgia. The research, undertaken on adolescents, aimed to analyse adolescents' lifestyle, awareness and attitudes towards healthy lifestyle.

Methods:
The study applied a mixed methods design and included both, qualitative and quantitative research methods. 145 students aged 17 to 23 years participated in the research. In order to evaluate the adolescent's perceptions and attitudes, qualitative individual interviews with university students were conducted. For the quantitative method, a self-administered questionnaire assessing the level of adolescents' awareness and attitudes towards healthy lifestyle was developed.

Results:
This section presents preliminary findings of the study. We found that more than 67% of adolescents were aware on the importance of healthy lifestyle. However, most of the participants did not transfer their knowledge into practice. The participants found it challenging to maintain healthy eating habits due to increased costs of healthy, organic food. The study also confirmed the need for integrated work of public, governmental, and non-governmental organizations to initiate and implement health promotion programs for children and adolescents.

Conclusions:
Overall, the study found that even though adolescents are aware about the importance of the healthy lifestyle, it is challenging for them to maintain it. In order to change adolescents' attitudes towards unhealthy behaviour, it is necessary to carry out targeted interventions.

Key messages:
Health education is a necessary component for healthy lifestyle. Healthy lifestyle requires careful study of the issue and making evidence-based conclusions.