Sustainability of a mobile phone application-based data reporting system in Myanmar's malaria elimination program: a qualitative study

Abstract

Background: Strengthening surveillance systems to collect near-real-time case-based data plays a fundamental role in achieving malaria elimination in the Greater Mekong Subregion (GMS). With the advanced and widespread use of digital technology, mHealth is increasingly taking a prominent role in malaria surveillance systems in GMS countries, including Myanmar. In Myanmar's malaria elimination program, an mHealth system called Malaria Case-based Reporting (MCBR) has been applied for case-based reporting of malaria data by integrated community malaria volunteers (ICMVs). However, the sustainability of such mHealth systems in the context of existing malaria elimination programs in Myanmar is unknown.

Methods: Focus group discussions were conducted with ICMVs and semi-structured in-depth interviews were conducted with malaria program stakeholders from Myanmar's Ministry of Health and Sports and its malaria program implementing partners. Thematic (deductive followed by inductive) analysis was undertaken using a qualitative descriptive approach.

Results: Technological and financial constraints such as inadequate internet access, software errors, and insufficient financial resources to support mobile phone-related costs have hampered users' access to MCBR. Poor system integrity, unpredictable reporting outcomes, inadequate human resources for system management, and inefficient user support undermined the perceived quality of the system and user satisfaction, and hence its sustainability. Furthermore, multiple parallel systems with functions overlapping those of MCBR were in use.

Conclusions: Despite its effectiveness and efficiency in malaria surveillance, the sustainability of nationwide implementation of MCBR is uncertain. To make it sustainable, stakeholders should deploy a dedicated human workforce with the necessary technical and technological capacities; secure sustainable, long-term funding for implementation of MCBR; find an alternative cost-effective plan for ensuring sustainable system access by ICMVs, such as using volunteer-owned mobile phones for reporting rather than supporting new mobile phones to them; and find a solution to the burden of multiple parallel systems.

Trial registration: Not applicable.

Keywords: Malaria; Myanmar; Surveillance; Sustainability; eHealth; mHealth.

Fig. 1

Flow of malaria case-based reporting data in the MCBR and PBR systems. DHIS2 District Health Information System 2, ICMV Integrated Community Malaria Volunteer, IP Implementation partner, MCBR Malaria Case-based Reporting (system/application), NMCP National malaria Control Program, Myanmar, MSS Malaria Surveillance System, PBR Paper-based reporting, RHC Rural Health Centre; Sub-RHC Sub-Rural Health Centre. This figure was published in Win Han Oo et al. [13] and is used with permission of Win Han Oo, et al.

Fig. 2

Thematic framework of factors influencing sustainability of the MCBR system. The authors developed this figure in Microsoft Office Word based on the information adapted from: Muhambe et al. [16]