C/Can 2025 City Cancer Challenge Report of the 3rd City Stakeholder Meeting Yangon, Myanmar, 11-12 January 2018
Members of the C/Can 2025 Technical Committee and City Executive Committee for Yangon, Myanmar came together from 11-12 January at the 3rd City Stakeholder Meeting to share findings from the needs assessment process, and discuss the emerging priorities for improving access to quality cancer treatment and care in Yangon.
Needs assessment in Yangon: Key findings On the 11th and 12th January, members of the Technical Committee shared the findings of the needs assessment for their assigned focus area including pathology, laboratory medicine, haematology, radiology and nuclear medicine, medical oncology, radiotherapy, surgery, palliative care, training and education, quality of cancer care, management of oncology services, and community access. Each presentation covered: a list of the institutions and experts that contributed to the assessment and any significant data gaps; an overview of the situation at city-level including key challenges, and suggested priority actions to address these. In addition to the identification of challenges and priority actions in specific disciplines, several common issues emerged throughout the presentations and subsequent discussion: •
Inadequate number of qualified health professionals to address the city’s cancer burden due to a lack of city, regional and national training opportunities in oncology sub-specialities, and poor retention of staff
•
Lack of national, resource-appropriate cancer treatment guidelines and protocols for the most common and curable cancers
•
Poor data collection and management; a key
challenge is that medical records in Yangon are generally paper-based rather than electronic which means that they cannot be easily shared between clinics or physicians at different locations, treating the same patient •
High out-of-pocket costs incurred by cancer patients in Yangon for treatment and care, and lack of financial support and counseling for these patients.
Members of the Yangon Technical Committee
A closer look at pathology services in Yangon Pathology laboratories face a number of challenges including a lack of trained personnel at all levels (pathologists, microbiologists, lab officers and technicians etc) and in some cases, absence of essential equipment, appropriate facilities for storage of samples, and reagents. Although work is underway on a set of National Laboratory Quality Management Guidelines, poor quality assurance remains an issue, and there is little awareness among healthcare providers of the importance of quality and its relevance for patient safety.
Identification of priority needs and actions “Cancer is not just a disease but a humanitarian issue, with a significant economic, social and psychological impact. It is important that we also consider the cost to cancer patients and how to ensure that services in Yangon are not just available, but accessible even to patients with limited income.” Prof. Rai Mra, President, Myanmar Medical Association & Chair of the C/Can 2025 City Executive Committee, Yangon
At the meeting of the City Executive Committee on 12th January, four leaders from the Technical Committee were invited to present a summary of discussions of the previous two days, including concrete recommendations of priority needs and actions (classified as requiring either low or high investment), to be included in the city implementation plan. The City Executive Committee, composed of 15 leaders from the city’s major public and private hospitals, professional associations, civil society, regional government, and Ministry of Health and Sports, shared their initial feedback, highlighting: •
Importance of establishing the practice of multidisciplinary teams in Yangon to ensure effective, timely, and quality diagnosis, treatment, and supportive care of patients
•
Development of a formal referral network and of patient navigation services is critical, and would help reduce delays in waiting-times for diagnosis and treatment, as well as improving treatment abandonment rates
•
Urgent need to improve palliative care services particularly in the primary care setting, and increase availability and access to pain relief. There is currently only one palliative care clinic in Yangon.
experts and institutions as appropriate. Two specific workshops will be organised in the next 4-6 weeks to allow for more in-depth discussion in the areas of 1) human resources; and 2) management of cancer services •
Sharing feedback on the C/Can 2025 Needs Assessment tool so that it can be augmented for use in other C/Can 2025 cities.
The Executive Committee is tasked with: •
Reviewing the findings outlined in the final diagnostic report for the city, and providing feedback ahead of a follow-up meeting scheduled for mid- March.
Between March and May 2018, four group leaders from the Technical Committee will continue working together, with support from Dr Jairo Aguilera (M&E Coordinator for the Colombian National Cancer Institute & C/Can 2025 Special Advisor) to develop a first draft of the implementation plan, with the Executive Committee providing oversight and guidance. Dr Soe Htet, Deputy Director, NCDs, department of disease control, a representative from the MoHS, Nay Pyi Taw and Dr. Pe Thet Htoon have also been appointed as Technical Coordinators to help guide development of the implementation plan, with additional support from Dr. Nway Nway Win, Assistant Director, NCDs, department of public health, Yangon. In May 2018, a first draft of the implementation plan will be shared with key stakeholders, C/Can 2025 partners and experts for review. Work will continue between May and July 2018 to finalise and cost the plan, and begin identification of sustainable financing solutions with support from C/Can 2025.
Next steps Between January and mid-March 2018, the Technical Committee is tasked with: •
Collating any missing information to complete the needs assessment and final diagnostic report for Yangon, including by convening additional
Report of the 3rd City Stakeholder Meeting - Yangon, Myanmar, 11-12 January 2018
“I would like to express my thanks to UICC and all those involved in the C/ Can 2025 process in Yangon. We recognise that there is much to be done in our health system, but by focusing on cancer treatment and care through this experience, new opportunities are emerging to build capacity and improve the health system.” U Naing Ngan Lin, Yangon Regional Minister & Patron of the C/Can 2025 City Executive Committee, Yangon
List of participants (*listed alphabetically) Technical Committee
Prof. Aye Aye Khaing, Prof. and Head, Department of Haemato-Oncology, Yangon Children Hospital
Dr Shu Mon, Senior Consultant Medical Oncologist, Bahosi Private Hospital
Prof. Cho Cho Nyunt, Prof. and Head, Department of Pathology, Yangon General Hospital
Prof. Soe Aung, President, Myanmar Oncology Society
Daw Mya Mya Kyi, Medical Physicists, Department of Radiation Oncology, Yangon General Hospital
Dr Soe Myint Than, Senior Consultant, No. 2 Military Hospital
Daw Thet Thet Thein, Matron, Yangon General Hospital
Prof. Soe Oo Maung, Prof. and Head (retired), Department of Radiation Oncology, Yangon General Hospital
Daw Tsel Tsel Phaw, Pharmacist, Department of Nuclear Medicine, Yangon General Hospital Prof. Htun Lwin Nyein, Prof. and Head, Department of Haemato-Oncology, Yangon General Hospital Dr Htun Thura, Asso. Prof., Surgical Unit-2, Yangon General Hospital Prof. Htun Oo, Prof. and Head (retired), Department of Surgery, University of Medicine-1, Yangon Prof. Khin Hla, Rector (retired), Medical Technology University, Mandalay Prof. Khin Mar Myint, Head of Training and Research, University of Medicine-1, Yangon Dr Khin Saw Aye, Deputy Director General, Department of Medical Research, Yangon Dr Khin Thiri, Leader, Pun Yaung Hnin Si Breast Cancer patient support groupl Dr Kyaw Htike Oo, Assistant Medical Superintendent, Yangon General Hospital Dr Moe Hlaing, Senior Consultant, Department of Radiation Oncology, Yangon General Hospital Prof. Moe Moe Tin, Prof. and Head, Department of Surgery, University of Medicine-2, Yangon Prof. Myo Khin, Director General (retired), Department of Medical Research, Yangon Prof. Myo Myint Maw, Prof. and Head, Department of Medical Oncology, Yangon General Hospital Prof. Ne Win, Director (retired), National Health Laboratory and Blood Bank, Yangon Dr Nway Nway Win, Assistant Director (NCD), Department of Public Health, Yangon Dr Pe Thet Htoon, Executive committee member, Shwe Yaung Hnin Si Cancer Foundation Prof. Rai Mra President, Myanmar Medical Association
Dr Su Thet Oo, Consultant, Department of Nuclear Medicine, North Oakkalapa General Hospital Dr Su Su Hlaing, Assistant Lecturer, University of Public Health, Yangon Dr Su Yin Phyo Shein, Specialist Assistant Surgeon, Department of Nuclear Medicine, Yangon General Hospital Dr Than Aung Htoon, Director, National Blood Center, Yangon Dr Thant ZIn Oo, Consultant Radiation Oncologist, No.2 Military Hospital, Yangon Prof Thida Aung, Prof., Department of Surgery, University of Medicine-2, Yangon Dr Tint Myo Hnin, Consultant, Department of Haemato-Oncology, Yangon Children Hospital Dr Wah Wah Myint Zu, Senior Consultant, Department of Radiation Oncology, Yangon General Hospital Dr Wai Wai Htun, Consultant, Department of Radiology, Yangon General Hospital Prof. War War Wann Maung, Prof. and Head, Department of Nuclear Medicine, Yangon General Hospital Dr Ye Moe Myint, President, Myanmar Private Hospital’s Association Prof. Yin Yin Htun, President, Shwe Yaung Hnin Si Cancer Foundation Executive Committee Prof. Aye Aye Khaing, Prof. and Head, Department of Haemato-Oncology, Yangon Children’s Hospital Prof. Khin Cho Win, Head, Department of Radiation Oncology, Yangon General Hospital. (not present)
List of participants Dr Myint Myint Aye, Senior Medical Superintendent, Yangon General Hospital, Hospital Administration. (not present)
H.E. U Naing Ngan Lin Minister of Social Affairs, Yangon Regional Government
Prof. Myo Myint Maw, Prof. and Head, Department of Medical Oncology, Yangon General Hospital
Dr Win Lwin, Deputy Director General, Department of Public Health, Ministry of Health and Sports, Yangon Region
Prof. Myo Nyunt, President, U Hla Tun Cancer Foundation
Dr Ye Moe Myint, President, Myanmar Private Hospitals’ Association (not present)
Dr Pa Pa, Senior Medical Superintendent, Central Women’s Hospital
Prof. Yin Yin Htun, President, Shwe Yaung Hnin Si Cancer Foundation
Dr Pe Thet Htoon, Executive committee member, Shwe Yaung Hnin Si Cancer Foundation
UICC C/Can 2025 team
Prof. Rai Mra President, Myanmar Medical Association
Tuyet Ha Iaconis, Regional Director for Asia Pacific
Dr. Rolando Camacho, Global Advisor C/Can 2025
Prof. Soe Aung, President, Myanmar Oncology Society
Dr. Susan Henshall, Director of C/Can 2025
Dr Soe Htet, Deputy Director, NCDs, Ministry of Health and Sports(MoHS), Nay Pyi Taw (On behalf of NCD Director - currently a vacant position in MoHS) (not present)
Rebecca Morton Doherty, Head, City Engagement & Impact
Dr Jose Jeronimo, Special Advisor
Dr Aung Naing Soe, City Manager, Yangon
Dr Thar Tun Kyaw, Director General, Ministry of Health and Sports (MoHS), Department of Medical Services. (not present)
Photo: Yangon City Executive Committee and C/Can 2025 team