The role and dynamics of malaria surveillance in Myanmar
Despite public health challenges, Myanmar is moving toward a more targeted approach to malaria control and considering malaria elimination as a possible medium-term objective. In Myanmar’s malaria landscape, surveillance becomes central to the program strategy. It needs to be strengthened, and new tools should be introduced to reach that goal.
The Myanmar National Strategic Plan for Malaria Elimination (2021–2025) outlines that its third intervention prioritizes case-based surveillance to eradicate malaria and prevent its re-establishment.
The country’s malaria surveillance previously relied on paper reporting, which evolved to Excel and then advanced to web-based reporting systems, specifically the Malaria Surveillance System and District Health Information System 2 (DHIS-2).
To effectively combat malaria and achieve elimination, it is essential to strengthen case-based reporting and surveillance at both the township and community levels. This ensures accurate data collection and enables timely responses to local malaria transmission.
"[The] current malaria situation varies. In ARC Hpa-an, we’ve seen an increase in cases, especially in certain regions because of migration and local transmission. Most cases are coming in from neighboring regions. There's been quite a surge in local transmission there." A Township Malaria Elimination Coordinator, American Refugee Committee (ARC) Hpa-an said.
“While the project villages are well covered, unfortunately, the non-project villages are still experiencing transmissions.”— Township Malaria Elimination Coordinator, ARC - Hpa-an
PATH's role in the PMI-EM project
In support of National Malaria Control Program (NMCP) goals, PATH aims to contribute its 40 years of public health experience to the PMI-EM project. The PMI-EM project, funded by the US Agency for International Development (USAID) and the PMI through the University Research Community (URC) aims to eliminate the local spread of Plasmodium falciparum malaria by 2026 and put Myanmar on the path to eliminating all human malaria by 2030. The project is currently active across 31 townships in three states and regions—Rakhine, Tanintharyi, and Kayin—in the country.
Collaborating with URC, PATH’s efforts are concentrated on enhancing the surveillance, monitoring, and evaluation systems for malaria cases. This includes providing technical assistance to the PMI-EM’s sub-partner organizations, and developing and deploying the DHIS-2–based EM-MIS—a crucial tool for the surveillance and strategic response necessary for malaria control and elimination settings.
“EM-MIS is free to use and can be modified according to specific needs, making it cost-effective for organizations.”— Dr. Kyi Tun Lwin (PATH’s Digital Technical Coordinator)
Key components and functions of EM-MIS in malaria surveillance
The EM-MIS is a digital tool, specifically designed for the collection, validation, analysis, and presentation of both aggregate and case-based malaria data.
Being highly customizable, EM-MIS allows its users to tailor data collection forms, reports, and dashboards to fit program-specific requirements. EM-MIS also supports integration with other systems through application programming interfaces (APIs) and standardized data formats, facilitating data exchange and interoperability between different health information systems.
The EM-MIS is designed with three main components: Tracker programs, event program and aggregate program.
Tracker programs: The tracker programs within EM-MIS consist of the case tracker, which utilize a data entry form based on a carbonless register and a case investigation form, and the foci tracker, which employs a specific data entry format for malaria foci investigation and response.
Event program: PATH designed the event program in EM-MIS with a survey format tailored for monitoring long-lasting insecticidal net (LLIN) coverage and utilization, alongside essential response activities.
Aggregate program: It encompasses aggregate data sets that cover various activities such as meetings, trainings, workshops, health education sessions, and continuous and mass LLIN distribution group health talks.
This structured approach to data flow ensures comprehensive data collection and analysis, supporting effective monitoring, evaluation, and response strategies within the PMI-EM project. Moreover, each of these programs ensures consistent monitoring and evaluation at the operational unit level, which is essential to align with the surveillance standards set forth in the National Strategic Plan.
PATH Myanmar's malaria team conducting a training of trainers (ToT) for EM- MIS. Photo: PATH/Phyo Wai Lynn
Progress in EM-MIS implementation
Starting from 2023, PATH collaborated with HISP India to develop the first two tracker programs for the EM-MIS software. After pilot training in four townships and a three-month pilot phase, the system received positive feedback in the pilot evaluation.
Building on this success, PATH launched multiplier training to support the system’s full-scale rollout. Between December 2023 and March 2024, virtual training sessions were conducted for PMI-EM staff, covering tracker, event, and aggregate programs.
These sessions reached staff from 4 townships in Kayin state, 10 townships in the Tanintharyi region, and 17 townships in Rakhine state. A data analytics training session was also conducted to improve the participants' analysis skills.
Following these efforts, more than 50 users from URC, ARC, Myanmar Health Assistant Association, and Myanmar Nurse and Midwife Association began actively using the EM-MIS system starting from March 2024 recording immense number of patients.
“The EM-MIS system is more efficient than previous tools, offering improved data visualization and allowing multiple encoders to work simultaneously. However, an internet connection is required.”— Township Malaria Elimination Coordinator, URC (Tanintharyi Region)
The way forward
In conclusion, the upcoming phase will focus on a comprehensive evaluation of the EM-MIS system, aimed at assessing its effectiveness, usability, and overall impact on malaria surveillance and data management. This evaluation will provide valuable insights into how well the system is functioning and where improvements can be made.
Based on these findings, the system will undergo necessary updates and modifications to enhance its performance and better align with user needs. Following the updates, refresher training will be conducted to ensure that all users are familiar with the new features and functionalities, enabling them to effectively utilize the improved version of the software.
This continuous process of evaluation, improvement, and training underscores the commitment to optimizing the EM-MIS system for long-term success in malaria control and data management efforts.
