National Strategic Plan For Cardiovascular Disease Services (Cardiology)

Objectives

Myanmar’s cardiovascular strategy aims to reduce cardiovascular morbidity and mortality by establishing a comprehensive, integrated system spanning primary prevention, regional and supra-regional clinical services, specialist education, research, rehabilitation and community partnership.[1]The intended model is an academic cardiac health-care system that delivers cost-effective care, strengthens community and referral services, develops the workforce, advances research and enables people to take greater ownership of their health.[2][3]

• Strengthen cardiovascular disease services through university hospital-based supra-regional centres of excellence in Yangon and Mandalay, with leadership in clinical care, education, research, quality assurance and support to regional centres.[4][5][3]
• Develop national guidance for acute and chronic cardiovascular disease, integrated care pathways and standard operating procedures that support consistent care across the referral network.[5][6]
• Expand cardiology sub-specialties, including echocardiography, interventional cardiology, electrophysiology and pacing, structural heart disease intervention, heart failure, cardiac rehabilitation, nuclear cardiology, cardiac imaging and research cardiology.[5][7]
• Train competent, ethical cardiologists and allied professionals through structured specialist education, local postgraduate programmes, overseas exposure and profession-specific nursing and technical curricula.[6][8]
• Strengthen regional cardiac services through phased development of physician-led coronary care units, non-invasive cardiology departments, invasive cardiology centres and district-level referral services.[9][10]
• Improve prevention and early management for people at high cardiovascular risk through primary health care screening, risk assessment, treatment, health-literacy promotion and action on tobacco use, physical inactivity, unhealthy diet and alcohol consumption.[11][12]
• Provide cardiac rehabilitation through multidisciplinary teams, effective referral pathways and services for patients with cardiovascular disease.[12][13]

Implementation

Implementation combines central specialist centres, a phased regional service network and primary health-care delivery. Yangon General Hospital’s Department of Cardiology, affiliated with the University of Medicine (1), Yangon, is linked to the New Yangon Specialist Hospital development project, while Mandalay General Hospital’s Cardiovascular Medicine Department, affiliated with the University of Medicine, Mandalay, is planned as a second supra-regional centre.[5][3]The Ministry of Health and Sports, medical professional bodies, universities, research institutions, regional services, private cardiac centres, social organisations and donors have identified roles in training, service development, research, equipment and financing.[6][9][14]

• Operate supra-regional centres as interdisciplinary, round-the-clock services providing diagnostic, therapeutic, preventive and rehabilitative cardiac care, with formal support to regional cardiovascular disease centres.[5][15]
• Develop cardiologists through a three-year local programme with overseas training opportunities, workplace-based assessment and collaboration with overseas cardiac centres for sub-specialist technical training and research.[5][6][16]
• Expand infrastructure through additional echocardiography, exercise testing, catheterisation laboratories, nuclear medicine, computed tomography and magnetic resonance imaging capacity, alongside staffing for clinical, nursing, radiography, engineering and technical functions.[17][15]
• Maintain 24-hour cardiac emergency care and primary percutaneous coronary intervention, plan round-the-clock cardiac surgical back-up for high-risk cases from 2022/2023, and provide round-the-clock computed tomography and magnetic resonance imaging from 2022.[8][15]
• Establish five-bed physician-led coronary care units in state and divisional hospitals within three years and in district hospitals within six years, linking them to township and station hospitals, general practitioners and regional referral centres.[9][10]
• Develop non-invasive cardiology services in specified state and divisional hospitals from 2022/2023, followed by invasive cardiology services in Taunggyi, Magway, Mawlamyaing and Pathein from 2025/2026, subject to budget availability.[18][19]
• Deliver primary prevention through township, urban, rural and sub-rural health facilities using the Package of Essential Non-communicable Disease approach, with training for township medical officers and basic health staff.[11][12]
• Establish a multidisciplinary rehabilitation service at Yangon General Hospital through collaboration between Physical Medicine and Rehabilitation and Cardiology, involving cardiologists, physiatrists, physiotherapists, cardiac nurses, occupational therapists and social workers.[13]
• Require national cardiology outcomes data returns from every cardiovascular disease centre, reform departmental databases and use quality assurance, integrated pathways and standard operating procedures to support service consistency.[5][6][3]
• Review progress every two years and revise targets and timelines when planned results are not achieved; primary health-care activities additionally use routine reporting, monthly review and supervisory visits.[2][9][12]
• Finance coronary care unit requirements through the Ministry of Health and Sports and donors, with a stated total cost of 78,468,000 Myanmar kyat; phase II non-invasive cardiology is costed at 211,000,000 Myanmar kyat and phase III invasive cardiology at 1,077,600,000 Myanmar kyat.[14][18][19]
• Address consumables shortages through a sustainable supply system, as Ministry of Health and Sports supplies currently cover one-third of existing workload and patients share the remaining costs.[17][16]

Monitoring & Evaluation

Monitoring arrangements combine service-quality standards, routine data systems, phased implementation milestones and periodic review, but many components lack defined indicators, reporting schedules or independent accountability mechanisms.[5][9][12]

• Develop and revise national guidelines for acute and chronic cardiovascular disease management, alongside integrated care pathways, documented standard operating procedures and quality assurance arrangements for supra-regional and regional services.[5][6][3]
• Establish a National Cardiology Outcomes Database or registry requiring returns from every cardiovascular disease centre, reform departmental databases in 2019, and establish a New Yangon Specialist Hospital database in 2022/2023 in accordance with the Health Management Information System and the Ministry of Health and Sports.[5][6][3]
• Complete integrated care pathways and standard operating procedures with regional centres within six months of 2019.[6][3]
• Assess implementation achievements every two years and revise targets or reset timelines when targets are not met.[2][9]
• Track training targets for cardiologists, cardiac nurses, allied professionals, coronary care unit doctors and nurses, and refresher courses across the 2018-2019 to 2023-2024 planning periods.[2]
• Use phased milestones for coronary care units, non-invasive cardiology, invasive cardiology and district-hospital services as implementation measures.[9][10]
• Report primary-care screening and treatment activity through relevant health-administration levels, review monthly reports and undertake supervisory visits to selected health centres.[12]
• Include patient assessment and evaluation of treatment-programme effectiveness among the competencies of cardiac rehabilitation teams.[13]

Quantitative performance indicators, indicator definitions, broader surveillance arrangements, evaluation methodologies, regular reporting schedules and formal independent accountability mechanisms are generally not specified.[6][2][3][9][18][12][13]

Costing & Financing

Financing is primarily associated with the Ministry of Health and Sports and donors for specified service-expansion investments, while most centre-of-excellence, prevention, rehabilitation and workforce activities have no stated budget, financing plan or funding-gap assessment.[14][11][13]

• Allocate 78,468,000 Myanmar kyat as the stated total cost of a coronary care unit, with the Ministry of Health and Sports and donors identified as financing sources.[14]
• Allocate 211,000,000 Myanmar kyat as the stated total cost of phase II non-invasive cardiology, including three-dimensional echocardiography; health-ministry and donor financing are identified.[18]
• Allocate 1,077,600,000 Myanmar kyat as the stated total cost of phase III invasive cardiology.[19]
• Condition phase III invasive cardiology implementation from 2025-2026 onwards on budget availability.[18][19]
• Establish a sustainable consumables supply system because Ministry of Health and Sports provision covers one-third of the existing workload, while patients meet the remaining share through out-of-pocket expenditure.[17][16]
• Promote cost-effective primary prevention and health care, although no cost estimates or economic assumptions for these measures are specified.[1][2][11]

Overall cardiovascular programme budgets, expenditure estimates, unit costs, resource-mobilisation plans, quantified funding gaps and economic assumptions are not specified; equipment, staffing, training, international placements, rehabilitation and wider service-establishment requirements are likewise largely uncosted.[17][16][11][13]