National Strategic Plan For Cardiovascular Disease Services (Cardiology)

Objectives

The strategy seeks to reduce cardiovascular morbidity and mortality in Myanmar through a comprehensive, integrated nationwide cardiovascular care system spanning prevention, primary healthcare, regional services and supra-regional centres of excellence.[1]It responds to the growing burden of non-communicable diseases and cardiovascular risk factors by prioritising prevention, early diagnosis, prompt treatment, rehabilitation, professional development, research and stronger health information systems.[2][3]

• Strengthen cardiovascular services at supra-regional and regional centres, including centres of excellence at Yangon General Hospital and Mandalay General Hospital.[4][2][1]
• Improve care for people at high cardiovascular risk through cost-effective primary prevention, community screening, cardiovascular risk assessment and treatment of uncomplicated cases at primary healthcare level.[4][5][6]
• Develop cardiology subspecialties in echocardiography, interventional cardiology, electrophysiology and pacing, structural heart intervention, heart failure, rehabilitation, nuclear cardiology, cardiac imaging and research.[7][8]
• Establish an academic cardiac healthcare system that integrates clinical care, education and research with patient and community partnership, and develops competent cardiologists and allied professionals.[9][3]
• Expand regional provision progressively, from physician-led coronary care units and non-invasive cardiology at State and Divisional Hospitals to selected invasive cardiology services and District Hospital coronary care units.[10][11][12]
• Provide comprehensive diagnostic, therapeutic, preventive and rehabilitative cardiac services, including round-the-clock provision for specified interventions and imaging services.[13][14]
• Develop cardiac rehabilitation for inpatients, outpatients and communities through multidisciplinary teams, referral pathways, occupational therapy and social counselling.[6][15]

Implementation

Implementation uses a tiered delivery model linking university-based supra-regional centres of excellence, regional hospitals, district hospitals and primary healthcare facilities.[4][1][10][6]The centres are intended to lead teaching, research, specialised care, quality assurance, integrated care pathways and standard operating procedures for supported regional services.[1][16]Governance involves the Ministry of Health and Sports, universities and professional bodies, alongside health departments, research institutions, private cardiac centres, social organisations, donors and international cardiac-centre partners.[9][17][11]

• Establish and equip specialist services through phased investment in staffing, catheterisation laboratories, diagnostic systems, echocardiography, computed tomography, magnetic resonance imaging, consumables and dedicated facilities.[7][13][8]
• Develop national guidance, integrated care pathways and standard operating procedures for acute and chronic cardiovascular disease, including emergency care, myocardial infarction, heart failure, arrhythmia, anticoagulation, rehabilitation, secondary prevention and device follow-up.[1][11][12]
• Train cardiologists, physicians, nurses, technicians and allied professionals through structured curricula, workplace-based assessment, coronary-care courses, refresher training, simulation, local research and overseas technical partnerships.[9][13][18][12]
• Strengthen referral networks between lower-level facilities, general practitioners, regional centres and supra-regional services, while providing primary healthcare through Urban Health Centres, Rural Health Centres and Sub-Rural Health Centres using the Package of Essential Non-communicable Disease services approach.[10][6]
• Build rehabilitation capacity through collaboration between physical medicine, rehabilitation and cardiology departments, practical exercise training and planned international exposure for physiatrists and physiotherapists.[15]
• Develop a National Cardiology Outcomes Database or registry with mandatory returns from cardiovascular disease centres, reform departmental databases, and align planned information systems with the Health Management Information System.[1][9][16]
• Monitor achievement every two years and revise targets and timelines when progress falls short; at primary healthcare level, review monthly reports and conduct supervisory visits to selected health centres.[18][3][6]

Monitoring & Evaluation

The strategy establishes a multi-level monitoring framework for cardiovascular services, combining national registry development, mandatory facility reporting, periodic performance review, supervision and target revision. It provides clearer monitoring arrangements for specialist centres and primary healthcare than for the phased regional service-expansion plans.[1][3][6][11][12]

• Develop a National Cardiology Outcomes Database or registry, with mandatory data returns from every cardiovascular disease centre.[1][16]
• Reform departmental databases, planned from 2019, and establish a New Yangon Specialist Hospital database in 2022/2023 in line with the Health Management Information System and Ministry of Health and Sports requirements.[9]
• Monitor and evaluate achievement every two years at the Yangon and Mandalay Centres of Excellence and within associated regional plans.[18][3][17]
• Revise targets and reset timelines where planned achievements are not attained.[18][3][17]
• Document integrated care pathways and standard operating procedures, linking specialist centres’ quality assurance to their support for regional services.[1][9][16]
• Review monthly primary-healthcare reports and conduct supervisory visits to selected health centres; report screened and treated patients through relevant administrative levels.[6]
• Track workforce and training targets over 2019 to 2024, including cardiologists, cardiac nurses, allied professionals, coronary care unit training and refresher courses.[3][17]

Available baseline evidence includes hospital statistics for 2014 to 2016, which attribute 5.7% of hospitalised morbidity and 20.6% of hospitalised mortality to cardiovascular disease.[1]The supplied extracts do not provide comprehensive indicator definitions, baselines for all targets, reporting frequency for specialist-centre data, independent evaluation methods, surveillance protocols or named formal accountability mechanisms.[4][2][17][11][12][15]

Costing & Financing

Financing information is limited but identifies substantial capital requirements for phased regional cardiac services, Ministry of Health and Sports responsibilities, donor involvement and a current shortfall in public consumables coverage. The extracts do not provide an overall programme budget, funding-gap analysis, resource-mobilisation plan or economic assumptions.[7][18][11][12]

• Fund consumables through the Ministry of Health and Sports for one-third of the existing workload, with the remaining workload costs shared through patients’ own expenditure.[7][8][14]
• Develop a sustainable consumables-supply system for cardiology services.[7][8][14]
• Assign finance as a Ministry of Health and Sports responsibility within the Centre of Excellence framework.[18]
• Cost a coronary care unit at 78,468,000 Myanmar kyat, with the Ministry of Health and Sports and donors identified as financing sources.[11]
• Cost non-invasive cardiology, including three-dimensional echocardiography, at 211,000,000 Myanmar kyat, with the Ministry of Health and Sports and donors identified as financing sources.[11]
• Cost the Phase IV physician-led district-hospital coronary care unit at 78,468,000 Myanmar kyat.[12]
• Record an invasive-cardiology cost in malformed source text as “1,077,600,00OMMK”; no unambiguous numerical value can be extracted.[12]

Infrastructure, staffing, specialist equipment, training, databases, research, service expansion and international placements are identified as resource needs, but no quantified costing is supplied for the national strategy, the Yangon or Mandalay Centres of Excellence, primary prevention, rehabilitation or most training activities.[1][9][3][5][15]