So Pyay (571-9661)

A STUDY ON THE IMPROVEMENT OF NATIONAL HEALTHCARE
SYSTEM IN MYANMAR
MBA BATCH- 11
ASSUMPTION UNIVERSITY, MYANMAR OFFSHORE CAMPUS
Written By: MR. SO PYAY {ID: 571 9661}

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TABLE OF CONTENTS
CHAPTER (1)
1.1 Introduction of a study
1.2 SWOT Analysis of National Healthcare System in Myanmar
1.2.1 Strengths & Weaknesses of National Healthcare System in
Myanmar.
1.2.2 Opportunities & Threats of National Healthcare System in
Myanmar.
1.3 Facts & Figures of National Healthcare System in Myanmar
1.4 Research Objective
1.5 Research Question
1.6 Significance of the study
1.7 Limitations of the study
CHAPTER (2)
2.1 Related Literature Review
2.2 Possible Improvement Factors from the Literature
2.3 The Conceptual Framework
2.4 The Definition of the Variables
2.5 Hypotheses

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CHAPTER (3)
3.1 Research Methodology
3.2 Research Methods
3.3 Sampling Procedures
3.3.1 Target Population
3.3.2 Sample and Sampling Units
3.3.3 Sample Size
3.4 The Questionnaires or the Research Instrument
3.5 Cronbach's Alpha & the Reliability of Questionnaires
3.6 Pilot Testing
CHAPTER (4)
4.1 Introduction to Descriptive Analysis & Hypotheses Testing
4.2 Descriptive Analysis of Demographic Factors
4.3 Descriptive Analysis of Independent Variables
4.4 The Reliability Test
4.5 The Hypotheses Testing Using ANOVA Method

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4.6 The Hypotheses Testing Using Regression Analysis
4.6.1 The Estimated Equation of the Regression Analysis
4.6.2 Summary of Regression Analysis
4.7 The Findings of Hypotheses Testing
CHAPTER (5)
5.1 Summary of Findings
5.1.1 Summary of Demographic Variables
5.1.2 Summary of Hypotheses Testing
5.2 Conclusion
5.3 Recommendation
APPENDIX A : Reference
APPENDIX B : Cover Letter
APPENDIX C : Questionnaires in English Version
APPENDIX D : Questionnaires in Myanmar Version

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CHAPTER-1
1.1 Introduction to a Study
Today in Myanmar, the population growth is becoming higher and higher than the previous
years. Therefore, the death rate could be increased by several types of diseases as well. In order to
solve that kind of problem, health care system and providers are much important in saving the lives
of people.
Nowadays, technologies and treatment methods are advancing rapidly and appearances of
new diseases are occurring, therefore, health care system and providers of Myanmar are needed to
improve for the sake of protecting the lives of peoples and for their families.
Therefore it could be the workload for the Ministry of Health (MoH) and they have to
change their current rules & regulations, policies and implementation of healthcare development
system. In Myanmar, we can find out that there are few in skilled health-care workers in hospitals,
clinics and other healthcare settings. In this case, research & development and human resource
management play an important role in developing the healthcare workers' skills, abilities
knowledge and communication with the patients and finding the most appropriate healthcare
strategies to implement.
This study can help us to determine which factors can significantly affecti the improvement
of National Healthcare System and solutions for these problems and implementing strategies for
the healthcare development system in Myanmar.

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1.2 SWOT Analysis of National Healthcare System in Myanmar
1.2.1 Strengths and Weaknesses of National Healthcare System in Myanmar
One of the strength of National Healthcare System in Myanmar is that the Ministry of
Health (MoH, Myanmar) is currently focusing on the improvement of healthcare by conducting
workshops and seminars, sending scholars to the foreign countries to explore more medical
knowledge, skills and treatment methods. In order to increase the health status of the whole
country, the MoH is now undertaking to provide preventive, curative and rehabilitative healthcare
services and it is tryingto provide top-notch medical services inMyanmar. And also local charities
are willing to participate in healthcare activities. Another strength is that the patients themselves
strongly want to involve in some minor medical treatments. Since the paid is very low in here, the
cost of hiring the health care providers is very much lower than other countries in South East Asia.
And also there are some weaknesses in the National Healthcare System of Myanmar as
well. In here, most of the medical facilities are outdated and healthcare providers do not set these
facilities in their priority list. There are also some fluctuation in the continuity of healthcare
because of poor communication between the healthcare providers and the patients. And lack of
skillful nurses and doctors can be assumed to be the weakness of National healthcare System. The
reasons of the unavailability of skillful doctors and nurses are inefficient training models,
insufficient training budgets to implement the development system and lack of advancing
technologies and treatment methods.

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1.2.2 Opportunities and Threats of National Healthcare System in Myanmar
As opportunities for the National Healthcare System, it can collaborate with different
healthcare organizations from other countries around the world if it has been improved. After that,
it can develop new healthcare programs required for the people living in the country. If the
National Healthcare System is improved, it can get support from the World Health Organization
(WHO) to increase the funds required in healthcare services. The development of National
Healthcare System can also give the opportunities for the medical students to gain more skills,
knowledge and abilities as well.
The external threats for the National Healthcare System can be considered as changes in
economic and political situation. Because of the new appearance of new diseases, there will
increase in demand for the expensive technology for the treatment. Therefore, there will increase
in pressure of cost reduction in healthcare services as well. Healthcare providers' forcing on
patients' coercion to do things what they do not actually want to do and doctors' confidentiality at
risk can also be considered as the threats for the National Healthcare system.
1.3 Facts & Figures of National Healthcare System in Myanmar
The National Healthcare System of Myanmar has been evolved due to the developing
political and administrative system and changing the corresponding roles of healthcare providers.
But the Ministry of health is still in a position as major healthcare provider in Myanmar. It consists
of private and public systems which are organizing and providing the Healthcare for the whole
country. The figure below shows the organization of the National Healthcare service in Myanmar.

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In order to improve the health status of the whole population, the Ministry of Health itself
taking the workload in providing preventive, curative and rehabilitative services for the sake of
implementing the National Health Policy.
Fig. 1.1: The Organization of Healthcare Service in the Republic of the Union of Myanmar

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Among the seven departments below the Ministry of Health, Department of Health plays
a vital role in supporting effective healthcare to the whole country and including to the border
areas. Some Ministries such as Ministry of Defense, Mines, Industry, Energy, Transport and
Railways are also providing healthcare for their employees and their families.
The important feature which is the uniqueness of Myanmar National Healthcare System is
that the existence of traditional medicine along with allopathic medicines. There are altogether
fourteen traditional hospitals run by the States in Myanmar. Traditional doctors are trained by the
Institute of Traditional Medicine and they are offered a bachelor degrees and master degrees for
more competency.
In the Republic of the Union of Myanmar, the life expectancy of males and females are
57.8 years and 63.78 years respectively. (Source: CIA World Fact-book) Malaria, AIDS and
malnutrition and its related diseases are the serious cases occurring in Myanmar. Due to the
country's repressive regime, it gets minimal assistance from the foreign nations. Sixty percent of
Malaria deaths are occurred in Myanmar among the other countries in Asia with 600,000 annual
malaria cases are reported and 3,000 deaths and it is also the serious case of deaths for children
under 5 years old. And also ten children out of 100 die before five years of age in Myanmar, the
reason is that they are malnourished and 32 percent are significantly behind the expected height of
their age according to the UNICEF.
Myanmar exists among the lowest countries in healthcare ranking. During the 1950s,
Myanmar existed as one of the wealthiest country in Asia and it had a best healthcare system but
in the 1990s, only 24 percent per person on healthcare was spent by the government of Myanmar.

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There are only around twelve thousands doctors and around seven hundred hospitals in Myanmar.
And the budget provided for the medical training and training methods are insufficient.
1.4 Research Objective
The objective of this research is to find out the factors which will strongly affect the
improvement of National Healthcare System in Myanmar. This study is relied on the healthcare
providers such as doctors, nurses, technicians, physicians, surgeon and medical students etc. The
purpose of this research is not only to understand the relationship between demographic
characteristics and the improvement of National Healthcare System and which independent
variables among technology, budget, training, work environment, Healthcare providers-patients
communication, hospitals & clinics' facilities availability and Medical Training Institute &
facilities are strongly related to the improvement of National Health Care System in Myanmar.
1.5 Research Question
Since the purpose of this research is to find out the factors which affect the improvement
of National Healthcare System in Myanmar. Therefore, my research question will be "What are
the factors affecting the improvement of National Healthcare system in Myanmar and what are the
possible solutions?"
1.6 Significance of the Study
This research study could provide information on the issues of the improvement of
Healthcare System in the Republic of the Union of Myanmar. It could find out what are the possible
factors which can affect the improvement of National Healthcare System. And also this study

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would be beneficial to the medical students and healthcare providers in Healthcare Services and
also for the Ministry of Health as well.
Furthermore, this research will provide recommendations on how to implement and
develop the National Healthcare System in Myanmar. It will be helpful to the human resource
management and research & development sectors in Healthcare Areas in order to provide efficient
training and required skills. And also it will give advantages to the peoples who are living in
Myanmar by giving medical knowledge of current National Healthcare System. And it will also
give the baseline information to the further researchers on the topic of improvement of National
Healthcare System.
1.7 Limitations of Study
During the limited amount of time constraints, there are some limitations in the study and
they cannot be controlled by the researchers. To complete this research paper, I have faced some
limitation such as time, number of respondents and locations. In this research paper, I considered
only a sample settings of 300 respondents who are working as a healthcare provider and studying
medical in Mandalay. Therefore, by applying different sample settings, different results could be
produced. Because of time constraints (Dec 15th
, 2015 – Dec 31st
, 2015), I could not reach the
whole survey targeted areas. If I was given more times, I would have asked more respondents by
door-to-door and face-to-face methods in hospitals, clinics, medical universities and dental
universities from the different locations in order to improve the whole National Healthcare System.
Therefore, this research paper requires further surveys or investigations for the extent to which my
findings can be generalized.

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CHAPTER- 2
2.1 Related Literature Review
Compared to the manufacturing sector, the service sector – particularly the healthcare
sector–is widely regarded as lagging in terms of adopting new management innovations
(Christensen et al., 2009; Greenhalgh et al., 2004; Walley, 2003).
As the population ages, increasingly more patients suffer from multiple illnesses that
require extensive specialist care. At the same time, new and expensive drugs and treatments are
introduced at an accelerating rate. These are just a few examples of changes that challenge the
whole healthcare system. Recent years have seen an increase in the demand to meet these
challenges by changing the way healthcare is delivered and increasing the efficiency of the sector
(Mohrman et al., 2012).
Broadly speaking, the question of how to improve healthcare system performance leads to
multiple possibilities. Strategies can be aimed at different levels and components of a healthcare
system such as how the system is regulated and ﬁnanced, and how services are organized and
provided (Evans et al., 2001; Rothgang et al., 2010).
2.2 Possible Improvement Factors from Literature
Technology
Some of the current issues in healthcare provision involve the training for the adoption of
progressive information technology (IT) systems. There appear to be barriers in providing
technical support and in the computer skills of hospital staff including doctors and nurses together

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with additional costs of transferring the traditional system of medical records (Khalifa, 2013; Al-
shorbaji, 2008).
The scope of technology covers a broad spectrum in a healthcare setting, including clinical
diagnostic tools, clinical decision support, hospital information management, laboratory
equipment, surgical robotics, and other biomedical engineering inventions. Examples of changes
in technology-enabled services include new medical and surgical procedures (e.g. angioplasty,
joint replacements), drugs (e.g. biologic agents), medical devices (e.g. computed tomography (CT)
scanners, implantable defibrillators), and new support systems (e.g. electronic medical records,
telemedicine). Technology is omnipresent and very little in the field of medicine has not been
affected by new technology (Moseley, 2005).
Budget
First, a system, which produces healthcare within a fixed frame of money, will not produce
care in proportion to demand (Berry and Bendapudi, 2007). The consequence of the fixed frame is
that a stiff budget systemis being used inorder to regulate the production of care (Nordgren, 2003).
Job Satisfaction
In a recent study (Williams et al., 1997) of accident and emergency senior house officers,
it was found that the most stressful factors in the workplace were coping with diagnostic
uncertainty, working unsociable hours, working alone, experiencing fatigue and the intensity of
workload. Another serious source of work stress for SHOs was represented by communication
problems with quite demanding or aggressive patients.
Dissatisfied providers not only create unstable organizations and give poorer quality, less
efficient health care (Grol and Lawrence, 1995), there is also evidence of a positive correlation

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between doctor satisfaction and patient satisfaction (Haas et al., 2000; Linn et al., 1985), and
compliance (Weisman and Nathanson, 1985).
Low work satisfaction may also have cost implications in the form of high absenteeism
and turnover, low morale and lower productivity (Mullins, 1999).
Work Environment
Health care systems have undergone major technological, organizational and financial
changes in many countries during the last decades. These changes have had a substantial effect on
the work environment for employees, not the least for physicians (Axelsson, 2000). Financial
productivity incentives have been introduced, which might result in an increased organizational
efficiency but, at the same time, also an impairment of the physicians’ working conditions
(Forsberg et al., 2000).
An extensive international study found that the majority of physicians express concern that
quality of care, as a result of physicians impaired work environment, has deteriorated over the last
five years (Blendon et al., 2001).
Training
A comprehensive specification of public health education and training requirements which
is purposely designed for the new agenda would require a full research program. This research
would include task, job and role analysis (Pearn and Kandola, 1988) and use of techniques such
as critical incident analysis (Flanagan, 1954) and the development of valid and reliable
measurement of attainment of specified competencies involving knowledge skills and attitudes
(Benardin and Beatty, 1984).

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Different people will have different education and training needs (Crainer, 1998). Many,
but not all, of these needs will be specifiable from close analysis of the roles, activities and
responsibilities each person is asked to employ intheir jobs or position(Pearn and Kandola, 1988)
Healthcare Providers-Patients' Communication
It is generally held that a good doctor-patient relationship and successful consultation
outcomes depend on the consultation skill of the doctor, the organization of the healthcare system,
and the cultural background, including the ability for doctors and patients to communicate in a
common language (van den Brink-Muinen et al., 2003a).
New health care systems, the development of medical and information technologies,
multicultural medical staff and patients as well as other changes in society have inﬂuenced the
doctor-patient relationship, and new consultation styles have emerged (Elwyn, 2004).
Patients may express their dissatisfaction with the doctor’s communication skills by
complaining about the doctor or even by initiating litigation (Levinson et al., 1997; White et al.,
2005).
Medical Institutes & its Facilities
The value of international health however, extends beyond a change in awareness. The
subject matter studied provides valuable knowledge and skills for future careers in medicine. Many
of the lessons learnt from studying international issues can be transferred to western settings. In
Colombia, a survey of medical graduates who had taken elective courses in public health found
that 84 per cent felt that their trainingwas of value in their professional careers (Rosenburg, 1998).

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There is a great demand amongst medical students for international health teaching. A
survey at Newcastle Medical School showed that 76 per cent of students felt that at least one global
health issue should be taught in the core curriculum (Edwards et al., 2001).
International health has been included as a compulsory topic since 1999 and has been rated
highly with students in terms of its perceived usefulness, scoring a mean of four out of ﬁve (Low
et al., 2003).
Hospital's Facilities
Over the years, facilities management (FM) has grown from what was traditionally
perceived to be mere managing of buildings or maintenance unit of an organization to the holistic
reality of being integrated into the core and support services of organizations (Price et al., 2011).
On account of the increasing competitiveness and globalization, it has embraced innovative
skills through not just delivery of services in the most effective way, but by providing them in an
ever changing world over the years (Noor and Pitt, 2009).
Other areas in whichFM adds value to healthcare deliveryin hospitals include management
of infrastructure facilities suchas estate and property, indoor air, structure and fabric, water supply,
electricity and telecommunication management referred to as hard FM; and catering, cleaning,
waste management, security and laundry services described as soft FM (Liyanage and Egbu,
2008).
Patients' Safety
Hospitals continue to be a major source of risk to people. Instead of solely beneﬁting
patients, hospitals and medical interventions often harm them (Baker, 2004). However, efforts are

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made across the globe to improve patient care and diminish harm. These efforts include many
changes, including clinical and organizational improvements to provide proper, quality care and
treatment. Patient safety and service quality have joined evidence-based medicine to better meet
patient needs and preferences (Kohn et al., 1999; Parasuraman et al., 1985). To accomplish this,
health care providers must incorporate safety and quality into their organization to assure
appropriate clinical and administrative activities. Although organizational patient safety factors
are critical, they have been much less studied in healthcare research (Naveh et al., 2005).
Creating a proper patient safety climate includes changing management behaviors, safety
systems and employee safety perceptions that directly inﬂuence healthcare professionals to choose
proper behaviors that enhance patient safety (Colla et al., 2005; Fleming, 2005).
Creating a positive patient safety climate inside an organization can only be accomplished
through managerial commitment, strong communication, dedicated organizational resources and
mutual trust shared by organizational members (Fleming, 2005; Singer et al., 2003).

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2.3 Conceptual Framework
Independent Variables
2.4 Definitions of Variables in Conceptual Framework
 Technology: It is a crucial part which is utilized in the healthcare system. It consists of
methods of treatment, facilities and invention of new medicines required.
 Budget: It is financial resource provided by the Ministry of Health to improve the National
Healthcare System.
Technology
Budget
Work Environment
Training
Healthcare Providers-
Patients'
Communication
Medical Training
Institutes & Facilities
Improvement of National
Healthcare System in the
Republic of the Union of
Myanmar.
Dependent Variable
Demographic Variables
Age
Gender
Marital Status
Education Level
Profession/Career
H1
H2
H3
H4
H5
H6
Patients' Safety

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 Training: It is the program that applied skills and knowledge to the healthcare providers
provided by the hospitals or the Ministry of Health, for e.g., on-job training, emergency
training and so on.
 Work Environment: It can be defined as the surrounding conditions where the healthcare
providers operate. It can enhance healthcare providers' job satisfaction, motivation and
their performance level.
 Healthcare Providers- Patients' Communication: It is the most important clinical function
in the healthcare system. It is the understanding between the two persons. It includes
healthcare providers' interpersonal skills, share perception and feeling.
 Medical Training Institutes & Facilities: It is the fundamental and most important to
generate talented healthcare providers. And the facilities included in the medical institutes
to provide proper training programs are sufficient or outdated or not.
 Patients' Safety: It is to maintain or improve, to prevent, recover or least minimize the
clinical errors to the patients.
 Age : It is a set of values to measure the age of the respondents.
 Gender : It is a variable to determine which respondents are male or female.
 Marital Status : It is a variable to determine whether respondents are single, married,
divorced, widow or separate.
 Education Level : It is used to categorize the respondents regarding to their last
achieved academic results.
 Profession : It is a variable to categorize work responsibility of the respondents who
are working in the healthcare settings.

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2.5 Hypotheses
H1o : There is no relationship between age and the improvement of National Healthcare System
in Myanmar.
H1a : There is a relationship between age and the improvement of National Healthcare System
in Myanmar.
H2o : There is no relationship between gender and the improvement of National Healthcare
System in Myanmar.
H2a : There is a relationship between gender and the improvement of National Healthcare
System in Myanmar.
H3o : There is no relationship between marital status and the improvement of National
Healthcare System in Myanmar.
H3a : There is a relationship between marital status and the improvement of National Healthcare
System in Myanmar.
H4o : There is no relationship between education level and the improvement of National
H4a : There is a relationship between education level and the improvement of National
H5o : There is no relationship between profession and the improvement of National Healthcare
System in Myanmar.

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H5a : There is a relationship between profession and the improvement of National Healthcare
System in Myanmar.
H6oa : There is no relationship between technology and the improvement of National Healthcare
System in Myanmar.
H6a : There is a relationship between technology and the improvement of National Healthcare
System in Myanmar.
H6ob : There is no relationship between budget and the improvement of National Healthcare
System in Myanmar.
H6b : There is a relationship between budget and the improvement of National Healthcare
System in Myanmar.
H6oc : There is no relationship between work environment and the improvement of National
H6c : There is a relationship between environment and the improvement of National Healthcare
System in Myanmar.
H6od : There is no relationship between training and the improvement of National Healthcare
System in Myanmar.
H6d : There is a relationship between training and the improvement of National Healthcare
System in Myanmar.
H6oe : There is no relationship between healthcare providers & patients' communication and the
improvement of National Healthcare System in Myanmar.

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H6e : There is a relationship between healthcare providers & patients' communication and the
H6of : There is no relationship between Medical Training Institutes & its Facilities and the
H6f : There is a relationship between Medical Training Institutes & its Facilities and the
H6og : There is no relationship between patients' safety and the improvement of National
H6g : There is a relationship between patients' safety and the improvement of National
CHAPTER -3
3.1 Research methodology
A field study was carried out to find out the factors affecting the improvement of National
Healthcare System in Myanmar. The research of this topic is based on the actual respondents who
are working as healthcare providers such as doctors, nurses, pharmacists and medical technician
and also it includes the medical students who are currently attending in the Medical Universities.
The survey was based on the some locations in Mandalay which is the second biggest state of
Myanmar. This survey can be said to be reliable because I conducted the survey and collected the
data face-to-face and using email. I welly explained about the survey which I am conducting to
the respondents and described the purposes and reasons why I am doing this topic.

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3.2 Research Methods
In this study, researcher used descriptive analysis, independent sample T-test, Analysis of
Variances (ANOVA) and multiple regression analysis. To describe the primary data of the
respondents, especially the demographic variables, the descriptive analysis is used. The target
population of this study was chosen by the fact that healthcare providers who are working in the
hospitals and clinics and the students who are studying medical courses in Mandalay, Myanmar.
It is used to measure the relationships towards the improvement of National Healthcare System in
Myanmar. In order to examine the consistency and reliability of the variables, the Cronbach's
Alpha Coefficient is used. And to find out the intensity of relationship between independent
variables and dependent variables and to analyze the factors affecting the improvement of National
Healthcare System in Myanmar, multiple regression method is used. In order to collect the primary
data of the research, the researcher generated a set of questionnaires. These sets of questionnaires
are distributed within two weeks, 200 sets are distributed by door-to-door and face-to-face and 100
sets are distributed via Internet through the Facebook friends who are working as healthcare
providers or students studying in the Medical Universities.
3.3 Sampling Procedures
3.3.1 Target Population
The target population of this study can be defined as the people who are working as
healthcare providers such as doctors, nurses, pharmacists, dentists, surgeons, physicians, medical
technicians, etc. in hospitals and other healthcare settings, students who are studying in the Medical
Universities and people with higher management level of the healthcare settings in Mandalay,
Myanmar.

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3.3.2 Sample and Sampling Units
In this study, the researcher chose the medical students who are currently attending in the
medical universities and peoples who are working as healthcare providers in Mandalay, Myanmar.
They are between 20-70 years of age and it can be classified into young adults and adults for this
research.
3.3.3 Sample Size
In this research, the set of questionnaires was distributed to people who are attending
medical courses in Medical University, University of Dental Medicine, University of Medical
Technology, University of Traditional Medicine and University of Pharmacy which are situated in
Mandalay, Myanmar and peoples who are working as healthcare providers in Mandalay General
Hospitals, Mandalay Children Hospitals, Universities Hospitals and Mandalay Orthopedic
Hospitals.
3.4 The Questionnaires or the Research Instruments
As the research instruments, in this study, the researcher applied a self-administered and
structured questionnaires. All the questionnaires generated by the researcher follow to the literature
reviews.
The questionnaires are classified into two sections; the first section includes the questions
related to the demographic factors of the respondents such as age, gender, marital status, education
level and departments that they are working currently. And the second section consisted of the

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questions that captured the independent variables such as technology, budget, training, work
environment, healthcare providers-patients' communication, medical training institutes & its
facilities, hospitals & clinics' facilities availabilities and patients' safety. Unlike demographic
variables, independent variables are measured by a five-point Likert Scale ranging from "Strongly
Disagree" to "Strongly Agree". It consists of the following interval scales:
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree
3.5 Cronbach's Alpha & the Reliability of Questionnaires
In order to measure the consistency of the questionnaires, Alpha Coefficient or Cronbach's
Alpha is applied. It examines the collected data from the respondents.
If the value of Cronbach's Alpha coefficient is equal to 0.6 or less than 0.6, the
questionnaires generated by the questionnaires can be said unreliable. If it is greater than 0.6, the
questionnaires can be said reliable.
3.6 Pilot Testing
Pilot testing can help the researcher to find out the relationship of the questionnaires
concerning with the variables, the researcher have to modify and adjust the questionnaires again if
the testing of questions in each variable are less than 0.6.

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The pilot testing in this study contained 10 total respondents who are currently attending
medical universities and those who are working as healthcare providers in Mandalay for testing
the questionnaires' reliability. This pilot testing was conducted on December 8th
, 2015.
The researcher used Cronbach's Alpha Coefficient in order to test the reliability of the
questionnaires. By using this method, the researcher can know that the questionnaires are reliable
if the coefficient alpha is greater than 0.6. If it is less than 0.6, the questionnaires are not reliable
and the researcher have to correct and amend the questionnaires again to collect the data from the
respondents effectively.
The outcomes of the pilot testing using Statistical Package for Social Sciences (SPSS) are
described below:
Variables Cronbach's Alpha
Improvement of National Healthcare System 0.766
Technology 0.606
Budget 0.733
Work Environment 0.644
Training 0.762
Healthcare Providers-Patients' Communication 0.683
Medical Training Institutes & its facilities 0.760
Patient Safety 0.636
Table 3.6.1 : Testing the Questionnaires By the Cronbach's Alpha Coefficient

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Regarding with the above table, the pilot testing examined to all the variables of the questionnaire
were reliable since the Cronbach's Alpha values are greater than 0.6. Therefore, the researcher can
use these questionnaires as a set of instruments for this research.

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CHAPTER – 4
Descriptive Analysis & Hypotheses Testing
4.1 Introduction
This chapter consists of Descriptive Analysis & Hypotheses Testing from the
questionnaires. The Statistical Package for the Social Science (SPSS) program is used to analyze
the data. There are altogether two parts in this chapter consisting of descriptive analysis for the
demographic factors and hypotheses testing. In the descriptive analysis, there are three parts such
as the analysis of demographic variable according to the frequency & percentage, the descriptive
statistics analysis depending on the standard deviation and average mean and the Cronbach's Alpha
reliability analysis. And the researcher used Analysis of Variances (ANOVA) to measure which
demographic factors influence on the Improvement of National Healthcare System. For the
independent variables, the researcher used Multiple Regression Method to test each hypotheses
and explain.
4.2 Descriptive Analysis of Demographic Factors
In order to determine the general information of the respondents such as age, gender,
marital status, education & departments of the total 300 respondents who are students of the
Medical Universities or currently working as healthcare providers such as doctors, physician,
nurse, pharmacists & dentists. The following are the descriptive analysis of the demographic
variables;

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Table (4.2.1): The descriptive Analysis of Age by using Frequency & Percentage
Age Group
Frequency Percent Valid Percent Cumulative Percent
Valid 20-30 154 51.3 51.3 51.3
31-40 61 20.3 20.3 71.7
41-50 70 23.3 23.3 95.0
51-60 15 5.0 5.0 100.0
Total 300 100.0 100.0
According to the above table, the highest number of respondents is in the age range of 20-
30 years which is 154 people or 51.3%, followed by the age range of 41-50 years that is 70
respondents or 23.3% of the total respondents. Respondents who are in the age range of 31-40
years are 61 people or 20.3%. Finally, the result shows that the lowest number of respondents is
the age range of 51-60 years and there is only 15 respondent which is 5% of the total respondents.
Table (4.2.2): The descriptive analysis of Gender using Frequency & Percentage
Gender Group
Valid Male 145 48.3 48.3 48.3
Female 155 51.7 51.7 100.0
Total 300 100.0 100.0
Regarding to the above table, the highest number of respondents are female which is 155
people or 51.7% of the total respondents and the remaining 145 people are male or 48.3% of the
total respondents.

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Table (4.2.3) The Descriptive Analysis of Marital Status using Frequency & Percentage
Marital Status
Valid Single 169 56.3 56.3 56.3
Married 131 43.7 43.7 100.0
Total 300 100.0 100.0
Table 4.2.3 shows that the total 169 people or 56.3% of the total respondents are singles, followed
by 131 respondents or 43.7% of the total number of respondents are married.
Table (4.2.4) The Descriptive Analysis of Education Level using Frequency & Percentage
Education level
Valid Graduate 95 31.7 31.7 31.7
Post-Graduate 85 28.3 28.3 60.0
MD 20 6.7 6.7 66.7
MRCP/MRCS/MRCOG 45 15.0 15.0 81.7
Others 55 18.3 18.3 100.0
Total 300 100.0 100.0
According to the above table, the highest number of respondents are graduated with 95
peoples or 31.7% of the total respondents, followed by the post-graduate which is 85 people or
28.3%. The third highest number of respondent are graduated with different degree which are 55
peoples or 18.3%. The second lowest number of respondents are graduated with MRCP (Member

Page | 31
of Royal College of Physicians), MRCS (Member of Royal College of Surgeons) and MRCOG
(Member of Royal College of Obstetricians and Gynecologists which are 45 respondents or 15%
of the total respondents. The smallest number of respondents are graduated with Medical Degree
(MD) which are 20 peoples or 6.7% of the total respondents.
Table (4.2.5) The Descriptive Analysis of Profession by using Frequency & Percentage
Profession
Valid Doctor 112 37.3 37.3 37.3
Nurse 76 25.3 25.3 62.7
Pharmacist 44 14.7 14.7 77.3
Dentist 48 16.0 16.0 93.3
Others 20 6.7 6.7 100.0
Total 300 100.0 100.0
Concerning with the above table, the majority of respondent are doctors which are 112 people or
37.3%, followed by the nurses which are 76 respondents or 25.3%. The third highest number
respondents are dentists which are 48 people or 16% of the total number of respondents, followed
by the pharmacists which are 44 respondents or 14.7%. The minority of respondents are from the
others group which are technicians and physicians with 20 number of respondents or 6.7% of the
total number of respondents.

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4.3 Descriptive Analysis of Independent Variables
The descriptive analysis offer the result of the mean, observation count (N) and the standard
deviation for each of the independent and dependent factors. The following tables describe the
descriptive analysis of the independent variables and their reliability.
Table (4.3.1): The Descriptive Analysis of the Factors Affecting to the Improvement of National
Healthcare System.
Descriptive Statistics
N Minimum Maximum Mean Std. Deviation
Technology 300 2.00 5.00 3.9000 .60929
Budget 300 3.00 5.00 3.3000 .65684
Work Environment 300 3.00 5.00 3.4000 .67937
Training 300 2.00 5.00 3.9433 .66453
Healthcare Providers-Patient
Communication
300 2.00 5.00 3.0867 .72762
Medical Institutes 300 2.00 5.00 3.9833 .78669
Patients' Safety 300 2.00 5.00 3.5967 .81005
Valid N (listwise) 300
Regarding with the table (4.3.1), the highest mean is 3.9833 referring to the factor "Medical
Institutes" and the lowest mean is 3.0867 indicating the factor "Healthcare Provider-Patients'
Communication". Since there is not much difference in mean, therefore the factors heterogeneity
towards the Improvement of National Healthcare System in Myanmar.
In the standard deviation column, the highest deviation is 0.81005 which refers to the factor
"Patients' Safety" and the lowest deviation is 0.60929 which indicates the factor "Technology". In

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here also, since there is not much variation in the standard deviation, therefore, the data are
reasonably homogenous.
Table (4.3.2): The Descriptive Analysis of Technology
Change in Technology 300 1.00 4.00 3.1000 .94497
Technical Support 300 2.00 5.00 3.8000 .74958
Technological Facilities 300 2.00 5.00 4.1000 .83205
According to the table (4.3.2), the highest mean is 4.1 which refers to the statement " I like
to work with high technology facilities can improve the treatment procedures and give accurate
clinical decisions" with the minimum 2 (Disagree) and the maximum 5 (Strongly Agree) and the
lowest mean result is 3.1 which points the statement " Changes in technology can enable services
such as new medical and surgical procedures in order to improve the National Healthcare System"
with the minimum 1 (Strongly Disagree) and the maximum 5 (Strongly Agree). This variable is
homogeneity towards the Improvement of National Healthcare System.
Standard deviation column shows that the highest deviation is 0.94497 which indicates the
statement "Changes in technology can enable services such as new medical and surgical
procedures in order to improve the National Healthcare System" and the lowest deviation is
0.74958 which refers to the statement " Providing technical support to the healthcare providers can
improve the traditional system of medical records" with the minimum 2 (Disagree) and the
maximum 5 (Strongly Agree). The difference between them tells that there is not much variation
in the standard deviation and the data are homogenous reasonably.

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Table (4.3.3): The Descriptive Analysis of Budget
Fixed Frame Budget 300 2.00 5.00 3.3000 .64138
Financial Support 300 2.00 5.00 3.7000 .78233
Allocation of Budget 300 2.00 5.00 4.4000 .91805
According to the table (4.3.3), the highest mean is 4.4 which indicating the statement "I
think the correct allocation of budget to the required sectors is needed to improve the whole
National Healthcare System" with the minimum of 2 (Disagree) and the maximum of 5 (Strongly
Agree). And on the other hand, the lowest mean is 3.3 which referring the statement "I prefer
providing a fixed frame of budget by the ministry of health to fulfill certain portion of demand"
with the minimum 2 (Disagree) to the maximum 5 (Strongly Agree). Since there is a little
difference in mean, therefore, this variable is homogeneity towards the Improvement of National
Healthcare System.
statement "I think the correct allocation of budget to the required sectors is needed to improve the
whole National Healthcare System " and the lowest deviation is 0.64138 which refers to the
statement "I prefer providing a fixed frame of budget by the ministry of health to fulfill certain
portion of demand" with the minimum 2 (Disagree) and the maximum 5 (Strongly Agree). The
difference between them tells that there is not much variation in the standard deviation and the
data are homogenous reasonably.

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Table (4.3.4): The Descriptive Analysis of Work Environment
Work hours & workload 300 1.00 5.00 3.4000 .66443
Safe work Environment 300 2.00 5.00 4.0000 .77589
Encouragement & Rewards 300 2.00 5.00 4.3000 .90150
According to the table (4.3.4), the highest mean is 4.3 which indicating the statement "I
want reward & encouragement from the top management to increase my job satisfaction." with the
minimum of 2 (Disagree) and the maximum of 5 (Strongly Agree) and the lowest mean is 3.4
which referring the statement "I like working unsociable hours, working alone and having an
intensity of workload" with the minimum 1 (Strongly Disagree) to the maximum 5 (Strongly
Agree). Since there is a little difference in mean, therefore, this variable is homogeneity towards
the Improvement of National Healthcare System.
statement "I want reward & encouragement from the top management to increase my job
satisfaction" and the lowest deviation is 0.66443 which refers to the statement "I like working
unsociable hours, working alone and having an intensity of workload". The difference between
them tells that there is not much variation in the standard deviation and the data are homogenous
reasonably.

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Table (4.3.5): The Descriptive Analysis of Training
Training Contents 300 2.00 5.00 3.4000 .68443
Skilled Trainers 300 2.00 5.00 3.6000 .66443
Training Facilities 300 1.00 5.00 4.2000 .87324
According to the table (4.3.5), the highest mean is 4.2 which indicating the statement " I
agree that the training room and facilities are adequate and comfortable" with the minimum of 1
(Strongly Disagree) and the maximum of 5 (Strongly Agree) and the lowest mean is 3.4 which
referring the statement "I agree that the current training contents are well organized, easy to
understand and more practical" with the minimum 2 (Disagree) to the maximum 5 (Strongly
statement "I want reward & encouragement from the top management to increase my job
satisfaction" and the lowest deviation is 0.68443 which refers to the statement "I agree that the
trainers should be knowledgeable about the trainingtopics so that trainees can get effective training
experience" with the minimum 2 (Disagree) and the maximum 5 (Strongly Agree). The difference
between them tells that there is not much variation in the standard deviation and the data can be
said reasonably homogeneous.

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Table (4.3.6): The Descriptive Analysis of Healthcare Providers-Patients' Communication
Consultation skills 300 1.00 5.00 3.0000 1.00167
Using Common Language 300 2.00 5.00 3.7000 .90150
Understandable Instructions 300 2.00 5.00 4.1000 1.04578
According to the table (4.3.6), the highest mean is 4.1 which indicating the statement " I
used to give easy and understandable instruction about taking care of patients' health problems"
with the minimum of 2 (Disagree) and the maximum of 5 (Strongly Agree) and the lowest mean
is 3 which referring the statement "I agree that consultation skill is important in building a good
relationship with patients." with the minimum 1 (Strongly Disagree) to the maximum 5 (Strongly
statement " I used to give easy and understandable instruction about taking care of patients' health
problems" and the lowest deviation is 0.90150 which refers to the statement " I agree that using a
common language by healthcare providers and patients can improve their communication. " with
the minimum 2 (Disagree) and the maximum 5 (Strongly Agree). The difference between them
tells that there is not much variation in the standard deviation and the data can be said reasonably
homogeneous.

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Table (4.3.7): The Descriptive Analysis of Medical Institutes & its Facilities
Facilities 300 2.00 5.00 3.7000 .90150
Elective Courses 300 2.00 5.00 3.8000 1.10184
According to the table (4.3.7), the highest mean is 3.8 which indicating the statement " The
elective courses given by the Medical Training Institutes were valued in my professional careers"
with the minimum of 2 (Disagree) and the maximum of 5 (Strongly Agree) and on the other hand,
the lowest mean is 3.7 which referring the statement "The medical training institutes in my country
have proper and enough medical training facilities such as equipment needed for the operations."
with the minimum 2 (Disagree) to the maximum 5 (Strongly Agree). Since there is a little
difference in mean, therefore, this variable is homogeneity towards the Improvement of National
Healthcare System.
statement "The elective courses given by the Medical Training Institutes were valued in my
professional careers" and the lowest deviation is 0.90150 which refers to the statement "The
medical training institutes in my country have proper and enough medical training facilities such
as equipment needed for the operations". The difference between them tells that there is not much
variation in the standard deviation and the data can be said reasonably homogeneous.

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Table (4.3.8): The Descriptive Analysis of Patients' Safety
Prevention 300 2.00 5.00 3.6000 .80134
Safety as Top Priority 300 2.00 5.00 4.1000 .94497
According to the table (4.3.8), the highest mean is 4.1 which indicating the statement " The
actions of hospital managements in my country show that patient safety is a top priority" with the
minimum of 2 (Disagree) and the maximum of 5 (Strongly Agree) and on the other hand, the
lowest mean is 3.6 which referring the statement " I think that the current healthcare system and
procedures are good at preventing errors from happening" with the minimum 2 (Disagree) to the
maximum 5 (Strongly Agree). Since there is a little difference in mean, therefore, this variable is
homogeneity towards the Improvement of National Healthcare System.
statement "The actions of hospital managements in my country show that patient safety is a top
priority" and the lowest deviation is 0.80134 which refers to the statement "I think that the current
healthcare system and procedures are good at preventing errors from happening". The difference
between them tells that there is not much variation in the standard deviation and the data can be
said reasonably homogeneous.

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Table (4.3.9): The Descriptive Analysis of the Improvement of National Healthcare System
Satisfaction 300 1.00 5.00 3.1000 1.22270
Budget & Training 300 2.00 5.00 4.0000 1.00167
According to the table (4.3.9), the highest mean is 4 which indicating the statement "In
order to improve the National Healthcare System, both budget and training for the health care
practitioners are equally important" with the minimum of 2 (Disagree) and the maximum of 5
(Strongly Agree) and on the other hand, the lowest mean is 3.1 which referring the statement I am
Satisfied with the current National Healthcare System in Myanmar" with the minimum 1 (Strongly
Disagree) to the maximum 5 (Strongly Agree). Since there is a little difference in mean, therefore,
this variable is homogeneity towards the Improvement of National Healthcare System.
statement "I am Satisfied with the current National Healthcare System in Myanmar." And on the
other hand, the lowest deviation is 1.00167 which refers to the statement "In order to improve the
National Healthcare System, both budget and training for the health care practitioners are equally
important". The difference between them tells that there is not much variation in the standard
deviation and the data can be said reasonably homogeneous.

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4.4 The Reliability Test
In this researchpaper, inorder to test the credibilityof eachvariable question, the reliability
test is applied by using SPSS. The results below are the outcomes of testing questionnaires by the
total 300 respondents which are shown in the Cronbach's Alpha values. Since all the alpha values
are more than 0.6, therefore, the researcher proceeds to study the further steps. If the alpha values
are less than 0.6, the researcher needs to edit to get better in understanding by the respondents and
for the internal consistency improvement.
Table (4.4.1) : The Results of the Reliability Tests
Variables Cronbach's Alpha Value No. of items
Healthcare system
0.720
2
Technology 0.655 3
Budget 0.639 3
Work Environment 0.808 3
Training 0.621 3
Patients' Communication
0.623 3
Medical Institutes & its
Facilities
0.890 2
Patients' Safety 0.730 2

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4.5 Hypotheses Testing Using ANOVA Method
Hypotheses testing could help the researcher to justify the impact which derive from the
variables such as independent variables (Technology, Budget, Work Environment, Training,
Healthcare Providers-Patients' Communication, Medical Institutes & Patients' Safety) and
demographic variables (Age, Gender, Marital Status, Education Level & Professional) towards the
dependent variable (Improvement of National Healthcare System in Myanmar). In this research,
the researcher studies on six hypotheses that related to independent, demographic and dependent
variables as described in the conceptual framework.
Hypotheses Testing-1
H1o : There is no relationship between age and the improvement of National Healthcare System
in Myanmar.
H1a : There is a relationship between age and the improvement of National Healthcare System
in Myanmar.
Table (4.5.1): Hypotheses Testing of Age using ANOVA method
ANOVA
Improvement of National Healthcare System
Sum of Squares df Mean Square F Sig.
Between Groups 1.302 3 .434 .934 .424
Within Groups 137.534 296 .465
Total 138.837 299
According to the above table of analysis of variance (ANOVA), it can be see that the significant
level is at 0.424 which is larger than 0.05 (0.424>0.05). Thus, the alternative hypotheses is

Page | 43
neglected and the null hypotheses is accepted. There is no significance relationship between Age
and the Improvement of National Healthcare System.
H2o : There is no relationship between gender and the improvement of National Healthcare
System in Myanmar.
H2a : There is a relationship between gender and the improvement of National Healthcare
System in Myanmar.
Table (4.5.2): Hypotheses Testing of Gender using Independent Sample T-Test Method
Group Statistics
Gender
Group N Mean Std. Deviation Std. Error Mean
Healthcare System
Male 145 3.9724 .70656 .05868
Female
155 4.0710 .65574 .05267
The above table shows the results from the Independent Sample T-test, the F-value of the Levene's
Test is 0.032 and the significance value is 0.857. Since the significance value is larger the p-value
0.05 (0.857>0.05), thus, the null hypotheses is accepted and fails to accept the alternative

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hypotheses. Therefore, the researcher has to look the first line (Equal Variances Assumed) of the
column Sig (2-tailed). Since the significance value is 0.211 and which is greater than 0.05.
Therefore, it rejects the alternative hypotheses. Thus, there is no significant relationship between
gender and the Improvement of National Healthcare System.
H3o : There is no relationship between marital status and the improvement of National
H3a : There is a relationship between marital status and the improvement of National Healthcare
System in Myanmar.
Table (4.5.3): Hypotheses Testing of Marital Status using ANOVA method
ANOVA
Between Groups 1.111 1 1.111 2.405 .122
Total 138.837 299
According to the above table of analysis of variance (ANOVA), it can be see that the significant
neglected and the null hypotheses is accepted. There is no significance relationship between
Marital Status and the Improvement of National Healthcare System.

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H4o : There is no relationship between education level and the improvement of National
H4a : There is a relationship between education level and the improvement of National
Table (4.5.4): Hypotheses Testing of Education Level using ANOVA method
ANOVA
Between Groups .853 4 .213 .456 .768
Total 138.837 299
Regarding with the above table of analysis of variance (ANOVA), it can be see that the significant
neglected and the null hypotheses is accepted. There is no significance relationship between
Education Level and the Improvement of National Healthcare System.
H5o : There is no relationship between profession and the improvement of National Healthcare
System in Myanmar.
H5a : There is a relationship between profession and the improvement of National Healthcare
System in Myanmar.

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Table (4.5.5): Hypotheses Testing of Profession using ANOVA method
ANOVA
Between Groups .181 4 .045 .096 .984
Total 138.837 299
Concerning with the above table of analysis of variance (ANOVA), it can be see that the significant
level is at 0.984 which is greater than 0.05 (0.984>0.05). Thus, the alternative hypotheses is failed
to accept and the null hypotheses is accepted. Therefore, there is no significance relationship
between Profession and the Improvement of National Healthcare System.
4.6 Hypotheses Testing Using Regression Analysis
4.6.1 The Estimated Equation of the Regression Analysis
The estimate equation of the Regression Analysis can be described as follow;
Y = a + b (Technology) + c (Budget) + d (Work Environment) + e (Training) + f (Healthcare
Providers- Patients' Communication) + g (Medical Institutes) + h (Patients' Safety)
Table (4.6.1.1): The Model Summary of the Regression Analysis
Model Summary
Model R R Square Adjusted R Square Std. Error of the Estimate
1 .625a .391 .376 .53824
a. Predictors: (Constant), Patient Safety, Training, Medical Institutes, Budget, Technology, Work Environment,
Healthcare Providers-Patient Communication

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According to the above table, since the R-square value is 0.391, it represents that total variation to
the Improvement of National Healthcare System in Myanmar can be solved by Technology,
Budget, Work Environment, Training, Healthcare Providers-Patients' Communication, Medical
Institutes and Patients' Safety with 39.1 %.
Table (4.6.1.2): ANOVA from the Regression Analysis
ANOVAb
Model Sum of Squares df Mean Square F Sig.
1 Regression 54.244 7 7.749 6.749 .000a
Residual 84.592 292 .290
Total 138.837 299
a. Predictors: (Constant), Patient Safety, Training, Medical Institutes, Budge, Technology, Work
Environment, Healthcare Providers-Patient Communication
b. Dependent Variable: Improvement of National Healthcare System
According to the above table, the Critical F-value is 6.749 and larger than the standard Critical F-
value 3.25 (6.749>3.25) at 5% significance level and the Degree of freedom, (n-k), (k-1) = 292, 7.
Therefore, the overall equation is statistically significant at 5% significant level.

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Table (4.6.1.3): Multiple Regression Analysis for the Independent Variables and the Dependent
Variable
Coefficientsa
Model
Unstandardized Coefficients
Standardized
Coefficients
t Sig.B Std. Error Beta
1 (Constant) .215 .397 .542 .038
Technology .463 .057 .414 8.124 .000
Budget .075 .063 .072 1.197 .232
Work Environment -.087 .059 -.086 -1.477 .141
Training .111 .054 .108 2.058 .040
Patients' Communication
.115 .044 .173 2.587 .010
Medical Institutes .239 .057 .205 4.216 .002
Patient Safety .085 .065 .101 1.303 .193
a. Dependent Variable: Improvement of National Healthcare System
According to the regression analysis, the equation of regression analysis can be written as below,
Y (Improvement of National Healthcare System) = 0.215 + 0.463b (Technology) + 0.075c
(Budget) – 0.087d (Work Environment) + 0.111e (Training) + 0.115f (Healthcare Providers-
Patients' Communication) + 0.239g (Medical Institutes) + 0.085h (Patients' Safety)
Hypotheses Testing-6a
H6oa : There is no relationship between technology and the improvement of National Healthcare
System in Myanmar.
H6a : There is a relationship between technology and the improvement of National Healthcare
System in Myanmar.

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Critical t-vale = 1.6501 (at 5% Significance Level, Degree of Freedom, (n-k) = 292)
Since the absolute t-value is 8.124 which is larger than 1.6501 (8.124>1.6501), therefore,
parameter "b" for the Technology is significant statistically.
The P-value for "b" is 0.000 <0.05, thus, the parameter "b" is statistically significant.
Therefore, the alternative hypotheses is accepted and there is a significant relationship between
the Technology and the Improvement of National Healthcare System in Myanmar.
Hypotheses Testing-6b
H6ob : There is no relationship between budget and the improvement of National Healthcare
System in Myanmar.
H6b : There is a relationship between budget and the improvement of National Healthcare
System in Myanmar.
Critical t-vale = 1.6501 (at 5% Significance Level, Degree of Freedom, n-k= 292)
Since the absolute t-value is 1.197 which is smaller than 1.6501 (1.197<1.6501), therefore,
parameter "c" for the Budget is not significant statistically.
The P-value for "c" is 0.232 > 0.05, thus, the parameter "c" is not statistically significant.
Therefore, the null hypotheses is accepted and there is no significant relationship between budget
and the improvement of National Healthcare System in Myanmar.
Hypotheses Testing-6c
H6oc : There is no relationship between work environment and the improvement of National

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H6c : There is a relationship between work environment and the improvement of National
Since the absolute t-value is -1.477 which is smaller than 1.6501 (-1.477<1.6501), therefore,
parameter "d" for the Work Environment is not significant statistically.
The P-value for "d" is 0.141 > 0.05, thus, the parameter "d" is not statistically significant.
Therefore, the null hypotheses is accepted and there is no significant relationship between work
environment and the improvement of National Healthcare System in Myanmar.
Hypotheses Testing-6d
H6od : There is no relationship between training and the improvement of National Healthcare
System in Myanmar.
H6d : There is a relationship between training and the improvement of National Healthcare
System in Myanmar.
Since the absolute t-value is 2.058 which is greater than 1.6501 (2.058>1.6501), therefore,
parameter "e" for the training is significant statistically.
The P-value for "e" is 0.04 < 0.05, thus, the parameter "e" is statistically significant.
training and the improvement of National Healthcare System in Myanmar.

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Hypotheses Testing-6e
H6oe : There is no relationship between healthcare providers & patients' communication and the
H6e : There is a relationship between healthcare providers & patients' communication and the
parameter "f" for the healthcare providers & patients' communication is significant statistically.
The P-value for "f" is 0.01 < 0.05, thus, the parameter "f" is statistically significant.
healthcare providers & patients' communication and the improvement of National Healthcare
System in Myanmar.
Hypotheses Testing-6f
H6of : There is no relationship between Medical Training Institutes & its Facilities and the
H6f : There is a relationship between Medical Training Institutes & its Facilities and the
parameter "g" for the Medical Training Institutes & its Facilities is significant statistically.

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The P-value for "g" is 0.000 < 0.05, thus, the parameter "g" is statistically significant.
Medical Training Institutes & its Facilities and the improvement of National Healthcare System in
Myanmar.
Hypotheses Testing-6g
H6og : There is no relationship between patients' safety and the improvement of National
H6g : There is a relationship between patients' safety and the improvement of National
Since the absolute t-value is 1.303 which is less than 1.6501 (1.303<1.6501), therefore, parameter
"h" for the patients' safety is not significant statistically.
The P-value for "h" is 0.193 > 0.05, thus, the parameter "h" is not statistically significant.
Therefore, the null hypotheses is accepted and there is no significant relationship between patients'
safety and the improvement of National Healthcare System in Myanmar.
4.6.2 The Summary of Regression Analysis
Among the four significant variable, the technology has the strongest relationship with the
improvement of National Healthcare System in Myanmar with the beta-value 0.414, medical
institutes has a second strongest relationship with the beta-value 0.205, the Healthcare Providers-
Patients' Communication has the third strongest beta-value of 0.173 and the relationship of training

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and the improvement of National Healthcare System has weaker relationship than others with the
beta-value of 0.108.
4.7 The Findings of Hypotheses Testing
Hypotheses Description Significance
Value
Outcomes
H1o There is no significant relationship between
age and the improvement of National
0.424 > 0.05 Null
Hypotheses
is accepted
gender and the improvement of National
0.857 > 0.05 Null
Hypotheses
is accepted
marital status and the improvement of
National Healthcare System in Myanmar.
0.122 > 0.05 Null
Hypotheses
is accepted
Education Level and the improvement of
0.768 > 0.05 Null
Hypotheses
is accepted
profession and the improvement of National
0.984 > 0.05 Null
Hypotheses
is accepted
H6a There is a significant relationship between
Technology and the improvement of National
0.000 < 0.05 Null
Hypotheses
is rejected
H6ob There is no significant relationship between
budget and the improvement of National
0.232 > 0.05 Null
Hypotheses
is accepted
H6oc There is no significant relationship between
work environment and the improvement of
0.141 > 0.05 Null
Hypotheses
is accepted
H6d There is a significant relationship between
training and the improvement of National
0.04 < 0.05 Null
Hypotheses
is rejected
H6e There is a significant relationship between
Healthcare Providers & Patient'
Communication and the improvement of
0.01 < 0.05 Null
Hypotheses
is rejected

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H6f There is a significant relationship between
Medical Institutes and the improvement of
0.002 < 0.05 Null
Hypotheses
is rejected
H6og There is no significant relationship between
Patients' Safety and the improvement of
0.193 > 0.05 Null
Hypotheses
is accepted.
CHAPTER (5)
SUMMARY OF THE FINDINGS, CONCLUSION & RECOMMENDATION
5.1 Summary of Findings
5.1.1 Summary of Demographic Variables
This topic covers the evaluation of demographic factors which are collected to the total 300
respondents. The demographic variables such as age, gender, marital status, education level and
profession are asked to the respondents respectively.
Age : The largest age is range is between 20 and 30 which is about 51.3 % of the total
respondents.
Gender : The largest gender group is Female with 51.7% of the total 300 respondents. The
respondents remaining are the male.
Marital Status: Most of the respondents in this study are single with 56.3% of the total
respondents and the remaining are the married. There is no divorced, widowed or separated in this
study.
Education Level: Most of the respondents are graduated with 31.7 % of the total 300 respondents.
And followed by the post-graduated which is about 28.3% of the total respondents.

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Profession : The largest group of respondents in this study are doctor with 37.3% of the total
respondents and followed by the nurse group which is 25.3% of the total 300 respondents.
5.1.2 Summary of Hypotheses Testing
The hypotheses testing summary includes the outcome of relationship status between the
independent & demographic variables and the dependent variable which are as follows;
Hypotheses 1 : There is no significant relationship between age and the Improvement of
Hypotheses 2 : There is no significant relationship between Gender and the Improvement
of National Healthcare System in Myanmar.
Hypotheses 3 : There is no significant relationship between Marital Status and the
Improvement of National Healthcare System in Myanmar.
Hypotheses 4 : There is no significant relationship between Education Level and the
Hypotheses 5 : There is no relationship between Profession and the Improvement of
Hypotheses 6a: There is a significant relationship between Technology and the
Hypotheses 6b: There is no significant relationship between Budget and the Improvement
of National Healthcare System in Myanmar.

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Hypotheses 6c: There is no significant relationship between Work Environment and the
Hypotheses 6d: There is a significant relationship between Medical Training and the
Hypotheses 6e: There is a significant relationship between Healthcare Providers- Patients'
Communication and the Improvement of National Healthcare System in Myanmar.
Hypotheses 6f: There is a significant relationship between Medical Institutes and the
Hypotheses 6g: There is no significant relationship between Patients' Safety and the
5.2 Conclusion
The objective of this study is to study how the independent variables such as technology,
budget, work environment, training, health-care providers-patients' communication, Medical
Training Institutes & Facilities and Patients' Safety are affecting the dependent variable, the
Improvement of National Healthcare System in Myanmar. And it also indicates that there is a
relationship or not between demographic variables such as age, gender, marital status, education
level and profession and the Improvement of National Healthcare System in Myanmar. In this
study, the researcher used ANOVA test, independent sample T-test, descriptive analysis and
multiple analysis method to analyze the data depending on the conceptual framework.
The outcomes of the Hypotheses Testing can explain that the independent variables such
as technology, training, healthcare providers'-patients' communication and Medical Training

Page | 57
Institutes & its facilities have significant relationship to the dependent variable, the Improvement
of National Healthcare System. And the remaining variables do not have significant relationship
to the Improvement of National Healthcare System in Myanmar. The demographic variables such
as age, gender, marital status, education level and the profession do not have significant
relationship to the dependent variable, the Improvement of National Healthcare System in
Myanmar.
5.3 Recommendation
According to the hypotheses testing result, there is significant factor, the technology, which
is strongly influence on the Improvement of National Healthcare System in Myanmar. Today, the
technology is advancing very rapidly and also new diseases are occurred at the same time.
Technology can help us in finding the diseases quickly and efficiently, curing the disease effective,
producing the medical vaccines for the required diseases and also in many medical fields. In our
country, Myanmar, compared to the other South East Asians Countries, there are many diseases
which cannot be cured in here and sending the patients to the hospitals in other countries due to
the least development of technology in medical fields and the healthcare providers are not well-
trained. The National Healthcare System has so long been overburdened by a slow moving
innovation of the Ministry of Health, Public and Private Hospitals due to the complexity of medical
ecosystem. The Ministry of Health and also the private hospitals should bring in the high
technology medical equipment and they should send some local healthcare providers overseas to
learn how these equipment are used efficiently. Especially the medial software which are very
helpful in making the clinical decision for the healthcare providers, the healthcare providers in
public and private hospitals need to learn how it is applied in the medical field. And the Ministry
of Health should cooperate with the other countries and innovate some development system

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together in order to improve the National Healthcare System and also the private and public
hospitals should do joint venture with oversea hospitals and learn how the advancing technology
can be applied in the medical fields effectively.
As there is a medical training strongly influenced on the Improvement of National
Healthcare System, not only the Ministry of Health but also the public and private hospitals are
fully responsible for this. The Ministry of Healthshould allocate the required budget to the medical
sectors needed and training programs sufficiently and so as the Hospitals. They need to analyze
that what healthcare providers' skills & knowledge are required in the country and make
implementation of the training models required. In providing the medical training, the trainers
should be well-experienced and skillful and hire the healthcare trainers from overseas if there are
not skillful and well-experienced trainers inlocal or send the local healthcare providers to overseas
for training programs in order to provide the efficient and effective training to the healthcare
providers. And what important is that these training programs are should be conducted
consecutively.
In order to improve the healthcare providers-patients' communication, the fundamental
requirement for the healthcare providers is the consultation skill. The healthcare providers should
encourage the patient by telling the stories of his illness, they have to listen actively what the
patients want to be. The healthcare providers should empower the patients as well, so as they will
feel a greater sense of participation in their care if medical treatments options are explained clearly
to them. Communication is not only a doctor-patients issues. Ministry of health, private and public
hospitals should take account into these practices to the other healthcare providers. Therefore, they
should invest in teaching their healthcare providers in effective communication skills and related
topics. As a training for the communication skills, provide the role-play with 4 or 5 members in

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group depending on the most encountered scenarios. It is also the most effective training method
for the improvement of healthcare provider-patients' communication.
According to the Hypotheses testing, there is another significant factor, the Medical
Training Institutes and its facilities which is significantly impact on the Improvement of National
Healthcare System. In order to fully serve the patients today and the future, healthcare providers
need to know more than clinical sciences and biomedical, they need to know the healthcare system
science contents which include, understanding the way to improve healthcare quality, patient
safety and so on. This content should be added into the curriculum of the Medical Training
Institutes in order to teach the healthcare providers how to advocate the patients and understand
the socio-economical determinants of health. And also the trainers from the medical training
institutes should be experienced and skillful towards the medical topics. The Ministry Health
should cooperate with the Medical Training Institutes to develop the medical technology in the
National Healthcare System since the technology change in medical education is accelerating very
rapidly. They should provide high technology facilities for the future generation of medical
students to learn and develop such as the use of electronic health records and interpretation of big
data in healthcare in order to get knowledge of how to use best technology medical facilities.

Page | 60
APPENDIX: A
REFERENCE
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loyalty?", International Journal of Health Care Quality Assurance, Vol. 24 Iss 4 pp. 266-
273
2. Piyali Ghosh, Jagdamba Prasad Joshi, Rachita Satyawadi, Udita Mukherjee, Rashmi
Ranjan, (2011),"Evaluating effectiveness of a training programme with trainee reaction",
Industrial and Commercial Training, Vol. 43 Iss 4 pp. 247-255
3. Jane Cowan, (2000),"Consent and clinical governance: improving standards and skills",
British Journal of Clinical Governance, Vol. 5 Iss 2 pp. 124 – 128
4. Vineet Sarode, Deborah Sage, Jenny Phong, John Reeves, (2015),"Intensive care patient
and family satisfaction", International Journal of Health Care Quality Assurance, Vol. 28
Iss 1 pp. 75-81
5. Muslim Amin, Siti Zahora Nasharuddin, (2013),"Hospital service quality and its effects on
patient satisfaction and behavioural intention", Clinical Governance: An International
Journal, Vol. 18 Iss 3 pp. 238-254
6. Robin Gauld, Jako Burgers, Mark Dobrow, Rubin Minhas, Claus Wendt, Alan B. Cohen,
Karen Luxford, (2014),"Healthcare system performance improvement: A comparison of
key policies in seven high- income countries", Journal of Health Organization and
Management, Vol. 28 Iss 1 pp. 2-20
7. Aditi Naidu, (2009),"Factors affecting patient satisfaction and healthcare quality",
International Journal of Health Care Quality Assurance, Vol. 22 Iss 4 pp. 366-381

Page | 61
8. Akre, V., Falkum, E., Hoftvedt, B.O. and Aasland, O.G. (1997), “The communication
atmosphere between physician colleagues: competitive perfectionism or supportive
dialogue? A Norwegian study”, Social Science and Medicine, Vol. 44 No. 4, pp. 519-26.
9. Austin, A.E. (2009), “Cognitive apprenticeship theory and its implications for doctoral
education: a case example from a doctoral program in higher and adult education”,
International Journal for Academic Development, Vol. 14 No. 3, pp. 173-83.
10. Calnan,M.andRowe,R.(2006), “Trust relations in the ‘new’ NHS: theoretical and
methodological challenges”, Working Paper 14/2006, Economic and Social Research
Council, University of Kent, Canterbury.
11. Freeman, G., Sheppard, S., Robinson, I., Ehrich, K. and Richards, S. (2001), “Continuity
of care: report of a scoping exercise summer 2000 for the SDO Programme of NHS R &
D”, available at: www.sdo.lshtm.ac.uk (accessed 28 June 2012).
12. Rowe, R. and Calnan, M. (2006), “Trust relations in health care: developing a theoretical
framework for the ‘new’ NHS”, Journal of Health Organization and Management, Vol. 20
No. 5, pp. 376-396.
13. Williams, S., Weinman, J. and Dale, J. (1998), “Doctor-patient communications and patient
satisfaction: a review”, Family Practice, Vol. 15 No. 5, pp. 480-492.
14. Baker, J. (1998), ``Education, training and development'', Public Health Forum, Vol. 2
No.1, p. 7.
15. Cornish, Y. (1998), ``Funding education and training ± the latest guidance: what does
EL(97)58 mean for public health and health promotion?'' Public Health Forum, Vol. 2No.
2, p. 6.
16. Stammers, R. (1987), ``Training and the acquisition of knowledge and skill'', in Warr, P.,

Page | 62
(Ed.) Psychology at Work, 3rd ed.,Penguin Books, Harmondsworth.
17. Wilson, T., Butler, F. and Watson, M. (1998), `Èstablishing educational needs in a new
organization'', Career Focus, BMJ Classified,19/26 December, pp. 2-3.
18. Radhika, V., Assaf, R.R. and Al-Assaf, A.F. (2007), “JHQ 197 –Making Patient Safety and
Quality Improvement Act of 2005 work”, Journal for Healthcare Quality, National
Association for Healthcare Quality.
19. Abrams, H.L. and Hessel, S., “Health technology assessment: problems and challenges”,
American Journal of Radiology, Vol. 149, 1987, pp. 1127-31
20. Shani, M., “High technology: the Israeli perspective”, Israel Journal of Medical Sciences,
Vol. 22, 1982: pp. 169-72.
21. Ellencweig, A.Y., “Development of medical care technology: the case of Israel”,
International Journal of Technology Assessment in Health Care, Vol. 4, 1988, pp. 255-67
22. Atreja, A.G., Steven, M., Pollock, D.A., Olmsted, R.N. and Brennan, P.J. (2008),
“Opportunities and challenges in utilizing electronic health records for infection
surveillance, prevention and control”, American Journal of Infection Control, Vol. 36,
April, pp. S37-S46.
23. Levaggi, R., Morretto, M. and Rebba, V. (2009), “Investment decisions in hospital
technology when physicians are devoted workers”, Economics of Innovation and New
Technology, Vol. 19 Nos 5/6, pp. 487-512.
24. Menachemi, N., Burkhardt, J., Shewchuk, R., Burke, D. and Brooks, R.G. (2006),
“Hospital information technology and positive financial performance: a different approach
to finding and ROI”, Journal of Healthcare Management, Vol. 51 No. 1, pp. 41-58.
25. Moseley, G.B. III (2005), “Changing conditions for medical technology in the health care

Page | 63
industry”, paper presented at the OGI School of Science and Engineering, Beaverton.
26. Salavou, H. (2003), “Do customer and technology orientations inﬂuence product
innovativeness in SMEs? Some evidence from Greece”, Journal of Marketing
Management, Vol. 21 Nos 3/4, pp. 307-38.
27. Schur, C. and Berk, M. (2008), “Views on health care technology: American consider the
risks and sources of information”, Health Affairs, Vol. 27 No. 6, pp. 1654-64.
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APPENDIX: B
Cover Letter
Dear Respondents,
I am a MBA student who is currently studying in the Batch-11 of Assumption University
(Thailand) offshore campus in Yangon. I am conducting a survey on "The Factors Affecting the
Improvement of National Healthcare System in Myanmar" as my Individual Paper in Management
course. This survey is being conducted under the supervision of Professor Dr. Vorapot Ruckthum.
Therefore, I would like to request a few minutes of your valuable time to answer a few questions
about your personal experience to improve the National Healthcare System in Myanmar. I
guarantee that any information that you give will be used only within our study group and for the
purpose of this study alone and that your personal information will be kept confidential and will
not be shared with anyone outside of our study group. You can refuse to participate at any time
since it is a voluntary. If you chose to participate in this survey, please answer all questions as
honestly as possible and try to return the completed questionnaires promptly.
The purpose of the research is to examine the factors affecting the Improvement of National
Healthcare System in Myanmar. I have developed the questionnaires and it will include a total of
(28) survey questions regarding with personal information such as gender, age, marital status,
education level, departments and various factors affecting the improvement of National Healthcare
System. It could take about 10-15 minutes to answer.
Thank you for taking the time to assist us in our educational endeavors. If you need any
additional information or questions, please contact me anytime via email.
Thank you in advance for your kind helps and I hope that I can get your valuable feedback in time.
Sincerely,
Mr. So Pyay
Email : sopyay21.3.1991@gmail.com

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APPENDIX: C
Research Questionnaires in English Version
1. What is your age?
1) 20-30 2) 31-40 3) 41-50 4) 51-60 5) 61-70
2. What is your Gender?
1) Male 2) Female
3. What is your Marital Status?
1) Single 2) Married 3) Divorced 4) Widow 5) Separate
4. What is your Education Level?
1) Graduate 2) Post-Graduate 3) MD 4) MRCP/MRCS/MRCOG 5) Others
5. What is your profession?
1) Doctor 2) Nurse 3) Pharmacist 4) Dentist 5) Others
6. Changes intechnology canenable services suchas new medical and surgical procedures inorder
to improve the National Healthcare System.
1) Strongly Disagree
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
7. Providing technical support to the healthcare providers can improve the traditional system of
medical records.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree

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8. I like to work with high technology facilities which can improve the treatment procedures and
give accurate clinical decisions.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
9. I prefer providing a fixed frame of budget by the ministry of health to fulfill certain portion of
demand.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
10. I think the ministry of health should take more financial support from the WHO or NGO for
further improvement in National Healthcare System.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
11. I think the correct allocationof budget to the required sectors is needed to improve the whole
National Healthcare System.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree

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12. I like working unsociable hours, working alone and having an intensity of workload.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
13. I like to work in a safe work environment and with skillful colleagues can help to improve
my individual skills & knowledge.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
14. I want recognition & encouragement from the top management to increase my job
satisfaction.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
15. I agree that the current training contents are well organized, easy to understand and more
practical.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree

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16. I agree that the trainers should be knowledgeable about the training topics so that trainees can
get effective training experience.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
17. I agree that the training room and facilities are adequate and comfortable.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
18. I agree that consultation skill is important in building a good relationship with patients.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
19. I agree that using a common language by healthcare providers and patients can improve their
communication.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree

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20. I used to give easy and understandable instruction about taking care of patients' health
problems.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
21. The elective courses given by the Medical Training Institutes were valued in my professional
careers.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
22. The medical training institutes in my country have proper and enough medical training
facilities such as equipment needed for the operations.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
23. The actions of hospital managements in my country show that patient safety is a top priority.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree

Page | 70
24. I think that the current healthcare system and procedures are good at preventing errors from
happening.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
25. I am Not Satisfied with the current National Healthcare System in Myanmar.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree
26. In order to improve the National Healthcare System, both budget and training for the health
care practitioners are equally important.
2) Disagree
3) Neutral
4) Agree
5) Strongly Agree

Page | 71
APPENDIX: D
Research Questionnaires in English Version
စစ္တမ္းေမးခြန္းလႊာ
၁။ သင္၏အသက္
၁) ၂၀-၃၀
၂) ၃၁-၄၀
၃) ၄၁-၅၀
၄) ၅၁-၆၀
၅) ၆၁-၇၀
၂။ ကား/မ
၁) ကား
၂) မ
၃။ အိမ္ေထာင္ေရးအေျခအေန
၁) အိမ္ေထာင္မရိ
၂) အိမ္ေထာင္ရိ
၃) တရားဝင္ကြာရင္း
၄) မုဆိုးဖို / မုဆိုးမ
၅) ကြြဲကြာ
၄။ ပညာေရးအေျခအေန
၁) ဘြြဲ႕ရ
၂) ဘြြဲ႕လြန္
၃) မဟာဘြြဲ႕
၄) သမားေတာ္ဘြြဲ႕

Page | 72
၅) အျခား
၅။ သင္၏အသက္ေမြးဝမ္းေၾကာင္း
၁) ဆရာဝန္
၂) သူနာျပဳ
၃) ေဆးအထူးျပဳ
၄) သြားဆရာဝန္
၅) အျခား
၆။ နည္းပညာအေျပာင္းအလြဲသည္ ေဆးးႏင့္ပက္သက္ေသာဝန္ေဆာင္မုူးႏင့္ခြြဲစိတ္ျခင္းဆိုင္ရာ လမ္းစဥ္မ ားကို
တိုးတက္ေစးႏိုင္ပါသည္။
၁) လံုးဝသေဘာမတူပါ။
၂) သေဘာမတူပါ။
၃) သေဘာတူသည္လည္းမဟုတ္ ၊ သေဘာမတူသည္လည္းမဟုတ္ပါ။
၄) သေဘာတူပါသည္။
၅) လုံး၀ သေဘာတူပါသည္။
၇။ ကန္းမာေရးဝန္ေဆာင္မႈေပးသူမ ားအား နည္းပညာအေထာက္အကူေပးျခင္းျဖင့္ ၄င္းတို႔၏
ေရး႐ိုးိုးေဆးမတ္တမ္းယူျခင္းမ ားအား ေကာင္းစြာတို႔တက္ေစးႏိုင္ပါသည္။
၈။ ကြၽန္ေတာ္သည္ ကုသနည္းတိုးတက္ေစေသာ၊ မန္ကန္ေသာအေျဖမ ားကိုေပးးႏိုင္ေသာနည္းပညာျမင့္
ပစၥည္းမ ားးႏင့္အလုပ္လုပ္ခ င္ပါသည္။

Page | 73
၉။ ကန္းမာေရးဝန္ႀကးဌာနမေပးေသာဘက္ဂ က္သည္ မလံုေလာက္ပါဟု ကြၽန္ေတာ္ထင္ပါသည္။
၁၀။ ကန္းမာေရးဝန္ႀကးဌာနသည္ WHO းႏင့္ NGO တို႔မေငြေၾကးမ ားစြာကို အေထာက္အပံ့ရယူသင့္ပါသည္။
၁၁။ တစ္းႏိုင္ငံလံုး၏ ကန္းမာေရးစနစ္တိုးတက္ေစရန္ လိုအပ္ေသာ ေငြေၾကးမ ားကိုေကာင္းစြာ
အသံုးခ သင့္ရန္လိုအပ္ပါသည္။
၁၂။ ကြၽန္ေတာ္သည္ အလုပ္ခ ိန္မဟုတ္ေသာအခ ိန္ တစ္ေယာက္တည္းလုပ္ရသည္ကို သေဘာကပါသည္။

Page | 74
၁၃။ ကြၽန္ေတာ္သည္လံုၿခံဳစိတ္ခ ရေသာ လုပ္ငန္းခြင္းႏင့္ ကြၽမ္းကင္ေသာလုပ္ေဖာ္ကိုင္ဖက္မ ားးႏင့္အတူ
တြြဲ၍လုပ္ခ င္ပါသည္။
၁၄။ ကြၽန္ေတာ္သည္အထက္စမံခန္႔ခြြဲမႈမ အသိအမတ္ျပဳခံရျခင္းးႏင့္ ယံုၾကည္ခ က္ေပးျခင္းကိုအလိုရိပါသည္။
၁၅။ ယခု ကန္းမာေရးဆိုင္ရာ သင္တန္းမ ားမာ ေကာင္းမြန္၍ နားလည္ရလြယ္သည္ဟုကြၽန္ေတာ္ထင္ပါသည္။
၁၆။ သင္တန္းေပးသူမ ားသည္ သင္တန္းေခါင္းစဥ္းႏင့္ပက္သက္၍ အေတြ႕အႀကံဳရိၿပး ၊
ဗဟုသုတႂကြယ္ဝရမည္ဟု ကြၽန္ေတာ္ထင္ပါသည္။

So Pyay (571-9661)

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