# The right people, in the right place—assessing the impact of a new outreach model for paediatric neurology specialist services in Myanmar

## TL;DR

A new outreach and telemedicine model improved access to pediatric neurology care in Myanmar, reducing costs and increasing service reach in underserved areas.

## Contribution

A scalable hybrid model combining outreach and telemedicine to address specialist shortages in low-resource settings.

## Key findings

- The program provided 2,603 consultations, with epilepsy as the most common diagnosis.
- Patient-related costs were reduced by 81% to 98% per hospital, with a mean cost per consultation dropping from $193 to $7.
- The model supported local capacity building and improved regional clinical networks.

## Abstract

Myanmar has a longstanding and severe shortage of paediatric neurologists, with only 11 specialists serving an estimated 14 million children, most of whom live in rural areas with limited access to tertiary care. This workforce constraint, combined with high out-of-pocket costs and long travel distances, creates substantial barriers to timely diagnosis, treatment, and follow-up for children with neurological conditions. In response to the growing burden of childhood neurological disorders and persistent inequities in access to specialist services, a blended outreach and telemedicine model was developed to extend paediatric neurology care to underserved regions beyond major urban centres.

A hub-and-spoke model was implemented, linking paediatric neurologists at Yangon Children's Hospital with general paediatricians in seven regional public hospitals. The model combined quarterly in-person outreach clinics by paediatric neurologists from Yangon supplemented with ongoing virtual support delivered through telemedicine and mobile messaging to support continuity of care. Routinely collected data on clinic activity, diagnoses, and costs from 2017 to early 2020 were analysed to assess service reach, impact, and cost.

Between 2017 and 2020, the programme facilitated 2,603 patient consultations. Epilepsy was the most common diagnosis (54%), followed by cerebral palsy (12%). The blended model enabled more efficient use of limited specialist time, with pre-clinic coordination improving case triage and care consistency. Cost analysis demonstrated substantial reductions in patient-related costs, ranging from 81% to 98% per hospital. The mean cost per patient consultation decreased from US$193 under the standard tertiary referral model to US$7 under the outreach model. The programme also supported local capacity building through continuing medical education, strengthened referral pathways, and enhanced regional clinical networks.

This evaluation demonstrates that a hybrid outreach and telemedicine model can deliver accessible, high-quality, and cost-effective paediatric neurology services in a low-resource setting. By leveraging existing national infrastructure and integrating local providers, the model improved access to specialist care, reduced financial barriers for families, and contributed to the long-term capacity of the system. The approach offers a scalable framework for other specialities and health systems facing similar constraints and supports progress towards universal health coverage.