Table 2.

Summary of key findings on the factors influencing the sustainability of the MCBR system

Major themes	Sub-themes	Findings
Individual factors	User satisfaction	Technological constraints make users unsatisfied Diverse ideas of user preference over PBR and MCBR systems
	System access	Technical problems with supported mobile phones Data managers lacking suitable computing devices for data access and management Financial and logistic burden of mobile phone maintenance Financial unsustainability of mobile phone-related costs, especially for national scale-up Insufficient mobile internet access Areas without internet access to be left out in national scale-up of MCBR
	User support	Poor IT literacy of the ICMVs Not enough training for ICMVs and stakeholders No proper user support system, especially for troubleshooting technological problems
Technological factors	System interoperability	Use DHIS2 platform endorsed by Myanmar MoHS
	System scalability	Financial and technological constraints for nationwide scale-up Basic health staff suggested as potential MCBR users
	System relevance	Data elements of MCBR reflect those of PBR Job-aid function helps ICMVs follow national malaria treatment guidelines Stock management module not covering all stocks Missing auto-alert system for positive case notification
	System quality	Simple, easy to use, and potentially timely Software bugs and errors, unsatisfactory system response time, unpredictable and unreliable outcomes Inconvenient data management Unsatisfactory output data quality
	Technology sustainability	Concerns with maintenance and improvement of mobile application (software)
Management factors	Ownership of the system	NMCP to take sole ownership of the system IPs thought NMCP is not currently ready to take over the system due to many constraints NMCP believes it is already in position to take over the system
	Human resources	Dropout of ICMVs trained for MCBR No separate focal person to manage MCBR at all levels in both NMCP and IP
	Policies and operational procedures	Lack of standard procedures and policies for proper operation of MCBR Mobile phone-based reporting not possible in non-government-controlled areas because of local security issues Concerns over standalone use of MCBR without physical documents for future reference
	Financial sustainability	Completely donor-funded currently Uncertainty about financial support after 2023
	Applicability of MCBR data	NMCP and IP do not apply MCBR data for practical applications, relying only on PBR data for such purposes Doubtful effectiveness of MCBR for malaria elimination due to many constraints, despite its potential

DHIS2 District Health Information System 2, ICMV integrated community malaria volunteers, IP implementation partner, IT information technology, MCBR Malaria Case-based Reporting (system/application), MoHS Ministry of Health and Sports, Myanmar, NMCP National Malaria Control Program, Myanmar, PBR paper-based reporting