I have spent the past couple of years reading and learning as much as I can about development and innovation, particularly in the field of global health. Throughout this learning process, I’ve asked myself the same question time and time again: what factors lead to success for development and global health interventions? Perhaps more importantly, what even constitutes the success of such projects? It has become increasingly clear that there are no straightforward answers, as these questions have been considered and debated by experts in the field for many years. In fact, more often than not, efforts to improve development and health metrics have led to a variety of contradictions.
Myanmar often referred to as the ‘land of contradictions’, is an interesting example of this. Even at first glance, it lives up to the moniker: ancient shining gold temples in the middle of bustling, modernized cities; an essentially deserted capital city, cut out of the middle of the jungle; and a burgeoning tourism industry alongside a flourishing local culture. However, I’ve seen the most striking contrast in Myanmar’s development across various sectors. While the country’s telecommunications sector has grown at an exceptional rate in recent years, Myanmar’s health system has hardly developed at all.
Since the military began its transition out of power in 2010, the rate of uptake of mobile phone technology by the general population has proceeded at unprecedented speed.
By the beginning of 2016, over 37 million people in this country of 54 million had an active mobile phone subscription, substantially more than the 10 million just two years previously.
Under military rule, SIM cards were nearly impossible for the average citizen to obtain, costing upwards of $1,500 USD. However, over the past 7 years, the price has dropped to the current going rate of approximately $1.50 USD. As Myanmar has emerged into the digital marketplace, they have leapfrogged past the feature phone technology that dominates much of the developing world, and have advanced directly to smartphones. By the beginning of 2016, over 37 million people in this country of 54 million had an active mobile phone subscription, substantially more than the 10 million just two years previously.
This is in sharp contrast to the state of the public health system, which is poorly equipped and incapable of providing basic services to the majority of the population. In its most recent analysis, the World Health Organization ranked Myanmar’s health system second last of 191 countries in terms of its overall efficiency. Many of the country’s inhabitants rely instead on NGOs to deliver essential health services. Myanmar is one of many countries around the world that are increasingly dependent on the support of NGOs and international donors for the provision of health care. It is not unusual that a private sector would develop rapidly while the largely publicly funded health sector would lag behind. However, the extent of the incongruity is what is notable.
It was precisely this contradiction that drew me to Myanmar, first with simple curiosity and then in a more academic capacity as a researcher seeking to understand it. I wanted to explore the incongruity, to understand the reasons for it. More significantly, I wanted to know whether this technology boom could be leveraged to address a seemingly intractable problem: child malnutrition. With approximately 35% of Myanmar children experiencing stunted growth and its consequences, child malnutrition is a critical issue in the country. Not only is malnutrition the underlying cause of 45% of child deaths globally, but it also has major economic ramifications. For a country emerging from decades of isolation under military dictatorship, investing in improving nutrition outcomes could be critical for the development of the country.
The two major causes of child malnutrition in Myanmar are a lack of nutrition education and a lack of access to proper nutrition. While the new availability of smartphones would not directly address the issue of access to food, it certainly could have great potential as a medium to provide nutrition information, and in particular to those people who are hardest to reach.
I arrived in Yangon in the spring of 2016. When I stepped off the plane, I smiled to myself: right inside the airport doors were (seemingly symbolic) signs advertising new SIM cards, with 3G data coverage guaranteed nearly everywhere in the country.
I spent the next few weeks doing fieldwork, and interviewing stakeholders from community health workers, to World Health Organization officials, to NGO leaders, to private sector businesses. The excitement was palpable – everyone I spoke with was excited about the possibilities ahead, both in terms of the new government that had just begun its transition into power, and in terms of the possibilities that technology offered for Myanmar’s future, including addressing problems like child malnutrition.
Despite this optimistic picture that was presented by the majority of interviewees, Myanmar continued to surprise. It became clear soon after I began interviewing that there are major obstacles to scaling up a local mHealth initiative; the most significant of which is a lack of coordination and cooperation between NGOs working on such projects. There is a significant lack of sharing of information amongst organizations, as well as a lack of cooperation on projects.
NGO collaboration faces several key challenges – with competition for funding being the main obstacle. NGOs have little incentive to cooperate and share ideas, nor to work together on projects when the organization itself stands to gain more funding by working independently.
Technical and logistical challenges can pose a problem as well. Each of the various mobile-phone based development projects already operating in Myanmar have different software and data collection protocols, making the compilation, integration, or sharing of this data very difficult. Data silos are common and greatly limit the usefulness of the data. Limited opportunities for NGO leaders to come together and discuss projects can be an additional limiting factor.
It may seem counter-intuitive, but organizations frequently even stand in their own way, with red tape being yet another barrier to collaboration. Many NGO employees I spoke with expressed a desire to work with their peers at other organizations, recognizing that such collaboration would likely lead to more effective and impactful interventions. However, they often cannot share project details with other organizations, because of agreements to protect intellectual property rights or copyright.
If cooperation was not already difficult enough, governmental disorganization and a lack of leadership further contributes to the difficulties in coordination. Myanmar’s isolation for the past several decades has led to a disorganized health system, lacking any systematic way of collecting and using the data collected by NGOs. However, it is possible that this particular situation will change in time as priorities change within the new government.
Mobile health technology certainly has the potential to help address child malnutrition in Myanmar. With the current instability in the Rakhine region, it is more important than ever to make an effort to address some of the most pressing health problems that the country faces.
Immense success can be seen when organizations collaborate. The Roll Back Malaria Initiative is a large-scale example of this. A partnership of over 500 NGOs, foundations, governments, and academic institutions, it has achieved great progress in the fight against malaria. The organization itself states that its “strength lies in its ability to form effective partnerships both globally and nationally”.
Both the government and NGOs in Myanmar will have to work together to address seemingly intractable problems like child malnutrition. Only then can interventions be scaled up to reach those who are hardest to reach.
By Jillian Sprenger
*This piece is based on research conducted in the spring of 2016 by the author (Jillian Sprenger) and Quinn Underwood