Myanmar: bringing about change in a frontier market

Shwedagon – one of Myanmar’s famous Pagodas

For some of the world’s “frontier” markets, such as in Myanmar (formerly Burma) the risks of accelerated growth are that many of the country’s poorest get left behind. Working alongside government and the private sector, the efforts of CARE International in Myanmar are starting to demonstrate that establishing from the outset more inclusive models of engagement with business, in an emerging economy such as Myanmar’s, can yield positive outcomes both for society and for doing good business.

Last week, I traveled to Myanmar to see for myself how CARE has been collaborating with one of the world’s largest pharmaceutical companies, GSK (GlaxoSmithKline), on an initiative which involves GSK investing back 20% of their consumer healthcare profits – across seven markets in Asia Pacific – into improving community healthcare services for some of the region’s most vulnerable citizens.

Whilst there, several of us visited CARE-GSK programmes in Lashio, Northern Myanmar, where we found some inspiring gains have already been made since the joint initiative was established two years ago between our organisations…

To paint the briefest of pictures first, the context within Myanmar is unique. You’d be hard pushed to find a more economically vibrant, politically charged and socially dynamic country in Asia than this one. Surrounded by the region’s heavyweight nations, Myanmar is the 2nd largest country in Southeast Asia, home to 50 million citizens, and a hybrid mix of Buddhist, Muslim and Christian followers.

myanmar_mapSince sanctions were lifted in 2010, many large corporations have been ready to open up businesses in Myanmar and reach out to Burmese consumers, suppliers and local producers.

Year on year growth for the country is spiking upwards, foreign direct investment is strong, hoardes of tourists are queuing up to visit, and a raft of international government development agencies are scrabbling to determine how to take advantage of the country’s popularity, in a way that won’t mean its predicted growth leaves the majority of its citizens behind.

As has been the case for so many of Myanmar’s neighbouring countries in recent times (and was mentioned on this site in previous posts) accelerated economic growth in emerging market economies can often be exclusively for richer citizens, and leave behind a significant under-served class, cut off from being able to access opportunities that others are afforded.

Myanmar already has one of the highest levels of inequality in the world, and this could very easily widen still more in the future.

So, what of the CARE-GSK collaboration within such a context?

The intervention funded by GSK is targeting expectant mothers and child health. One of the most frequent causes of maternal mortality and neo-natal death is a lack of on hand midwives and, more generally, poor standards of medical services. With GSK’s investment alongside CARE, these gaps are being addressed via the training and recruitment of a wave of new Auxiliary Midwives (AMWs) working as volunteers alongside government paid midwives.

The AMWs are selected with the input from Village Development Committees (VDCs) and after their training are able to operate most of the duties that a normal midwife would – before, during and after the birth.

Additionally, in each community, our programme has established a “referral fund”, managed by the VDC and used to financially support the healthcare needs of expectant mothers.

What struck us from visiting the Lashio programme was how GSK’s investment has not directly targeted their core business (selling pharmaceutical products) but instead focused on improving ‘common goods’ at the local level – funding training courses and new medical clinics, establishing the referral funds, and even looking at how improved water and sanitation facilities at the local level can be improved.

A typical local household in Lashio, Northern Myanmar

With limited public services reaching these groups, and with ongoing internal conflict and displacements happening in the very same villages, CARE believes engagement with a private business such as GSK is one of the only ways in which to address, over the longer term and at scale, the raft of social access barriers which hold people back from living more empowered day-to-day lives.

The result of this work in Lashio is the creation of truly “frontier” healthcare services, reaching marginalised communities, and leveraging the private sector’s interest in the country. What our colleagues there were clear on next was how these outputs must link up with the government health systems, and in doing so catalyse engagement between public, private and NGO stakeholders.

Auxiliary Midwives alongside a government trained midwife (far left) working together in Lashio

We met several AMWs, all under thirty years old and each explaining how the new role they play in their communities is not only one they are proud to have, but one that gives them (as young women predominantly still living with their parents) a higher degree of respect and recognition by their communities – communities which are traditionally led by the male members, and by elders.

“Before I was trained as an AMW I was not seen to have much to offer the community because I am young”, explained one AMW we met, “but now people listen to me and accept me as having something to offer.”

We heard from the AMWs that culture plays a dominant role in how expectant mothers in their communities perceive what to do, and what not to do, during their pregnancies. For example, during their third trimesters it is not uncommon for mothers-to-be to hardly eat at all – antiquated advice passed down to mothers as simply “what you do”. One theory attached to this practice being that it encourages smaller babies and easier births.

What was positive to see on our visit was the rapport and joint working arrangements that AMWs were having with government trained midwives, many of whom seem to have already accepted AMWs as an increasingly important set of co-workers.

Village escort for our tour of a local community

All of such impacts have obvious benefits for local Burmese communities, but what about GSK?

Whilst GSK’s return on investment seems on the surface of things to be less obvious, it is clear that (in a competitive market such as the pharmaceutical industry) the more that citizens in places such as Lashio have an improved understanding about nutrition and healthcare issues, then the more informed a market will develop in Myanmar for the types of products GSK manufactures.

There are gains to be had in the long term for companies prepared to financially invest their businesses with social purpose outcomes from the outset, and also in collaboration with civil society and NGO partners. GSK’s “20% Reinvestment” initiative has set out to do just this, whilst CARE’s commitment is to ensure the resulting programme is delivered a way that is both socially responsible and in demand at the local level in first place.

Returning from Lashio, we met with GSK at their head office in Yangon, and the perspectives shared by their General Manager there, Maung Maung Naing, echoed ours, in terms of how these early interventions created together could start to have a ripple effect in influencing changes in the government’s investment in pre and post natal healthcare services in Myanmar.

“Aligning this investment to the government’s National Plans for public health services is key”, Maung Maung explained. This work represents a step in the right direction to doing just that, whilst advocating in the future to government ministries for more funding and support to the emerging AMW network are other ways of advancing this programme further.

The CARE Myanmar team with their visitors
The CARE Myanmar team with their visitors

In a year’s time, a new set of global commitments addressing the social and environmental issues of our time will be ratified and universally adopted. These are currently set to be called the Sustainable Development Goals and, more than ever before in our recent history, governments, civil society and the private sector will collaborate together over the next fifteen years to achieve these Goals.

And it is this issue of collaboration between sectors, especially where the private sector is concerned, that CARE has long felt holds the key to success in finally breaking down some of the historic barriers – regulation, access, inequality, market development, human rights, gender equity – to addressing poverty and social injustice.

In a “frontier” country such as Myanmar, perceived to be very much on the rise, there is little question that it will still take enormous effort and time to bring everyone in Myanmar up to an acceptable level of prosperity and empowerment.

However, as the sun came up on our last morning in Lashio, I also had very little to question over the fact that if we don’t find ways of engaging some of the world’s largest companies into this equation, and co-creating with them more inclusive models of engagement at the local level, then we will continue to fall short in addressing poverty’s underlying causes, and in reaching any sort of scale in our efforts to re-balance the status quo.

The opportunity to engage more efficiently and effectively across all sectors may yet unlock the right type of answers, and avoid the risk of seeing yet more “exclusive” and unequal growth taking place in a country which promises so much for its future generations.

Last sunrise, Lashio

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