TESTING A SOCIAL ENTREPRENEURSHIP MODEL TO DELIVER FAMILY PLANNING IN MYANMAR

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Theresa Preston-Werner

Theresa wears many hats. Anthropologist. Entrepreneur. Investor. Philanthropist. She has spent the past two decades working to understand global poverty and injustice and to support efforts on the ground aimed at transforming political, economic, and social systems in order to better the lives of individuals.

Theresa received her BA in Anthropology and Gender Studies from Scripps College and her PhD in Anthropology from Northwestern University. Her research focused on the development of enclave economies throughout Central America and the recent surge of international direct-sales companies in their wake. In particular, the work examined how companies are able to manipulate vulnerable populations, often poor, uneducated women and young, unskilled men. In the U.S. and abroad, Theresa has worked with, advised, and founded various non-profit and for-profit organizations in fields ranging from girls and education to women and family planning to youth and technology to the tech world and
philanthropy.

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The Issue

The mean number of children born to a woman in Myanmar is 1.6, quite low. Similarly, the unmet need for contraceptives is 16.2%. This relative success and accepted practice of family planning, coupled with other social, political, and economic factors listed below, make Myanmar an ideal location to pilot a model for micro-enterprise distribution of contraceptives, such as Pills, condoms, and Sayana Press.

In Myanmar, the private sector is an essential, and culturally accepted channel to deliver health services. The country has one of the highest rates of out-of-pocket health expenditures (93.7%) in the world, due to chronic underfunding of the public sector. At present, Myanmar is also experiencing a major political transformation as a result of the government’s transition in 2015 away from decades of military rule, resulting in a friendlier business environment. Still, the country remains the poorest economy in Asia and is ranked 149 out of 186 countries in the Human Development Index. A pilot aimed at both developing work opportunities and supplying a crucial and desired healthcare need would be greatly welcomed.

Pilot And Learn

In April 2015, PSI, in partnership with Living Goods, launched the Win-Win Network of micro-entrepreneurs. These health agents, often auxiliary midwives, work in their own communities to sell contraceptives and other health-related products, provide various medical services (such as the testing and treatment of malaria), and lead public health discussions. In three years’ time, Win-Win has grown to five hubs with over three-hundred active agents across the country.

PSI acts as wholesaler to the entrepreneurs, retaining a small margin to cover the costs of recruitment, marketing, training, and managing the network. The Win-Win model builds on the purchasing power of value-conscious consumers to build a sustainable and scalable model designed to fight poverty and disease, with a focus on women and children.

Progress is measured in terms of health impact (measured through sales volumes of health products such as contraceptives, oral rehydration salts, zinc tablets, and water purification products), and sustainability (income generation and cost recovery for both the agents and the hub, and agent retention rates).

Leverage And Scale

By the end of 2018, an evaluation of the five existing hubs will identify the best working model of product sales, services, and incentive combination. Based on the results, this model is expected to be adopted by the existing PSI community health services network, comprised of thousands of volunteers and private outlets, and will include a next-stage iteration of strategic purchasing within a private-public partnership, which will test a model of universal healthcare provision.

The Win-Win project currently works in partnership with the public system by providing products and services through the private sector to those who can afford them, allowing the public sector to focus on the poorest of its citizens. The project will also help balance costs through the development and testing of an effective model of strategic purchasing for primary, maternal, and child-under-five universal healthcare. If successful, Win-Win will ultimately show the power of micro-entrepreneurship as a model to lower costs and increase efficiency of last-mile healthcare.