Improving Child Nutrition Through Digital Conditional Cash Transfers in Myanmar
Pitch us on your solution
Existing Maternal and Child Cash Transfers (MCCT) in Myanmar are manual, making them labor-intensive and costly for the government, and posing fiduciary risks related to leakage and delayed payment. Social Behavioral Change Communication (SBCC) activities aimed at improving knowledge and changing behaviors on nutrition and hygiene are likewise costly and labor-intensive. These two services are critical to ensuring that mothers have resources to provide for their baby’s cognitive and physical development. However, the inefficiencies with both service delivery systems hinder their nation-wide rollout. We’re proposing a new, digital system which combines these two services into a single delivery modality through our popular maternal health mobile app “Maymay,” making it easier for the government to provide them to every mother and baby. By enabling low-cost, high-quality, scalable public service delivery, our solution could change the lives of millions of Myanmar babies, and serve as a model for resource-constrained, developing countries globally.
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What is the problem you are solving?
Global evidence shows that the first 1,000 days of a person's life marks the most rapid development period in the human lifecycle. Inadequate nutrition during this period can stunt the physical and cognitive development of a child, leading to higher susceptibility to illness, poor physical status, and impaired cognitive ability. Thus, supporting nutrition during the first 1,000 days is key to ensuring the health and productivity of Myanmar’s new generations.
There are nearly one million new babies in Myanmar every year. Myanmar mothers face multiple challenges during the critical first 1,000 days, including the lack of resources to meet with health professionals, access accurate nutrition information, and provide nutritious food and a healthy growing environment for their children. The Myanmar government is also resource constrained, as it currently does its cash transfers manually, leading it to spend a dollar to deliver every dollar. Furthermore, delivering social and behavioral change communication (SBCC)--necessary to ensuring that the mother uses the money she receives wisely and makes long-term behavioral changes beneficial for her child--is very labor-intensive.
Who are you serving?
While the Myanmar government is an intermediate beneficiary (our solution makes their jobs easier and cheaper), mothers and their babies are our ultimate beneficiaries (as a more efficient government will enable the greater delivery of financial and educational services to them). The content in Maymay, Myanmar’s most popular mobile health application, is aimed at low to middle income mothers and pregnant women across Myanmar. Maymay was first launched in 2014, and has since built a user-base of 300,000+ in both rural and urban areas. Throughout Maymay’s development process, our ethnographers have engaged with target users through multiple rounds of user-testing to understand their needs. Maymay has had 7 major iterations thus far based on user feedback. From our engagement with mothers, we understand that digital financial literacy is low. We thus applied (successfully) for a UNCDF grant to develop a gamified version of a digital conditional MCCT that will teach women financial literacy so that they can easily adopt the final MCCT scheme when it’s ready.
We’ve also spoken extensively with Myanmar’s Department of Social Welfare to map out current workflows associated with MCCTs, as well as engaged with LIFT, who has funded cash transfer schemes in Myanmar.
What is your solution?
Our solution focuses on three elements: 1) digitizing the MCCT process (i.e. setting up a mobile payment system to facilitate digital cash transfers from the government to the mothers) 2) digitizing the SBCC process (i.e. developing information and quizzes on infant nutrition and health in the Maymay app), and 3) linking SBCC and MCCT, specifically by conditioning MCCTs on quizzes focused on infant health and nutrition. Digitizing the cash transfers would make the process cheaper and less labour-intensive for the government, as it would diversify the groups that could provide the mothers money as well as incentivize these groups--mobile money providers and banks--to set up infrastructure in rural, more remote areas. Mothers would receive the payment through a digital wallet and cash out at banks or money providers in their area; the government would have greater resources (human and financial) to provide services to the mothers and expand their service reach to more areas around the country. The greatest challenge from a technological standpoint is ensuring the security of the sensitive data from our beneficiaries. Using technology to disseminate SBCC is an innovative approach not yet implemented in Myanmar. Existing SBCC is done only through in-person meetings, which is costly and non-scalable. By linking the SBCC and MCCT (i.e. conditioning the provision of money on the consumption of SBCC), mothers would be incentivized to read about the topics that are most relevant to their baby’s health and empowered to make behavioral decisions beneficial for their child. Maymay currently includes an essential nutritional health information pack for mothers and infants for the first 1,000 days (approved by the Myanmar National Nutrition Center (NNC)), as well as other Maternal, Newborn and Child Health (MNCH) information (approved by the Ministry of Health and Sports), all presented in an appealing, culturally-appropriate manner that has been refined by years of user-testing by Koe Koe Tech ethnographers.
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Where is your solution team headquartered?Yangon, Myanmar (Burma)
Our solution's stage of development:
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New application of an existing technology
Describe what makes your solution innovative.
While electronic cash transfers have been piloted in Myanmar for pension delivery, they haven’t been done for maternal and child cash transfers (MCCTs). Digital social and behavioral change communication (SBCC) exists but has not been used specifically to supplement MCCTs. Building infrastructure for digital SBCC will simultaneously give the government more capacity to provide SBCC in areas where there is less digital connectivity and provide opportunities for women who cannot physically access in-person SBCC sessions. Furthermore, the two services have not been combined into a single digital system in the way we are proposing anywhere in the world. Combining the two would empower and incentivize mothers to make healthy decisions for their child after they receive the money.
An additional note: once the infrastructure above is solidified, we plan to integrate it with Myanmar’s birth registration process (which we are digitizing along with the Ministry of Health and Sports with funding from UNICEF) to make it easier for mothers to register for a bank account. This additional integration is unprecedented in the world.
Describe the core technology that your solution utilizes.
We would need to develop application program interfaces (APIs) to integrate Maymay and back-end databases with digital financial services. All requirements for cash transfers will be programmed into the Department of Social Welfare’s (the government department responsible for cash disbursement to mothers) Management Information System. The Management Information System can then poll Maymay for completed quizzes and initiate cash transfers if the requirements have been met.
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Why do you expect your solution to address the problem?
Our solution addresses the problem of high rates of childhood stunting on two levels: First, by making the government processes for delivering social behavior change communication (SBCC) and maternal and child cash transfers (MCCTs) more efficient, we will enable a broadening of their service delivery reach. Currently, given limited capacity, the government cannot reach all of Myanmar, especially rural and remote areas. Second, by combining electronic MCCTs and digital SBCCs into a single modality, we increase the likelihood that women would be exposed to SBCC content and make behavioral changes accordingly, leading to beneficial results for their babies. A midline study of a maternal and child cash transfer program implemented by Save the Children revealed that cash combined with social and behavioral change support led to the largest improvements in the percentage of children (6-23 months) meeting the minimum acceptable diet, compared to the “cash only” and control groups. Furthermore, research done by HelpAge International on their electronic pension cash transfer program in Myanmar showed that money transferred was spent on health clinic fees, medicine, food, and donations. This makes the prospect that the mothers will use the money towards nutrition and health of their child (rather than on irrelevant or harmful purposes) quite promising. Our experience engaging with Myanmar mothers over five years throughout our development of Maymay has shown that mothers eagerly seek to do what’s best for their children’s health.
Select the key characteristics of the population your solution serves.
In which countries do you currently operate?
In which countries will you be operating within the next year?
How many people are you currently serving with your solution? How many will you be serving in one year? How about in five years?
Our Maymay app has 60,000 monthly active users and 300,000 registered users, so it’s an excellent platform to host the integrated digital system. We are not serving any populations right now with this particular solution, as it has not yet been launched. As of July 1, 2019, we’ve started development of our UNCDF-funded gamified MCCT system (through Maymay) to teach women financial literacy so that they can easily adopt the final MCCT scheme when it is developed. We will do user-testing on a minimum of 1000 women, and complete this process, as well as accordant app iterations, before November 1, 2019. After the initial launch of the MCCT scheme, we aim to reach 3000 beneficiaries in the first year. In the following five years, after feedback has been gathered and incorporated, and relationships built and deepened with key stakeholders like local government, banks, mobile money providers, and NGOs that can perform in-person SBCCs, we hope to reach 500,000 beneficiaries. By the end of five years, we aim to reach 1 million new mothers and babies per year. Given that the government does not currently discriminate cash transfers by income -- given that there is no good record of every mother’s family income in Myanmar-- we assume that every new mother/baby is eligible for the MCCT scheme.
What are your goals within the next year and within the next five years?
Digital social behavioral change communications (SBCCs) and digital maternal child cash transfers (MCCTs) are both quite new to the Myanmar context. Our ultimate goal by the end of five years is full coverage of Myanmar using this integrated platform. We also want to eventually link the MCCT scheme with Myanmar’s eVR (electronic vital registry) scheme - electronic platform for recording births and deaths - so that midwives can play a role in disseminating Maymay to new mothers, and registering them for the payment platform (we will match the Know-Your-Customer level needed to register a baby with the level needed for a bank account). We are already working with the Myanmar Ministry of Health and Sports on developing this eVR scheme (with UNICEF funding), and see Maymay as the perfect platform to host the baby registration system, making the entire service delivery system even smoother for the mother. In five years, we envision Maymay processing 3 million MCCTs every month, earning Koe Koe Tech at least 600,000 USD monthly (with minimum 20 cents per transaction charged to Myanmar’s Department of Social Welfare).
What are the barriers that currently exist for you to accomplish your goals for the next year and for the next five years?
Large financial investment required to roll out to all states/regions
Forming partnerships with financial institutions (who often take a more protectionist approach in Myanmar, meaning they may be hesitant to collaborate)
Security risks because dealing with large amount of sensitive data
Difficulty of setting up financial infrastructure in remote, rural areas
Difficulty of gaining government approval for all aspects of our proposed integrated platform
Difficulty with securing buy-in from the Ministry of Health and Sports and Department of Social Welfare, as well as the Auditor General and other relevant government stakeholders
Myanmar women may not be used to apps or digital payment system and may be reluctant to use the app
Only 60% of women have mobile phones (80% of those with mobile phones have smartphones). Thus, not all mothers will have a smartphone, and access to Maymay requires smartphones
Beneficiaries lack financial and digital literacy skills
Only 25% of Myanmar has a bank account
How are you planning to overcome these barriers?
We will fund the start-up costs through grants, using our back-up repository of funds if necessary. Once the MCCT is launched, we will start gaining revenue from the Department of Social Welfare.
Put in place authentication measures; ensure encryption of data. Back information up in secure Microsoft Azure Cloud server.
Structure and negotiate contracts with mobile money providers and banks. Continue to build relationships with banks and mobile money providers
Leverage our previous relationships with government offices and with UNICEF/LIFT (who have long standing relationships with the Myanmar government) to continue to build relationships to gain approval for solution and develop the necessary financial infrastructure across Myanmar
Build relationships with local organizations to assist with developing financial infrastructure across Myanmar
Partner with trusted organizations in the beneficiaries’ communities to teach beneficiaries about digital/financial literacy.
Post engaging, culturally-appropriate success stories on Facebook using our experience with ethnography and user-testing.
Focus first on users with smartphones (NGOs and government will continue to provide in-person sessions and cash transfers in areas where smartphones are less common). We already have a sufficient pool of users to draw on for this stage. Expand user-base as digital connectivity grows in Myanmar
Based on human-centered design, create a feature in Maymay app where women learn digital and financial literacy through games and quizzes on an appealing user-interface. Perform user-testing on our gamified MCCT system to garner feedback for the final MCCT scheme.
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If you selected other for the organization question, please explain here.
How many people work on your solution team?
31 full-time staff and one contractor to form the core team: Health Program Manager, Health Project Manager, Health Project Coordinator, Lead Mobile Developer, Senior Mobile Developers (3), Junior Mobile Developers (2), Ethnographers (2), Data Scientist, Creative Creator, Senior Graphic Designer, Content Manager, Business Development Director, Digital Marketing Manager, Marketing Executive, Sales Manager, Sales Executives (3), Distribution Manager, Branding Executives (2), Marketing Assistants (5), Consultant (to advise on payment platforms)
For how many years have you been working on your solution?
Less than a year
Why are you and your team best-placed to deliver this solution?
With 60,000+ monthly active users, Maymay is the most popular maternal Health app in Myanmar. It has official government approval for its content and distribution in government health care facilities. Our experience developing Maymay provides us a strong understanding of the political, social, and cultural context surrounding our solution, as well as of our beneficiaries’ needs. Over five years, we have refined our user-testing and ensured a smooth workflow of feeding insights to our app development team that iterates the app based on the insights. We have experience with processing digital payments, having launched a movie tickets software that processes about 150,000 electronic payments per month. We’re also in the process of building and strengthening our relationship with banks and money providers.
Our staff is 92%+ Myanmar. We have 5+ years of experience collaborating with the Myanmar government on technical solutions to health, law, and governance issues. We have 4 years of experience working with municipal tax offices, involving extensive Training of Trainers (ToTs) and direct trainings of tax workers; 5 years of experience working with Ministry of Health and Sports (MoHS), Myanmar Nurse and Midwife Association (MNMA), and Myanmar Nurse and Midwife Council (MNMC), including ToTs and direct training of midwives, nurses, and doctors; 2 years of experience with UNDP, Central Statistical Organization, and the Supreme Court. We’re currently building a mobile birth and death registry with the MoHS.
There’s no other Myanmar organization that has the experience we do for multi-stakeholder, government-related digitization and software implementation.
With what organizations are you currently partnering, if any? How are you working with them?
A key content partner is Population Services International (PSI). Content in Maymay is approved by the Myanmar National Nutrition Center (NNC) and the Ministry of Health and Sport (MoHS). We are in discussions with the Ministry of Social Welfare, Relief and Resettlement (MSWRR) -- the ministry that disburses the cash transfers in Myanmar -- about linking the MCCT scheme with their electronic birth registry platform (which we are currently developing with funding from UNICEF). We are also in the process of finalizing partnerships with three banks and two mobile money providers. Additionally, with funding from UNCDF, we are in the process of developing a gamified version of the MCCT to teach women financial literacy so that they can easily adopt the final MCCT scheme when it’s rolled out.
What is your business model?
Our key customer would be the Myanmar government (the Department of Social Welfare within the Ministry of Social Welfare, Relief and Resettlement)- they will pay us a small fee for every cash transfer made. Our key beneficiaries are the mothers and their babies, as greater government efficiency in delivering cash and social and behavioral change information through an integrated digital system would allow government service delivery to expand to more areas around the country, including to rural and remote areas.
What is your path to financial sustainability?
Grants will be used as upfront capital. Once the integrated digital platform is launched, our primary revenue stream will be a payment from the Department of Social Welfare (DSW) for every cash transfer made (we’ll charge a small fee of around 20 cents per transaction). In the long term, we expect that our primary revenue stream will cover all our expected expenses, as the user-base will grow with expanding digital connectivity around the country, improved digital and financial literacy amongst our beneficiaries, and expanding financial infrastructure. A larger user-base comes with a larger number of transactions and thus a larger amount of revenue from the DSW. By the end of five years, we expect to be processing 3 million MCCTs per month.
Why are you applying to Solve?
Because our solution is relatively new in the Myanmar context, we are applying to Solve for the community of expertise. We want to learn from those who have worked in similar fields around the world, especially those who have attempted similar solutions in developing countries in the region. Experienced, knowledgeable experts are sparse in Myanmar, and while we do our best to train up a skilled workforce, we understand the need to bring in external expertise. We would thus value feedback on our operations, M&E, app design (particularly the behavioral science aspect), and financial and business models. We want to know how to tailor our models to low-resource contexts like Myanmar. Access to a global network of experts would provide us with the expertise to execute the project efficiently and effectively, ensuring we achieve maximum impact.
What types of connections and partnerships would be most catalytic for your solution?
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With what organizations would you like to partner, and how would you like to partner with them?
We would like to partner with organizations that can help us perform trainings on digital literacy, as well as in-person social and behavioral change communications (SBCCs) to accompany the MCCTs, as digital SBCCs are not meant to fully supplant in-person SBCCs. We would also appreciate partnerships with organizations (i.e. consulting companies) that can mentor and train our staff on specific topics like Monitoring & Evaluation, operations, and app behavioral design. We are also interested in organizations working in similar fields in different countries where we may be able to expand our solution; KKT aims to bring the benefits of our solution to Southeast Asia, and the rest of the world.
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