729912

research-article2017
GSP0010.1177/1468018117729912Global Social PolicyBonnerjee

GSP Forum
gsp
Global Social Policy

Piloting social protection

2017, Vol. 17(3) 375­–380
© The Author(s) 2017
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DOI: 10.1177/1468018117729912
https://doi.org/10.1177/1468018117729912
Challenges and opportunities journals.sagepub.com/home/gsp

within a context of fragility

Aniruddha Bonnerjee
Policymetrica, India

Abstract
This article provides a glimpse into the opportunities and challenges facing Myanmar as
it roles out the first Mother and Child Cash Transfer (MCCT) in one of the country’s
most disadvantaged areas, Chin State. Already known for its fragile context, women
and children have among the most alarming social indicators in Myanmar. A vicious
interaction between demand (influenced, i.a., by poverty, behaviour and knowledge) and
supply side factors (e.g. health and market infrastructures) can only be broken through
explicit support measures to families to overcome the multiple risks they face in their
daily lives, while also ensuring that supply side constraints are eased over time. Despite
the many types of obstacles the role-out faces, the pilot programme provides a strong
socio-economic, political and rights-based case for genuine improvements in Chin State,
and across Myanmar more generally.

Keywords
Cash transfer, child malnutrition, Chin State, mother and child benefits, scalability,
social protection, sustainability

Chin State in Myanmar only has about half a million inhabitants. However, children com-
prise more than 40% of the population and face crippling challenges on a daily basis.
Poverty was estimated to be over 70% in 2009/2010 (Ministry of National Planning and
Economic Development, Planning Department (PD) and Central Statistical Organization,
2010), and although the situation may have improved in recent years, the latest data from
the Myanmar Demographic and Health Survey (MDHS, 2016) reveal a dangerous

Corresponding author:
Aniruddha Bonnerjee, Upohar Apt, Flat 1503, Kolkata, India 700094.
Email: aniruddha.bonnerjee@gmail.com
376 Global Social Policy 17(3)

situation unfolding in Chin: more than 41% of children are stunted – suggesting long-term
food deprivation and illness. Not surprisingly, the under-five mortality rate – estimated to
be 104 per 1000 live births – is also the highest in Myanmar. Extreme remoteness and
poverty ensure that just about 15% of birth deliveries are in a health facility, while ante-
natal care visits are rare. Maternal mortality is also among the highest in Myanmar.
Natural disasters such as landslides occur regularly. With a population density of just 13
persons per square kilometre (http://myanmar.unfpa.org/sites/default/files/pub-pdf/3D_
Chin_Figures_ENG.pdf),1 and the absence of critical economic infrastructure such as
paved roads, transportation, banking systems and communication facilities, delivering
social services in Chin – a fragile state under any definition – is a formidable challenge.
Yet, if this situation persists, there is a real danger that children and their mothers will face
an even bleaker future
This contribution provides a glimpse into the opportunities and challenges facing
Myanmar as it roles out the first MCCT in one of the country’s most disadvantaged areas,
Chin State. A vicious interaction between demand (influenced by, for example, poverty,
behaviour and knowledge) and supply side factors (e.g. health and market infrastruc-
tures) can only be broken through explicit support measures to families to overcome the
multiple risks they face in their daily lives, while also ensuring that supply side con-
straints are eased over time.

Design and challenges

Against this backdrop, the Ministry of Social Welfare Relief and Resettlement
(MoSWRR) is about to embark on the provision of donor-financed cash transfers to all
pregnant women and their children (until the age of two) in Chin State (MCCT). These
cash transfers are a component of Myanmar’s National Social Protection Strategy, agreed
to in 2014, which is based on the principles of human rights and universality (see Rabi
and Koehler in this Forum).
These cash transfers, amounting to 15,000 Myanmar Kyat (MMK) (approximately
US$10)2 per month, are to be paid out every 2 months to save on delivery costs. At first,
only pregnant women will be registered, while new pregnancies will be added to the
register on a monthly basis. It is expected that about 10,000 women who are pregnant
will register first and in 2 years, the total number of beneficiaries (pregnant women plus
their new born children) will exceed 45,000. Village heads and township/ward heads
have been tasked with the responsibility for registering beneficiaries. Thus, the design
resembles a regression discontinuity (pregnancy status at inception of the programme)
with a pipeline (future pregnancies). An important component of this programme is a
continuous campaign for social behaviour change that aims to promote positive, health
conscious behaviour and encourage mothers to use these cash transfers for nutrition pur-
poses for themselves and their newborn children.
The programme is donor-funded (LIFT fund3) for 2 years. MoSWRR does not yet
have functional offices or bank accounts at the township level and therefore is unable to
transfer money to townships and villages directly. The logistics of delivering cash ben-
efits will involve township-level General Administration Department (GAD) officers
(working under the Ministry of Home Affairs, with access to government bank accounts).
Bonnerjee 377

They are to liaise with newly appointed case managers working for the MoSWRR to
ensure transparency – especially in remote and distant villages. In villages and village
tracts, the village or village tract head will be responsible for registering beneficiaries
and making cash payments, while in townships it will be the ward head. Registration and
cash payments should be witnessed by stakeholders (village elders or midwives for
example) who would constitute the village ‘social protection committee’. This commit-
tee should also play a key role in addressing grievances and reconciling finances. At the
same time, the behaviour change campaign should be conducted by trained midwives
and auxiliary midwives who work for the Ministry of Health and Sports (MoHS) with
support from donors. Hence, the roll out will necessitate cooperation and coordination
among different ministries and departments.
As with any initial roll out of government programmes, especially in a context of
wide-spread poverty and remoteness, several challenges and opportunities exist.
The reliance on donor financing of cash transfers to mothers and children will impact
the sustainability of the programme. First, donor funding for this programme is available
only for 2 years – an extremely short window of opportunity to make a major impact on
child nutrition indicators such as stunting. Second, due to the pipeline regression discon-
tinuity design, only one cohort (the first cohort) of beneficiaries will receive benefits for
the full 24 months, and one cohort of women – those becoming pregnant just before the
programme ends – will receive benefit payments for just 1 month. This makes it difficult
to calculate the impact as there will be a mixture of beneficiaries receiving the payment
for various lengths of time.
At the same time, donor-driven imperatives to demonstrate impact or success requires
a massive sample to ensure sufficient power and statistical precision. The evaluation
design being proposed focuses only on those under the age of two even though interna-
tional evidence suggests that it is unlikely that the accumulative effects of cash transfers
on nutrition would have an impact in just 2 years. In order to reject the possibility of a
‘false negative’,4 nearly 15%–20% of all households would have to be surveyed.
Clearly, this is not feasible within the context of Chin, where torrential rains and remote-
ness generate substantial survey risks and costs. Neither is this scalable to other areas,
as the search for adequate power requires similar sample sizes in every state/region –
well beyond what is feasible, affordable, or sustainable. Since the benefit level, the
frequency of payment, as well as process or operational efficiency, also has a direct
bearing on outcomes the evaluation framework is being modified to incorporate these
elements into the design.
Second, donor requirements in terms of monitoring and evaluation (M&E) are neither
replicable nor scalable, unless considerable efforts are directed towards system building
– especially in relation to an M&E framework and information system within which
donor reporting requirements could (and should) be met. However, it is a challenge to
align donor interests within a sub-national pilot scheme with the requirements of devel-
oping a national-level system. There is a real danger that planned reporting mechanisms
and the evaluation framework evolving for this programme will be heavily biased
towards donor requirements, and hence may not be replicable in a subsequent setting
where the government is financing cash transfers from its own budget. More importantly,
it may be a waste of resources to try and set up parallel systems – one for donors and one
378 Global Social Policy 17(3)

for the government’s own M&E requirements. Government ownership could be lacking
under these circumstances – a crucial ingredient for sustainability.
A lack of human resources and the management of the programme is another major
challenge facing MoSWRR as it rolls out Myanmar’s first cash transfers for pregnant
mothers and their children in Chin State. Human resources for the management of the
programme, procurement of services and assets, developing and maintaining informa-
tion systems, building transparent and effective M&E systems, communicating lessons
learnt and ensuring a robust and participatory feed-back loop could be bottlenecks in
terms of replicating the Chin experience and scaling it up to others states/regions or the
gradual introduction of other elements of the National Social Protection Strategy.
Arguably, demonstrating impact at this stage is not the point – but scaling up is. It will
be more difficult to convince policy makers if the evidence is patchy, thin, or incomplete
and the processes developed are not in tune with government procedures or processes.

Implementation and supply side issues

There has been a significant expansion of MoSWRR budget allocations in the 2016/2017
fiscal year, and new staff have been hired for the purposes of the Chin MCCT. However,
capacity constraints remain, as many of the newly recruited staff do not have adequate expo-
sure or training for this purpose. A systematic effort to ensure that MoSWRR has the requi-
site human resource base to roll out urgently needed cash transfers is critical at this juncture.
But this issue has not received much attention especially compared to the Ministry’s focus
on inter-ministerial coordination which may itself be threatened by a lack of ‘collective
wisdom’ structures such as coordination committees, M&E committees and so on.
There are also valid questions regarding inequities in implementation, and concerns
regarding the dilution of benefits. The first cohort of beneficiaries would include all
pregnant women at the time of the programme’s inception, but babies born just before
the programme’s inception would not be covered. While this may be due to resource
constraints that are forcing a phased implementation, by covering only the future flow of
babies but not those already born who also face crippling nutrition deprivations, there is
a possibility that this cash transfer could be seen as a pro-fertility transfer. This may be
problematic as Chin state already has one of Myanmar’s highest fertility rates.
Apart from questions about equity, there is also the possibility that benefits could be
diluted, in the sense that other children in the household – or even adult members - may
benefit from this cash transfer. Or, given Myanmar’s extraordinary spirit of charity, other
households living nearby could benefit. This is not necessarily bad, but it may affect
outcomes. Women’s decision making with respect to the distribution of food, or access
to health services, is often influenced by elders, husbands and mothers-in-law within the
household. Progressively introducing other programmes, such as, for example, social
pensions, or child grants for children older than 24 months, could, to an extent, mitigate
this (dilution) problem, especially when compounded with strong social behaviour
change messaging. There is also the question of the adequacy of benefits given that Chin
State has on average, larger household sizes than other areas (Census, 2014). Nevertheless,
as mentioned before, capacity and resource constraints may preclude these complemen-
tary interventions in the immediate future.
Bonnerjee 379

Critically, supply side constraints are not addressed through the programme. Markets
as well as medical and health infrastructure are extremely limited in Chin State. Although
the elasticity of food consumption with respect to income is close to one, market disrup-
tions and extreme weather events, compounded by a lack of health facilities, could pre-
clude the optimal use of these cash transfers for mother and child nutrition. Supply side
financing for health facilities and other requisite infrastructure is therefore urgently war-
ranted in Chin, but currently there seems to be little recognition of this sobering fact.
The role of civil society organizations (CSOs) as well as stakeholders will also have
to evolve to avoid fragmentation and duplication. Quite naturally in the absence of any
cash transfers to date, other stakeholders are providing ‘stop-gap’ arrangements. For
instance, some CSOs may have experience in post-distribution monitoring, which would
be crucial for the Chin MCCT, but within the context of a national policy that will be
progressively scaled up – the role must shift towards supporting government-led and
-owned structures. This includes a focus on transferring capacity and knowledge, so that
the government owns processes and institutions.

Seizing the golden opportunity

Despite the many challenges outlined above, a golden opportunity exists for the govern-
ment of Myanmar. It can use its fiscal budget to co-finance and expand coverage for all
children under the age of two in Chin State, and to do this, it can use innovative means
to finance health and social infrastructure. The Myanmar economy is growing rapidly,
and revenue growth is expected to remain strong over the medium term (Asian
Development Outlook [ADB], 2017). At the same time, logistical arrangements for reg-
istering and payment of benefits are already being put in place for the donor-financed
cash transfer. Complementing donor-financing and expanding coverage to all newborn
babies and their mothers would provide a strong socio-economic and political base for
genuine improvements in Chin State, and across Myanmar more generally.

Funding
The author(s) received no financial support for the research, authorship and/or publication of this
article.

Notes
1. The 2014 Myanmar Population and Housing Census,Union Report, Department of Population
Ministry of Labor, Immigration and Population, 2015. Also available at http://myanmar.
unfpa.org/sites/default/files/pub-pdf/3D_Chin_Figures_ENG.pdf (Census, 2014).
2. The poverty line in Myanmar is dated. Calculations performed by the Ministry of National
Planning and Development during the post-flood damage assessment of 2015 showed that
estimated per capita income is US$415, or about 415/12 = US$35 per person per month. The
average household size is around five persons – which means that average household income
is about US$175. The scheme is therefore transferring roughly 10-12/175 of household
income which is just less than 10% on average.
3. Livelihoods and Food Security Trust Fund (LIFT) http://www.lift-fund.org
4. The likelihood that the sample was too small to detect a programme effect when in fact there was.
380 Global Social Policy 17(3)

References
Asian development outlook (ADB) (2017) Asian development outlook 2017. Available at: www.
adb.org.
MDHS (2016) Ministry of Health and Sports (MoHS) and ICF 2017. Myanmar Demographic and
Health Survey 2015-16. Nay Pyi Taw, Myanmar and Rockville, Maryland, USA: Ministry of
Health and Sports and ICF.
Ministry of National Planning and Economic Development, Planning Department (PD) and
Central Statistical Organization (2010) Myanmar–Integrated Household Living Conditions
Assessment II 2009–2010. Yangon: IHLCA2. Available at: http://catalog.ihsn.org/index.php/
catalog/6256.

Author biography
Aniruddha Bonnerjee is the Director of Policymetrica, Kolkata, and currently a senior consultant
on Social Policy to UNICEF Myanmar. His previous positions include having worked for the
World Bank as an economist on social protection, fiscal space and budgets. He has also worked as
a senior advisor to UNDP for MDG costing, advised the private sector on corporate social respon-
sibility and assisted governments in development planning in diverse regions of the world.