Reflections on a Site Visit in Myanmar (Burma)

We recently traveled to Myanmar to visit a project Good Ventures is supporting to help prevent the spread of drug-resistant malaria. This post shares some observations from the trip and general thoughts about the value of site visits versus other ways of learning about the impact of one’s giving.

About the project

To recap, this project aims to rapidly replace one type of malaria treatment in Myanmar (AMT) with another (ACT) to reduce the risk of drug resistance, which could have a devastating effect on global malaria control efforts if left unchecked.

The project is being carried out by Population Services International (PSI) with support from the Gates Foundation, the UK Department for International Development (DFID) and Good Ventures. We contributed to the project as part of our effort to learn from other major funders through co-funding.

The project involves selling subsidized ACTs to the largest pharmaceutical distributor in Myanmar, sending “product promoters” to private drug providers to promote the appropriate use of ACTs, and piloting a project to promote the use of rapid diagnostic tests (RDTs) among such providers. It also involves encouraging the Myanmar government to follow through on its commitment to end the importation of AMTs.

The project got off to a slow start in 2012, but progress has accelerated over the course of 2013. The latest data show that the ratio of AMT to ACT in the market has decreased from about 20:1 in 2012 to about 1:2 in 2013. The subsidy has been largely passed on to patients: the price of a full course of ACT is less than or equal to the price of a typical (partial) dose of AMT in 94% of drug outlets. Due to quickly declining malaria rates in the country, PSI Myanmar estimates that the project has enough funding to continue into 2016, 18 months longer than originally planned. (A more detailed update is forthcoming.)

Observations on the site visit

We spent five days with PSI Myanmar for the annual donor review of the project, which was also attended by representatives of the Gates Foundation and DFID. We spent the first day in PSI Myanmar’s office in Yangon reviewing the project’s progress and potential risks to its continued success and sustainability. We spent the next three days traveling through Mon State and interviewing people working at various levels of the supply chain, including itinerant drug vendors, village pharmacists, drug wholesalers, and representatives of the large pharmaceutical distributor, AA Medical Products. (We’ll refer to these three days as the “field visit.”) We spent the last day in Yangon reflecting on the visit with PSI and DFID. We’re deeply grateful to PSI Myanmar for hosting us and organizing the trip.

We’ll post detailed notes from our travels soon. In the meantime, we wanted to share some miscellaneous observations and reflections:

General thoughts on the value of site visits

As we research potential focus areas, we’re often advised to “get out into the field” in order to understand the work we’re funding, or considering funding, better. We agree with the notion that site visits can be valuable for learning. That said, we’ve found that such visits are helpful for some — but not all — types of learning. They are not a substitute for desk research, though they can complement such research in important ways. Site visits also take a great deal of time to conduct, and hosting them requires a significant investment on the part of the nonprofit. These are trade-offs we take into account when deciding how to prioritize our time to maximize our learning.

What are site visits good for?

What aren’t site visits good for?

In most cases, site visits do not seem to be an appropriate tool for learning how a project is going in general, because they only allow for a small number of anecdotal observations, which are not necessarily representative of the situation overall. Furthermore, despite our best efforts not to ask leading questions or prime interviewees to respond in certain ways, we’ve found it hard to know whether we’re getting a fully accurate view of circumstances on the ground in the places we’ve visited. This is to be expected and doesn’t diminish the other benefits of conducting site visits. But it does point to the importance of representative monitoring data and rigorous, independent evaluation in learning about whether the work we’re funding is succeeding in meeting its goals.