This innovative case not only documents the South-South Cooperation between two countries – Thailand and the Lao People’s Democratic Republic (Lao PDR) – but also shows the framework of determining the tangible economic and social benefits of conducting South-South cooperation, its social returns of investment (SROI). Economists and government decision-makers are extremely interested in learning about these benefits of cooperation and communicating them to their public, hence this case documentation.
The United Nations Population Fund (UNFPA) and the Royal Government of Thailand through the Thailand International Cooperation Agency (TICA, have collaborated extensively to share Thailand’s pioneering and widely lauded practices in sexual and reproductive health. In recent decades, Thailand’s international development cooperation efforts have progressed considerably. UNFPA has supported the Government to take a leading role in sub-regional, regional and global initiatives to exchange successful experiences and technical knowledge, especially on maternal health care and services. It is in this context that the study on the measurable benefits of SSC is of interest and relevance to TICA, since it aims to expands its external cooperation. It is equally relevant to the Lao PDR since it has sought to determine if the investments it made in this partnership earned significant returns.
The Thailand Maternal Health Programme is globally recognized for producing significant declines in maternal mortality. With a rate of 24.6 maternal deaths per 100,000 live births, Thailand is already considerably below the Sustainable Development Goal target of 70 deaths per 100,000 live births. As such, UNFPA has been supporting the Government of Thailand to take a leading role in sub-regional, regional and global initiatives to exchange successful experiences and technical knowledge, especially on maternal health care and services.
Due to the challenges in Lao PDR in this area, the midwifery programme in the country was selected for analysis. The Government, UNFPA and TICA had co-invested in comprehensive programme management, comprising needs assessment, programme design and development, planning, programme implementation, monitoring and evaluation. Between 2015 and 2017, through Government cost-sharing, US$450,000 went towards improving human resource skills and systems of the midwifery programme.
Towards a Solution
Concerted collaboration on the human resources component of the midwifery programme in Lao PDR began in 2015 with a needs-based prospectus to tailor the initiative to national priorities. Subsequently, high-level officials carried out a study visit to Thailand to learn about its nurse midwifery systems and maternal health programme. The Faculty of Nursing at Thailand’s Khon Kaen University became a major source of technical advice. Participatory curricula were developed for human resource professionals, including a four-month course for 11 managers of midwifery schools and colleges, and a six-month training for two groups of 52 midwifery educators from all 11 midwifery educational institutions. Participatory monitoring and evaluation took place regularly to adjust activities based on needs and demands.
To assess the value of the programme, UNFPA and TICA applied the principles and methodology of the social return on investment (SROI) framework, which is more comprehensive and participatory than traditional cost-benefit analysis. SROI applies financial proxies to measure socio-economic outcomes. By investigating and consolidating the views of multiple stakeholders in an easy-to-understand financial ratio, the framework can make a convincing case for the value of a project, shedding light on the social value created for each dollar invested.
The ratio is calculated by estimating the total present value of costs and benefits. The timing of these costs and benefits is taken into account with the discount rate, a percentage that represents the estimated value of depreciation per year.
To probe the cost-effectiveness of the initiative and the value provided to different stakeholders and beneficiaries, the SROI exercise drew on the quantitative analysis of surveys and key informant interviews. It focused specifically on activities to improve midwifery education according to standards set by the International Confederation of Midwives and the World Health Organization.
Close coordination with UNFPA’s country office in Lao PDR, as well as a series of questionnaires, meetings and interviews helped ensure that relevant stakeholders would agree on and endorse the SROI results.
The SROI studies found a substantial return from the programme. The total investment of US$ 450,000 created a social value of nearly US$1.8 million. Each dollar invested generated nearly four additional dollars.
This value stemmed from 93 percent of trained participants having increased self-confidence in the midwifery profession, 63 percent having greater capacity to contribute to their institutions, 29 per cent having better job prospects, and 24 per cent having better abilities to contribute to their community.
The SROI confirms that South-South cooperation equipped midwifery educators with knowledge and expertise in line with international standards. Nursing and midwifery institutions have benefited greatly from improved skills and staff quality, and many innovations have emerged. These include: (i) work with medical doctors to train midwifes at health centres and district hospitals; (ii) the exchange of teachers; (iii) an exclusive breastfeeding project; (iv) educational videos and micro teaching; and (v) a network of competent teachers.
The compelling findings of the SROI analysis led TICA, UNFPA and the Government of Lao PDR to recommend continued investment in midwifery educators and institutional capacity development. Since the South-South model is effective and makes efficient use of Thailand's expertise as well as financial resources, it has potential over time to deliver long-term and sustainable results in a number of areas, in maternal health, and sexual and reproductive health more broadly.
For UNFPA, changes in the funding structure of the country programme in Thailand underscore the imperative to pursue more multilateral partnerships or co-financing. The programme now has a clear case for continuing to advocate and mobilize resources for South-South projects, including with civil society networks and private sector firms in Thailand and other countries.
UNFPA plays vital roles in providing extensive technical support on the SROI initiative, offering evidence-based policy development assistance to TICA on South-South initiatives, and advocating further South-South resource mobilization among government organizations. It is UNFPA’s hope that these findings contribute to the global knowledge of evidence on the value of SSC.