Belizean Tongues: The Socioeconomics of Language and Education in Belize

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by Rachel Staples Guettler

 

 “In the beginning was the Word, and the Word was with God, and the Word was God.”

John 1:1

 

Introduction

In June 2018 I traveled to Belize as an American-born, English-speaking, doctoral student with the Pepperdine University Graduate School of Education and Psychology to research aspects of a developing country in regards to education, economics, and global leadership.  I recognized an initial feeling of comfort in my travel preparation from the fact that English is the official language of Belize.  Before the trip, I began to research economics and access to educational tools in Belize.  As my research deepened, I began to reflect upon the possible discomfort many Belizean natives from non-English speaking cultures may experience because of English being the official language of the country.

Once in Belize, speaking directly with local Belizeans, I found that every Belizean I met, who told me they were indeed born in Belize, also said that English was not their native language or not their mother tongue.  Additionally, an ex-patriot who has been living in Belize for several years after moving from the US told me he chose to move to Belize because it is the only Central American country on the Caribbean Ocean with English as the official language (Personal Communication, June 13, 2018).  Having studied vocal pedagogy for many years, I know that the voice is an instrument of culture, communication, identity, and connection to others (Love & Ansaldo, 2010).  Thus, I began to wonder about the influence of globalization and language policy on Belizean educational structures and on access to educational tools in Belize with the added challenges stemming from a global rise in minority language endangerment (Olster, 1999).

Language is a powerful tool in society, it has the power to shape a person’s identity, and it has the power to shift the economy (Manning, 2006; Nichols, 2006; Olster, 1999).  Manning (2006) argues, “The subject of linguistics, the idealized speaker-hearer, a native speaker with a perfect knowledge of a language, resembles the subject of economics, the rational actor with an encyclopedic knowledge of commodities” (p. 271).  Economists, Levitt & Dubner (2005), emphasize the importance of using an inquisitive economic lens, specifically focusing on what people value, how incentives drive people’s choices, and how value-incentives influence economic trends.  Belize is a country rich in language diversity with many minority languages spoken there, which are not only an integral part of communication but also represent cultural spirituality, ritual, dance, historical value, community, and so much more (Patten, 2001; Thompson, 2004).  When a person is born and reared from birth to speak the same language spoken in the person’s home, that language is the person’s native language or “mother tongue” no matter what the official language is in the country where the person’s resides (Love & Ansaldo, 2010, p. 589).

Minority languages are under threat from the widespread global influence of standardization through majority languages, and minority languages need political and cultural support to stand the test of time in an increasingly globalized world (Moore, 2006; Olster, 1999; Yamamoto, Brenzinger, & Villalón, 2008).  Olster (1999) laments, “linguists predict that at least half of the world’s 6,000 or so languages will be dead or dying by the year 2050” (p. 16).  There are many activist groups and organizations with a mission to help and save endangered languages urging more use for minority languages in public spaces and domains (Yamamoto, Brenzinger, & Villalón, 2008).  The National Science Foundation in conjunction with the National Endowment for the Humanities created by the US Congress in 1950 has a “Documenting Endangered Languages” project, which has already funded a project specifically working with Mayan women from the Guatemalan Highland region to provide access and encouragement of the endangered Mayan “Ixil” language (Moore, 2006, p. 303).

Many scholars argue that pressure for groups of people to become bilingual or multilingual can be complex, challenging, and in some cases detrimental to cultural groups, personal identities, and can ultimately influence a cultural group’s ability to thrive (Love & Ansaldo, 2010; Ravindranath, 2009; Rubinstein, 1979).  Globalization and economics can influence languages and cultures, causing shifts in language use, and oftentimes creating environments where many minority languages are at risk of becoming endangered (Olster, 1999).  When an area has many different people who speak many different languages, the heritage, the culture, and the identity of the diverse groups of people in that region can experience negative impacts by the government and official language policy changes (Patten, 2001).  This paper utilizes the “SPELIT Power Matrix methodology” (Schmieder-Ramirez & Malette, 2007, p. 3) to analyze the social, political, economic, legal, intercultural, and technological aspects of language, education, and socioeconomics in Belize.

SPELIT Analysis: Social and Intercultural

Schmieder-Ramirez & Malette (2007) encourage researchers to explore “social cultural norms” (p. 6), as well as “how people interact with one another and how the structures they create impact how they interact with one another” (p. 33).  Schmieder-Ramirez & Malette also encourage culturally diverse groups to move away from the unhealthy denial, defensiveness, and minimization of “ethnocentrism” into healthier intercultural “ethnorelativism” (p. 97) through patterns of accepting, adapting, and integrating with other’s cultural differences.  Thus, my research on the socioeconomics of education and language in Belize explores how the government’s choice to structure a majority language like English as the official language policy of the country does impact how groups of people in Belize interact with each other through education, the economy, and conflicting social norms.

Tourists from all over the world travel to Belize to experience the ancient Mayan ruins, the diverse plant and animal species, the Caribbean coastal landscapes and jungles, and to research the indigenous and immigrant cultures, food, history, and heritage found in Belize (Thompson, 2004; Medina, 1998; Medina, 2003).  Belize has a history of diversity from the indigenous Mayan people, to the 16th, 17th, and 18th century Spanish, British, and French colonies (Medina, 1998).  The diverse history of Belize also stems from the influence of the neighboring countries of Guatemala, Mexico, and the maritime border country Honduras (Thompson, 2004).  Furthermore, the Belizean population’s diversity is influenced the by the cultures of the Mayan, Garifuna, Mestizo, African Creole, German and Canadian Mennonites, as well as the influence of globalization, industry development, and tourism bringing people, cultures, and languages from all over the world (Cox, Driedger, & Tucker, 2013; Medina, 2003; Thompson, 2004).

Immigration, tourism, and globalization has influenced Belize and continues to impact education and the many minority groups in Belize, some of which claim to be Belizean natives such as the Maya, Garifuna, Mestizo, and Creole (Rubinstein, 1979; Medina, 1998; Medina, 2003).  The Mayan people have a particular spiritual intimacy with their native language, and Mayan rituals must be performed in the Mayan tongue by someone who “speaks and understands” the language (Medina, 1998, p. 361).  For example, the Maya recognize a “cosmological core that has persisted across centuries, [which] continues to link the living with their ancestors and divine forces, and that is transmitted and activated through the use of Mayan languages” (Medina, 1998, p. 361).  However, some scholars argue, “Mayan ethnicity, language, and traditional economic strategies are rendered disadvantageous for school achievement by historical, social, cultural, and economic forces” (Crooks, 1997).

As tourism and globalization have permeated Belize, many people, cultures, and languages face the threats of widespread use of majority languages such as English (Medina, 1998; Nichols, 2006; Ravindranath, 2009).  The Garifuna people also believe their native language is an essential part of their heritage encompassing their music, dance, religious practices, what they eat, and food preparation which is celebrated annually during the national holiday in Belize, “Garifuna Settlement Day” (Ravindranath, 2009, p. 14).  However, even with a day dedicated to the Garifuna people in Belize, there are still some cultural groups in Belize that go so far as “to choose to remain insulated in their culture and language” (Spang, 2014, p. 61).  Moreover, Belizean social norms vary between groups, and each group can experience the influence of majority languages, such as English and Spanish, in different ways (Nichols, 2006).

SPELIT Analysis: Political

Schmieder-Ramirez & Malette (2007) encourage researchers to frame the analysis of political influence in groups by regarding “competing interests, views, assumptions, and values” (p. 55).  My research explores these competing interests, views, assumptions, and values of the diverse Belizean people, the influence of colonization, and the influence of a tourism economy in a developing country in Central America.  The people of Belize are diverse, the languages spoken in Belize are diverse, and the structure of power and values follow suit in their diversity.

Various languages are a part of the diverse cultural groups of Belize:  the Mayan languages of the Mayan-Yucatec, Mayan-Mopan, and Mayan-Kekchi speakers; Spanish speakers; Kriol or Creole speakers; Garifuna speakers; the Mennonite language of the low-German dialect of Plautdietsch; English; and many more languages from various ethnic groups, dialects, and socioeconomic statuses (Medina, 1998; Rubinstein, 1979; Thompson, 2004).  However, even with all the diversity of people, culture, and language spoken in Belize, the Belizean Ministry of Education declared English to be the official language of the country (Rubinstein, 1979; Ravindranath, 2009).

The language policy is in alignment with the 1862 British colonization of the country, but in a 2010 census, more than 37% of Belizeans reported not being able to speak English well conversationally, much less academically (Nixon, 2015).  Patten argues, “Language policy is an issue of considerable ethical, political, and legal importance in jurisdictions around the world” (2001, p.691).  Furthermore, minority languages are impacted and have a higher risk of becoming endangered or even extinct when language policy establishes the official language of a country as a majority language, such as English (Olster, 1999; Patten, 2001).

There is linguistic controversy over countries that declare a majority language like English to become the official language, especially in a country like Belize possessing a wide variety of cultural groups, languages spoken, and heritages preserved (Patten, 2001; Ravindranath, 2009; Nichols, 2006).  Crooks (1997) emphasizes, “The vitality of a language is challenged when individual speakers abandon it and shift to a new tongue” (p. 61).  The controversy of language policy is especially important when exploring the language taught in public school classrooms, not only from a mere educational standpoint but also from a social perspective (Patten, 2001).  Scholars concede that in Belize, “English is the primary language of instruction; students are expected to be proficient by the end of primary school.  Primary teachers are encouraged to recognize that students come to the classroom with a variety of languages and are urged to build on these experiences to improve instruction” (Nixon, 2015).

Official language policy that influences languages taught in schools has a significant impact on a student’s cognitive development, and impacts how a student may begin to judge his or her ancestors, community, and other students based upon skill or lack of skill in the language taught versus skill in the native tongue (Crooks, 1997; Nichols, 2006’ Rubinstein, 1979).  Rubinstein (1979) explores these complex sociolinguistic aspects of English instruction for Spanish-speaking Mestizo children and Belizean Creole-speaking children in his research of seven schools in Corozal Town, Belize:

“First, the child is likely to be classed as slow or lazy in school if he/she fails to keep apace of his/her classmates in the acquisition of English language skills. This classification carries with it a whole range of implications: the child’s belief in the importance of his/her efforts vis-a-vis the school environment and his/her self- evaluation may ultimately result in school failure or school leaving. Second, for those students who do stay in school through standard 6 (eighth grade), the real control they are able to exercise over English is often minimal and quickly lost” (p. 585).

Additionally, minority languages suffer from the risk of becoming endangered or extinct if they are not passed down from generation to generation, spoken by children, or shared in written word, which is similar to the ways that plant and animal species can suffer from becoming endangered or extinct from the effects of globalization, tourism, and industry development (Olster, 1999).  Furthermore, since the British colony was established in Belize, there has been a duality of church and governmental control on the educational system, which causes even greater controversy because the diverse people in Belize also have an even greater diversity within their religions, belief systems, and denominations (Rubinstein, 1979).

Moore (2006) urges governments to support official language policy that allows minority languages to continue to be taught to children so they can speak it with others on a regular basis as well as being able to write in the language or the language will decline.  Moore specifically emphasizes preserving language in written form is the most imperative, and that languages that are not written are the languages that eventually become “lost” or “dead” (Moore, 2006, p. 313).  Teaching children to speak, read, and write a language can even revive it, such as in the example of the 19th-century Palestinian movement to reintroduce Hebrew teaching in all Israeli schools and now Hebrew is the most common language of the citizens in that region (Olster, 1999).  However, language revitalization through schools may not be a realistic option for Belizeans. Often young Belizeans must leave school or choose to leave school years before high school graduation to enter the workforce.  Moreover, Belizean schools have little governmental support, poorly educated teachers, social structures that have negative attitudes towards education taught in English, and poverty creating challenges of lacking resources, textbooks, and supplies (Crook, 1997).

SPELIT Analysis: Economic, Legal, and Technological

Schmieder-Ramirez & Malette (2007) emphasize to researchers that economic analysis must explore the “factors that affect the production and consumption of resources needed to operate” (p. 63).  In a diverse country, operations vary between individuals, families, cultural groups, religions, and communities, of which all are governed by the legal boundaries set by the policy, which either creates or takes away access to technology or tools for learning and development.  This research explores the production and consumption of the majority language use in minority language settings in Belize, the legal nature of language in Belize, and the over-arching results of technological access in Belize due to language and education policy.

Scholars contend that language has value, is a commodity, effects trade, influences labor market trends, and is a significant factor of economics (Chiswick & Miller, 2003; Li, 2013; Manning, 2006).  Additionally, scholars argue that people who adapt and become proficient enough in the official language may use their native language less often and may have a greater chance at earning more money in that labor market (Chiswick & Miller, 2003).  Poverty, especially in remote areas of Belize, also influences education, access to educational tools, and the use of the English language in public areas, schools, and in the home (Crooks, 1997).

Scholars argue that even in towns such as Placencia, Belize, where I stayed during the doctoral delegation with Pepperdine University, there is an “uneven distribution of wealth, an influx of wealthier outsiders and tourists, a sometimes controversial real estate boom, and socio-economic frictions resulting from rapid change and growth” (Spang, 2014, p. 13).  In a personal interview I had with a local Belizean, anthropologist, organic farmer, and creator of Taste Belize Tours, Dr. Lyra Spang Ph.D., she shared with me how many Belizeans become stuck in a “cycle of poverty” because of lacking access to education, to basic educational tools, and due to minimal government funding for education (Personal communication, June 12, 2018).  She also shared with me how different cultural groups value different aspects of Belizean life from food grown to land choice.  For example, the Mayan people strategically built their homes, villages, and temples in the more remote inland areas away from the more populated coastal areas (Medina, 1998).  This Mayan, inland-living preference is also why it is challenging to track exactly when the Mayan people came to Belize since the British colonies did not always travel as deeply into the jungle areas where Mayan villages could be found, and there are many conflicts in the literature regarding who was first to populate areas of Belize (Thompson, 2004).  In other words, Mayans value remote areas and desire to settle in remote areas.  The cultural value of historically building Mayan communities in remote areas in Belize has put Mayan children at a disadvantage because schools in remote areas have less access to educational resources and tools (Crooks, 1997).

Tourism is also a significant contributor to the Belizean market, and Medina (2003) explores how the Belizean tourism economy has influenced changes in indigenous culture and cultural preservation efforts.  Historically and presently, the Mopan and Kekchi Mayans have faced injustice and marginalization as the lands where they claim they are indigenous to have become developed from agriculture to ecotourism with governmental strategy to capitalize on Mayan culture in the name of ecotourism efforts to grow the economy through the leveraging of the Mayan culture and Mayan ruins (Medina, 1998).  Furthermore, Medina (1998) explains that:

In pursuit of this strategy, Belize joined with El Salvador, Guatemala, Honduras, and several states of southern Mexico in 1992 to launch the Mundo Maya or “Maya World” project. This joint public-private sector project discursively and practically constructs regional ‘Maya’ space which reflects the expanse of’ Maya civilization’ during the Maya Classic and Post-Classic periods and incorporates contemporary Maya groups as the continuing manifestation of that ancient culture. Within the regional space of Maya World — unlike the national space of Belize — the nativeness of Mopan and Kekchi as Maya is unquestioned. Further, the Maya World project constructs them as ‘native’ for an audience — tourists — to whom Maya culture and civilization have already been represented as monolithic and singular” (p. 155).

While the people of Belize are a diverse population consisting of a variety of languages, ethnicities, and religious affiliations, the legal aspects of the language policy in Belize is such that the language spoken in schools in Belize is far from diverse and is homogeneously in English (Crooks, 1997; Nixon, 2015; Rubinstein, 1979).  In Belizean schools with students from various backgrounds, cultures, religious beliefs, and native language, school instruction has been impacted since British colonization and, “a ruling of the Ministry of Education making English the only allowable language of instruction in Belizean schools” (Rubinstein, 1979, p. 584).  Furthermore, policy influences access to technology such as trained versus untrained teachers, textbooks, and funds for education (Crooks, 1997).  Belizeans in remote areas such as the Toledo District note that there are not many trained teachers or educational tools, but tourism is thriving in the area due to the Toledo Ecotourism Association’s Village Guest House Program giving tourists access to learn about remote Mayan villages (Crooks, 1997).  The socioeconomic standard here is a paradox with tourists learning about Mayan culture while simultaneously Mayan children do not have equal access to strong educational opportunities.

Alternatives

What are the alternatives to these conflicts of interest from the economic gain of tourism and globalization to educational loss for Belizean cultures?  What are the alternatives to the education policy set by the government in Belize?  Scholars argue in support of strategizing through avenues of ecotourism in ways that bring tourists in a respectful way to learn from and celebrate a minority group while also preserving the culture and language, with careful effort to avoid exploitation (Medina, 2002; Spang, 2014).  Economies that are thriving from tourism can find ways to integrate their culture with outsiders in ways that help others learn what is unique about their society, spiritual practices, food, and language (Medina, 2003).  If each group that claims to be native in Belize could have designated, national celebration days such as Garifuna Settlement Day, this could also draw tourism specifically tailored around the celebration of a minority culture and language, thus creating pathways for preservation (Ravindranath, 2009).

Another policy alternative could come from the legal and political spectrum of Belize with petitioning that the Ministry of Education enforce equality in resources and access to the educational systems for students in the heavily populated coastal areas as well as the more remote, inland farm areas.  Too many remote villages, cultures, and people in Belize are denied access to educational development (Crooks, 1997).  Policy change must happen so that the people in these areas can have social justice and equal access.  Furthermore, language policy changes that allow schools to teach students not only in English but also support teaching in the native languages represented in the classroom by offering opportunities for cultural celebration, historical exploration, and language study in efforts to preserve the minority languages in the area.

Lastly, an educational policy that creates pathway opportunities for students to develop skills to become teachers could result in developing teachers with real training and expertise to continue to develop current and future students.  Teachers in Belize without real educational training are a major issue in the Belizean educational system (Crooks, 1997).  If students could have an option to train as a student-teacher, instead of leaving school to work, this option could create new prospects to develop Belizean people from the classroom as students to the classroom as teachers.  Furthermore, these educational pathways could be developed such that students are empowered to learn how to teach in a variety of languages to a diverse student population.

Conclusion

In conclusion, lawmakers must begin to recognize how education and language policy can influence changes in social groups, which can thus influence economic trends (Patten, 2001).  The cycle of poverty in Belize needs to end, and social justice for Belizeans in imperative.  The diverse people and languages in Belize need to be celebrated, not just by tourists, but also by the Belizean people and Belizean government on a national scale.  Such language policy changes could be vital in protecting from the threat of language endangerment or extinction to the people that help to make Belize a historically diverse country.  Adopting policies that address language endangerment could be the conduit for this imperative change by developing Belizeans through respectful ecotourism targeted at cultural awareness and preservation, as well as education and language policy changes that create access to educational tools for the development and preservation of language diversity.  Belize is a melting pot of cultures, and each deserving equality, social justice, recognition, and empowerment.  Belize must preserve and maintain the unique cultural diversity that is the foundation of its history.  Finally, the Belizean people must unite in efforts to be strategic in educational and language policy that supports the development and preservation of language diversity, attracting many culturally curious people from across the globe.

REFERENCES

Chiswick, B. R., & Miller, P. W. (January 01, 2003). The complementarity of language and other human capital: immigrant earnings in Canada. Economics of Education Review, 22, 5, 469-480.

Cox, C., Driedger, J. M., & Tucker, B. V. (August 01, 2013).  Mennonite Plautdietsch (Canadian Old Colony).  Journal of the International Phonetic Association, 43, 2.

Crooks, D. L. (September 01, 1997). Biocultural Factors in School Achievement for Mopan Children in Belize. American Anthropologist, 99, 3, 586-601.

Levitt, S. D. & Dubner, S. J. (2005) Freakonomics. New York, New York:  Harper Collins Publishers.

Li, Q. (March 01, 2013). Language and urban labor market segmentation: Theory and evidence. Journal of Urban Economics, 74, 1, 27-46.

Top of Form

Love, N., & Ansaldo, U. (November 01, 2010).  The native speaker and the mother tongue.  Language Sciences, 32, 6, 589-593.

Nichols, R. L. (March 01, 2006).  Struggling with language: Indigenous movements for linguistic security and the politics of local community.  Ethnicities, 6, 1, 27-51.

Nixon, J. (2015). Belize Colonial Language Education Policy. In F. V. Tochon (Ed.), Language Education Policy Studies (online). Madison, WI: University of Wisconsin—Madison.

Retrieved from: http://www.languageeducationpolicy.org.

Manning, P. (January 01, 2006).  Words and things, goods and services: Problems of translation between language and political economy.  Language and Communication, 26, 3, 270-284.

Bottom of Form

Medina, L. K. (September 01, 1998).  History, culture, and place- Making: ‘Native’ status and Maya identity in Belize.  Journal of Latin American Anthropology, 4, 1, 134-165.

Medina, L. K. (January 01, 2003).  Commoditizing culture: Tourism and Maya Identity. Annals   of Tourism Research, 30, 2, 353-368.

Moore, R. E. (January 01, 2006). Disappearing, Inc.: Glimpsing the sublime in the politics of access to endangered languages. Language and Communication, 26, 3, 296-315.

Patten, Alan (2001).  Political Theory and Language Policy.  Political Theory 29(5): 691–715.

Ostler, R. (August 01, 1999).  Disappearing Languages. Futurist, 33, 7.

Ravindranath, M. (December 22, 2009).  Language Shift and the Speech Community: Sociolinguistic Change in a Garifuna Community in Belize. Publicly Accessible Penn Dissertations. 33.

Rubinstein, R. (August 01, 1979).  The cognitive consequences of bilingual education in northern Belize. American Ethnologist, 6, 3, 583-601.

Schmieder-Ramirez, J. H., & Mallette, L. A. (2007). The SPELIT power matrix: Untangling the organizational environment with the SPELIT leadership tool.  Place of publication not identified: publisher not identified.

Spang, L. H. (2014).  A real Belizean: Food, identity and tourism in Belize (Order No. 3642857).

Available from ProQuest Dissertations & Theses Global. (1609197732). Retrieved from https://lib.pepperdine.edu/login?url=https://search-proquest com.lib.pepperdine.edu/docview/1609197732?accountid=13159.

Thomson, P. A. B. (2004). Belize: A concise history. Oxford: Macmillan Caribbean.

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Global Leadership Reflection of Belize: Ya Da Fu We (Belizean Independence)

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by Ed Eng

 

1. Introduction/background

Belize is home to a very functional democracy, with great emphasis on order, education, and the inclusion of all social classes in one democratic process.  The country is a good example to its regional neighbors, able to carry out peaceful, cooperative elections, with a strong emphasis on participation.  This political stability has contributed greatly to the country’s positive relationships with regional neighbors and with countries around the world.  The stable and cooperative nature of Belize and its economy make for a healthy cooperative environment.  However, in order to attract high-growth startups and investments to the country, the Belize government should consider adopting alternative approaches to bring in new investment, develop a robust pipeline of skilled workers, and grow the middle class.  This paper will begin with an environmental scan to assess strengths and opportunities in Belize, followed by a discussion of the main leadership challenge facing the government, and finally, a set of proposed recommendations for policy changes and action plan to strategically grow the economy.

2. Environment of the issue (SPELIT)

In this section, I will be using the SPELIT Power Matrix as the framework for my environmental analysis to assess the strengths and opportunities for change.  This methodology was chosen over other tools because it includes a focus on the human dimension as well as other strategic factors (Schmieder-Ramirez & Mallette, 2007).

Social

There are distinct degrees of socioeconomic inequality based on wealth, power, and status.  This unequal standing is further stratified according to skin color and ethnicity. At the top echelon, there are lighter-skinned Creoles, mestizos, and newly arrived North Americans, East Indians, and Middle Easterners.  These higher-level groups retain control of the two political parties and the retail trade sector.  At the lower levels, there are darker-skinned Creoles and Garifuna who are largely unemployed.  The Maya and Garifuna display the enduring character traits of the indigenous people.  The Maya are subdivided into the Mopan and Ketchi peoples.  Both groups have exorbitantly high levels of poverty and participate insignificantly in the political and socioeconomic realms.  The violent crimes that happen most often are murder, manslaughter, and rape.  The most widespread property crimes are robbery, burglary, and theft (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Belizeans in urban areas expect the government to assist them in raising their children and support early education.  In contrast, child rearing in rural communities is aided by family and relatives.  By statue, a child has to attend primary school up to age fourteen.  However, only 40 percent of primary school students progress on to secondary schools because of poor test performance in the national school examination and for lack funds for tuition fees and textbooks.  Overall, less than 1 percent of the population qualifies for higher education.  A national university that was commenced in 1987 only offers a limited number of programs and has fewer than 500 students (“Belize School System – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System,” n.d.).

Belizeans use the healthcare systems in Guatemala and Mexico for medical services because of the insufficiency of health facilities and inadequacy of trained professions to deliver quality services.  Many locals also turned to old-fashioned remedies like plants and other and inherited rituals (“Healthcare in Belize – International Living Countries,” n.d.).

Political

The government is ratified by a parliamentary democracy and exercises the executive, legislature, and judiciary branches of authority.   However, the political parties have essentially eliminated the power of the legislature in preference for a cabinet of ministers.  The two main parties are the Peoples United Party and the United Democratic Party and both draw support across all ethnic groups and social classes.  All members of the government foster openness to the public and encourage their constituents to engage with them (“Belize POLITICAL DYNAMICS – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System,” n.d.).

The national army supplies protection against Guatemala, which in the past, has threatened to invade the country and claim its stake of Belizean territory.  The army also provides drug prohibition efforts and aids in disaster endeavors.  The police force is the first line of defense against all crime. However, the police are perceived to be only active in urban communities and the limited number of villages with police stations (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Economical

The services industry is the largest sector in the country, contributing a total of $718 million in 1996, equivalent to 57 percent of the gross domestic product (GDP).  The dominant industry in the private sector remains agriculture, with fishing and logging in a distant second and third respectively.  The government promotes international trade and encourages export of food production in the country.  The main food items of sugar, citrus and bananas accounted for 86 percent of exports in 1996 and made up almost 80 percent of foreign exchange earnings (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

However, the prevalent heritage of colonialism in the modern economy is displayed in the large holdings of land owned by foreigners for real estate speculation.  This near-monopoly resulted in only 15 percent of the land left are available for agriculture purposes.  The government has never had a comprehensive land development and reallocation policies (“Belize GROWTH AND STRUCTURE OF THE ECONOMY – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System,” n.d.).

Legal

The judiciary system is a leftover of the British system, and appeals can still proceed as far as the Privy Council in London.  Locally, the formal functioning of the system is at risk due to a lack of judges, law administrators, and prosecutors, resulting in a logjam of cases (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Intercultural

Christianity is the main religion in Belize.  Most of the people are Roman Catholics or Baptists.  There are also some Moslems and Hindus.  The authority of churches comes from State laws, which allows for the legal incorporation of churches, thus freeing them from paying taxes.  Ministers are state-sanctioned marriage officers, and the state anoints them to co-manage the majority of primary schools (Gregory, 1975).

Artists make a living by selling their works at exhibitions supported by wealthy Belizeans who display art for their private pleasure. The National Arts Council also promotes training and the display of various forms of art.  Foreign scientists from North America do almost all the scientific research in the country.  Studies in the fields of Maya archaeology and natural history are major contributors to understanding the significance of Belize within the subregion.  There is a potentially rich source of oral literature, but very few are preserved in writing. The best graphic arts are painting and sculpture that build on a rich practice of the use of wood.  International plays are performed in schools and sporadically for the public (“Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage,” n.d.).

Technological

Belize Telemedia Limited (BTL) monopolized telecommunication services at excessive rates in the eighties and nineties.  To encourage competition, the government assisted Speednet in getting its licenses to operate in Belize as an alternative provider in 2005.  In a relatively short time, Speednet became the choice of Belizean professionals with its lower rates, better service, and less bureaucratic structure.  In 2009, the Belize government nationalized BTL, which is now the main competitor of Speednet.  Both companies now offer a full range of telecommunication services including dial-up and high-speed internet access, cellular roaming, and other basic telephone services (Breaking Belize News, 2015).

3. Leadership Problem Statement

To compete in a global economy, investing in higher education and equipping citizens with training to compete for jobs in emerging sectors are essential to a nation’s prosperity.  However, the lack of reliable broadband infrastructure and limited social mobility has left Belize vulnerable, with unrealized potential.  Belize’s lack of readiness for the digital economy is further crippled by their lack of higher educational system, resulting in a lack of skilled workforce.  While the government of Belize has committed to raising the standard of living for locals and attracting foreign investments, they have not been able to draw the growth sectors that have spurred jobs and transformed economies.  The problem statement then becomes what can the Belize government do to attract the growth sectors that have spurred jobs and transformed economies in other emerging countries?  In the following sections, I will be recommending a growth strategy using Uber as an economic partner guided by relevant economic theories and conclude with an action plan for implementation.

4. Recommendations for Policy Changes

The Belize government should consider adopting the following policy changes to develop a robust pipeline of skilled workers, attract foreign investments, and grow the middle class to enhance the overall quality of life for the citizens of Belize.

Adopt a new labor law for foreign investors.

Pass a law that requires foreign investors to hire 20 percent of workers locally in an apprentice program.  This is similar to the United States’ “First Source” program, based on the principle that private companies that receive public dollars should help local residents find work.  This policy would create an ecosystem that would expand the labor force and strengthen its culture through a more productive workforce.

Attract strategic partnerships.

Belize needs a strategic partner who is willing to invest in developing countries.  Uber, with all the well-publicized toxic culture of sexual harassment that ultimately led to the ouster of its Chief Executive Officer (CEO), is also famously known for its appetite for risk-taking, even at the expense of taking a loss just to be the first to market in areas of high growth (Dickey, 2017).  This propensity to accept a risk to be the pioneer in a country fits in well with the Belizean economy and hard-working citizens of Belize.  Being the pioneer and leader in a new strategic location is considered a competitive advantage to Uber and Belize should take advantage of this risk-taking culture.

Reconceptualize the Belizean education system.

From a long-term perspective, Belize must adopt the worldview toward education that a degree from a four-year university is considered higher education.  The current educational system In Belize regards a high school education a successful gateway to the workforce.  While this might be the norm in Belize, it is not creating a work-ready workforce to compete globally, or access opportunities to advance.  The middle class already values education; the government needs to invest more in education and to build the human capital infrastructure to redefine the middle class and take advantage of new investments coming into Belize.

Private-Public Partnerships (PPP). 

To attract these high-growth sectors to Belize, the Belize government must intervene and provide the necessary incentives for these companies to invest in Belize.  This view is consistent with the Keynesian Economic Model which supports the view that government is in a better position than market forces when it comes to creating a robust economy.  Government spending would increase consumer demand in the economy, leading to added business activity and even more spending, which would, in turn, increase the overall economic activity, the natural result of which would be deflation and a reduction in unemployment (Mell & Walker, 2014).

Building large scalable sectors in Belize require a strong strategic partner who is willing to invest in developing countries.  This perspective is compatible with the Endogenous Growth Theory, which postulates that that improvements in productivity can be tied directly to faster innovation and more investments in human capital.  As such, they advocate for government and private sector institutions to nurture innovation initiatives while offering incentives for individuals and businesses to be more creative.  Under this theory, knowledge-based industries play a particularly important role — especially telecommunications, software and other high-tech industries as they are becoming ever more influential in developed and emerging economies.  A key tenet to the endogenous growth theory is that there are increasing returns to scale from capital investment especially in infrastructure and investment in education and health and telecommunications (Mell & Walker, 2014).

Uber, with all the well-publicized toxic culture of sexual harassment that ultimately led to the ouster of its Chief Executive Officer (CEO), is also famously known for its appetite for risk-taking, even at the expense of shareholder profits just to be the first to market in areas of high growth.  This propensity to accept a risk to be the pioneer in an emerging country fits in well with the hard-working citizens of Belize.  Being the pioneer and leader in a new strategic location is considered a competitive advantage to Uber and Belize should take advantage of this risk-taking culture.  This is similar to the Ricardian Model of Comparative Advantage, used to explain why countries engage in international trade even when one country’s workers are more efficient at producing every single good than workers in other countries (Mell & Walker, 2014).  In Uber’s strategic plan, being first to a market means having a comparative advantage in that country.  With its innovative culture and willingness to invest in emerging countries even in money-losing situations, Uber also has the cash and technology to uplift and transform the Belize economy by expanding this middle class.  An industry cannot grow without an active and skilled workforce.  The government must work in unison with Uber to welcome, support and promote its entry into Belize.

This private-public partnership is supported by the Linear Stages of Growth Model, which posits that an injection of capital, creating superior technology, and growing the labor force lead to economic development and industrialization (Mell & Walker, 2014).

5. Action Steps

The Belize government can first create the incentives to attract Uber by outsourcing its fleet of public buses.  Most of the middle class rely on public transportation to get around in the city.  It is the cheapest form of transportation to go from point A to point B in the quickest time.  The buses current used for public transportation are old, converted school buses.  The Belize government can allow Uber to be the exclusive operator of the buses in exchange for Uber’s investment to replace all the buses with state-of-the-art new ones and a sum of cash to be used for loans to support nascent small businesses, and train workers in specialized jobs in emerging sectors.

Step two of the implementation is a two-step phase process focus on growing a robust pipeline of skilled workers.  To tap into one of the most important growth sectors in the country-tourism, the government can allow Uber to convert all taxi-drivers to Uber contract drivers as long as that on an hourly basis; the Uber drivers will be making more than what they were earning previously as a taxi driver.  With Uber’s GPS and on-demand technology, more taxi drivers will be mobilized, saving on gas, and total earnings will be higher, resulting in higher output.  Currently, the taxi association was formed by the taxi drivers to give them a form of structure and rights; Uber can help them create their own management structure and teach them about maintenance and other skilled trades in the public transportation arena using Uber’s technology.

Finally, the working class of Belize is large, diverse and included the traditional middle class made up of civil servants, skilled manual workers, taxi drivers, and other commercial employees unified by a belief system that emphasized cultural uprightness, upward social mobility, and the importance of education.   Uber can rebrand its name in Belize to “Uber Ya Da Fu We” (We the People), to rally the Belizeans around the partnership, and show off the Belizean pride to the rest of the world.

For Uber, once the brand is accepted by Belize, they can expand their product lines such as Uber X for the wealthy, VIPs and dignitaries, and lock out any future competitors coming in and replicate the model in other emerging countries.

6. Conclusion

While the goal is to help every emerging country compete on a world stage, I want to begin by helping Belize adopt economic policies that could potentially transform their economy and improve the quality of life of its citizens.  By doing research on Belize, gathering information by talking to various Belizeans, and reflecting on my international experience, I felt in love with the Belizean culture especially the pride they have for their country.  This international policy class has enriched my life through an experiential, hands-on approach.  The cultural interaction with the Belizeans has given me meaning for what it means to serve and affect a community.

Nation building is a community project.  I hope to come back to Belize in the near future and contribute by donating my time and expertise to improve the quality of life for its people.

 

REFERENCES

Agrawal, N. (2017, May 1). Kalanick is caught on video berating a driver. Retrieved from http://www.latimes.com/la-fi-uber-updates-ceo-caught-on-video-berating-1498057858-html

Belize GROWTH AND STRUCTURE OF THE ECONOMY – Flags, Maps, Economy, History,
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Belize POLITICAL DYNAMICS – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System. (n.d.). Retrieved from
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Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage. (n.d.). Retrieved from http://www.everyculture.com/A-Bo/Belize.html

Dickey, M. R. (2017, November 7).  These are Uber’s new cultural norms.  Retrieved from https://techcrunch.com/2017/11/07/these-are-ubers-new-cultural-norms/

Fowler, S. (2017, February 19). Reflecting on one very, very strange year at Uber.  Retrieved from https://www.susanjfowler.com/blog/2017/2/19/

Gregory, J.R.. (1975, May 27).  The modification of an interethnic boundary in Belize. Retrieved from https://anthrosource.onlinelibrary.wiley.com/doi/pdf/10.1525/ae.1976.3.4.02a00080

Healthcare in Belize – International Living Countries. (n.d.). Retrieved from https://internationalliving.com/countries/belize/health-care-in-belize/

International Agreements, Population, Social Statistics, Political System. (n.d.). Retrieved from https://photius.com/countries/belize/society/belize_society_school_system.html

Levitt, S. D., Dubner, S. J., & Harper Audio (Firm), OneClick Digital (Firm). (2012). Freakonomics: [a rogue economist explores the hidden side of everything]. New York, NY: HarperCollins.

Levitt, S. D., & Dubner, S. J. (2010). Superfreakonomics: Global cooling, patriotic prostitutes, and why suicide bombers should buy life insurance. New York, NY: William Morrow.

Marshall, A. (2018, February 9). Uber and Waymo abruptly settled for $245 Million.

Retrieved from https://www.wired.com/story/uber-waymo-lawsuit-settlement/

Mehrotra, K. (2017, May 10). Uber Greyball investigation expands to multiple U.S. cities.

Retrieved from https://www.bloomberg.com/news/articles/2017-05-10/

Mell, A., & Walker, O. (2014).  The rough guide to economics. Rough Guides Ltd: London.

Schmieder-Ramirez, J. H., & Mallette, L. A. (2007). The SPELIT power matrix: Untangling the organizational environment with the SPELIT leadership tool. Place of publication not identified: BookSurge Publishing.

 

 

mHealth: Achieving Equitable Healthcare In Emerging Countries Using Mobile Technologies

/in /by

by Theresa Dawson

 

Abstract

Access to quality healthcare plays a critical role in the economic growth of developing countries. The growing field of mobile technology in healthcare, known as mHealth, has potential for enhancing the healthcare delivery systems of these emerging markets. The benefits and value propositions of mHealth are illustrated in global use case models. The healthcare system of Belize, a developing country, is examined utilizing a SPELIT analysis (Schmeider-Ramirez & Malette, 2007) of the social, political, economic, legal, intercultural, and technological aspects as well as the World Health Organization Health Services development framework. Economic policy changes are recommended, and the addition of an mHealth strategy to the Belize national healthcare vision is proposed.

Background

Global health challenges are significant barriers to global economic development in developing countries, particularly disease and lack of prevention, epidemics, and the spread of communicable disease, combined with a shortage of healthcare workers. The quality of citizens’ health and well-being affects the human capacity needed for a country to progress (Vital Wave, 2009). Indeed, common indicators of a country’s development, as measured by the United Nations Human Development Index (2016), include assessments of a country’s birth and death rates, life expectancy, health, and education. As part of an initiative to develop solutions to meet these challenges, since 2010 the World Health Organization (WHO) has formally asked for manufacturers, institutions, universities, and individuals to submit innovative health technology solutions for low and middle-income countries (WHO, 2016). This has resulted in a comprehensive compilation of innovative technologies and worldwide use cases for solutions using mobile communications that have potential to improve and meet healthcare needs in those countries with inadequate resources (WHO, 2015). Consequently, the use of mobile communications to deliver health-related services has resulted in the field of mobile health known as mHealth. Thus, mHealth is beginning to play a key role in transforming the global healthcare delivery system by providing technological solutions to enhance healthcare provisions in developing countries.

What is mHealth?

mHealth refers to the use of mobile technologies for facilitating the delivery of healthcare services. There are 900 global mHealth products and services, and this global mHealth market is expected to exceed 30 billion in U.S. dollars (Lauler, 2013). Key areas of mHealth employment include improved access, education and awareness, remote data collection, disease tracking, remote monitoring and treatment support, and communication and training for healthcare workers (Gorski et al., 2016; Vital Wave, 2009). The 2009 United Nations and Vodafone mHealth report (Vital Wave, 2009) described worldwide evidentiary mHealth use cases. Gorski et al. (2016) posit that such use cases are important in illustrating strategies and sustainable value propositions for mHealth implementation.

As an example, distance and access can be a barrier to care. Many citizens in rural areas must travel long distances for healthcare. Lack of transportation, travel, and wait time makes seeking health services in urban areas challenging. Using hotlines, connecting doctors to patients via phone, text, video, or utilizing screening applications for patients to self-monitor their condition can alleviate and reduce time traveling and waiting for health services. This approach provides a broader reach in serving and meeting the needs of those requiring medical care.

When short messaging service (SMS) was used in Africa for campaigns to provide HIV/aids awareness, the improved awareness helped individuals understand conditions of disease and alternatives for prevention and treatment. Subsequently, there was an increase of

40% of citizens who elected to undergo testing for HIV, seeking treatment as needed, thus reducing the spread of the disease (Vital Wave, 2009).

In Uganda, healthcare workers used personal devices to collect data for the Uganda Health Information Network (Vital Wave, 2009). Because those that live in rural areas may not visit health facilities regularly, data collection in the field is important to assess need and efficacy of healthcare services provided by the government. Additionally, tracking disease and outbreaks using mobile phones and web-based technology can help in decision making for containment and prevention of outbreaks.

Remote monitoring plays an important role in preventing complications for chronic diseases by assisting with adherence to treatment plans that might otherwise put a patient at risk for complications. Specifically, healthcare workers can call patients to monitor their medication regime, or patients can use their phone to remind themselves to take medications or to record and track their blood sugar or blood pressure. This recorded data can be provided to the local health clinic for patient monitoring. Remote monitoring can be especially effective for a disease like tuberculosis (TB), where proper medication compliance can cure the disease. In South Africa, healthcare workers used SMS monitoring for TB medication compliance resulted in a 90% medication regime compliance, over 20% to 60% without the reminder (Vital Wave, 2009).

Finally, training a healthcare workforce is critical, and mobile technology can be used to provide information and education for healthcare professionals. In Coban, Guatemala a nursing school used a combination of mobile phones, landlines, and telegraphic devices that transmit handwriting, to train nurses residing in a rainforest (Innovation and Technology for Development Centre, 2014). Mobile technology can allow workers to communicate with one another to provide additional support for diagnosis and treatment. Utilization of mobile apps and use of artificial intelligence can provide reinforcement and empower patients to take responsibility to monitor their own health.

Why mHealth in Emerging Countries?

While quality healthcare is often difficult to obtain in developing countries, cell phones and wireless devices are becoming more commonly used, according to the International Telecommunication Union (ITU). The ITU reports there are over six billion wireless subscribers with over 70% of them residing in low- and middle-income countries (WHO, 2011). The growth of this technology, particularly in low-income settings, can compensate for the lack of infrastructure that hinders access to quality healthcare. Wireless technology can connect patients to healthcare workers, help patients monitor their own conditions, and allow healthcare workers to communicate with one another. There is great potential in using this technology as a solution for providing improved global health resources and for facilitating patient centered care.

mHealth as a Solution for Improving Equitable Healthcare Access in Belize

Belize, a Central American country with a population of approximately 360,000, is located on the Caribbean coast of Central America.  Belize borders Mexico in the north and Guatemala to the west and south. The Caribbean Sea is to the east. Forest covers 60% of the country, making the terrain difficult to access. Agriculture such as bananas and sugar cane are located in the low-lying areas. Offshore, the Belize Barrier Reef is the second longest barrier reef in the world. Belize achieved full independence from British Colonial rule in 1981 (Central Intelligence Agency [CIA], 2018). Male and female distribution is equal and approximately 55% of the population lives in rural areas. The population is young with just 6% over the age of 60 (Ministry of Health, 2014).

In Belize there has been increased report of non-communicable diseases, such as diabetes mellitus type2, heart disease, cardiovascular disease, cancer, and depression. The leading causes of death are heart disease and complications related to diabetes (Ministry of Health, 2014). These preventable and treatable diseases are contributing to a reduction of overall life expectancy. Additionally, there are incidences of communicable diseases such as dengue, vector borne malaria, and HIV (Ministry of Health, 2014). These problems are associated with high costs and an increasing need for healthcare workers.

The use of mHealth as a solution for potentially improving the healthcare delivery system in the country of Belize was explored using a social, political, economic, legal, intercultural, and technological (SPELIT) approach (Schmeider-Ramirez & Malette, 2007), to examine the environment of the issue of healthcare access in Belize. Incorporated into the SPELIT analysis was the use of a strategic healthcare analysis tool, the World Health Organization (WHO) System Assessment Framework (WHO, 2018). The WHO framework is comprised of essential building blocks required for an effective healthcare delivery system. These system building blocks include leadership and governance, healthcare financing, health workforce, medical technology, service delivery, and health information systems.

Environment of the Issue (SPELIT)

Social determinants of Belize healthcare
Where an individual resides and grows up are social elements that impact one’s health and well-being. Poverty, access to clean water, quality of housing, education, and lifestyle choices all have an effect on health. According to the World Fact Book, approximately 41% of Belizeans live below the poverty line (CIA, 2018), and the Caribbean Development Bank’s (2009) poverty report emphasizes that in Belize there is a high correlation between lack of income and health and well-being. Over half of the population lives in rural areas, 99% have access to drinking water, and 90% have access to improved sanitation conditions (CIA, 2018). While education plays a role for disease prevention, health literacy is also a key to wellness. Many Belizeans have limited access to education, as high costs prohibit them from attending high school; therefore, formal education and science-backed information about health and wellness is often lacking.

While there are private medical care associations in Belize, the government implements a national insurance plan overseen by the Ministry of Health. This national insurance plan provides affordable healthcare to the citizens of Belize. National funding is concentrated on urban areas, and these areas are served by hospitals. Those living in poor and remote areas have fewer resources and might be served by a small health center with a nurse as the primary point of care, with a weekly visiting physician (Belize Ministry of Health, 2014). There is additionally the presence of non-governmental organizations that provide healthcare services to underserved areas (Pan American Health Organization, 2009).

Physicians are trained in the UK, Cuba, US, Guatemala, and Mexico. There are offshore medical schools, and the University of Belize has a nursing school. Locally trained professionals are in high demand and are often recruited to practice out of the country. As a result, the government has formed agreements with Cuba and Nigeria to supply nurses to Belize (Belize.com, 2018; Pan American Health Organization, 2009).

Political aspects of Belize healthcare

The government of Belize is a parliamentary democracy (National Assembly) under a constitutional monarchy with a system of English common law (CIA, 2018). The Ministry of Health, located in the capital city of Belmopan, is run by a Chief Executive Officer who works with a Director of Health Services to oversee the Belize healthcare system. Services are organized by region, overseen by a Regional Manager and Deputy Regional manager. The National Health Information Steering Committee leads the strategy and advises the Ministry of Health. This committee is comprised of 13 members of the Ministry of Health and various government officials (Belize Ministry of Health, 2010). This Steering Committee makes decisions about health needs of citizens, issues of public and private healthcare delivery, government healthcare policies, regulations, and service quality standards (Ministry of Health, 2014).

Economic factors affecting Belize healthcare. Major economic industries are agriculture, tourism, and fisheries. The service industry and tourism account for 55% of the country’s GDP (Ministry of Health, 2014). High unemployment, debt, and a trade imbalance contribute to the economic issues that account for the cause of poverty. The country lacks training programs for job creation; it lacks infrastructure support for education, community development, and social programs (CIA, 2018).

Approximately 5.8% of the GDP is spent on healthcare (CIA, 2018).  The total health expenditure is primarily from public sources. The Belize Health Care Sector reform program was a 30 million (U.S. dollars) project intended to provide universal health access to all citizens (Belize Ministry of Health, 2014). While this universal healthcare plan was intended to make healthcare accessible for all citizens of Belize, there is an inequitable distribution of resources, with rural regions receiving less investment.

Legal considerations for Belize healthcare.  There are legislative proposals pending for regulating medical and dental care, including nursing, midwifery, and distribution of pharmaceuticals and medical equipment. The legislation is intended to provide the Ministry of Health with the constitutional authority for regulating the health care system (Ministry of Health, 2014). While there was a national e-government policy formulated in 2008, it appears there are no national laws or regulations for electronic health systems that establish a system of privacy protections for consumers.

Intercultural influences of Belize healthcare. Belize is comprised of an ethnically diverse population containing four ethnic groups: Creole, Maya, Garinagu, and Mestizo (CIA, 2018). Culture plays a part in the high incidences of non-communicable diseases such as diabetes and hypertension, as these are related to diet and lack of awareness of nutrition and its effects on disease.

Current use of healthcare technology. In 2004, the government invested in a Health Information System, an IT solution with a goal to expand health information to rural areas and to improve data and reporting of information. Utilizing an electronic medical record system allows portability of healthcare information among the regions (Belize Ministry of Health, 2010).  However, challenges such as weak IT support, lack of standards, and poor interoperability have rendered this system inefficient. Wasden (2014) reports that to take advantage of mHealth in providing service delivery, a market needs an electronic health record system. He further posits that integrating electronic healthcare records to communicate within a system with hospitals and physicians is a prerequisite for a successful mHealth strategy. While the system is not efficient, it is a strength that Belize has the infrastructure in place and is working towards effective use of the electronic system. Furthermore, 63% of Belizeans have mobile phones and 44% are internet users (CIA, 2018), making use of mobile technology for healthcare delivery to be a feasible option.

Problem Statement

Belize suffers from healthcare deficiencies, including a rise in the incidence of non communicable diseases such as diabetes, heart attack, stroke, and depression. Furthermore, Belizeans have poor awareness and education about the prevention and consequences for these diseases. Consequently, there is needed improvement in overall education, particularly in the areas of health awareness, nutrition, and disease prevention. In addition, there is an inequality in healthcare access for all citizens, with those in rural and poor areas lacking consistent access to physicians, nurses, and medicine. Finally, a shortage of healthcare workers results in an infrastructure that cannot meet the needs of the people.

Key Economic Principles That Have an Effect on the Quality of Healthcare in Belize

Production, resources, and scarcity. Healthcare can be viewed as a service that can be produced, with resources being personnel required for delivery of those services. Production of health care workers in Belize is limited to a few in-country training institutions and import of workers from other countries. By not supporting a high school educational system, the government is in effect limiting the number of students that can enter the university system to produce a pool of needed health care resources in the communities of Belize. The shortage of healthcare workers, or scarcity of personnel resources, results in unmet needs of the Belizean people. Furthermore, by not supporting healthcare workers with an efficient system, workers are enticed to practice in other countries.

Human capital. Human capital refers to the knowledge and skills of people. The knowledge and skills provide economic value. Human capital is related to economic growth as measured by investment in education, resulting in higher earnings and higher spending (Nickolas, 2018). Health expenditures are also an investment in human capital (Chang & Ying, 2005). To improve health, it is important to reduce the disparity of quality health services in the country. Lee, Kiyu, Millman, and Jimenez (2007) state that research shows a strong correlation between a strong national health system and health outcomes. They posit that strong human and social capital can be created by developing a national health care system strategy of strengthening communities through service delivery in health care centers and clinics and by improving education in schools.

Investing in education and an equal distribution of health care access will improve disease prevention and life expectancy, thereby preserving human capital for working and contributing to the economy. Establishing mHealth education and training programs for building a workforce will be an investment in human capital.

Efficiency and equity. Economic maximization of resources can be viewed according to efficiency and equity. Efficiency is a means to the greatest production, and equity is how those resources are distributed fairly across a population (Parkin, 2017). The quality resources for health education, diagnosis, and treatment in Belize are not only lacking but not used efficiently and equally in urban and rural areas. Most healthcare professionals are located in urban areas, and there are gaps in staffing and distribution of medical equipment in the regions (Pan American Health Organization, 2009).

The WHO states that there is inequity in healthcare in emerging countries. There is not a fair and equal distribution of healthcare services throughout the world, and in particular, those in emerging countries suffer from a shortage of healthcare workers. Belize should include reduction of healthcare inequalities as a goal of the country’s health policy and strategy in order to maximize service delivery, focus on prevention, and reduce overall costs associated with disease.

Alternatives

The use of mHealth is a viable alternative and adjunct to the current healthcare delivery system of Belize. There are many key benefits to the implementation of a mobile health access program, specifically in the areas of access, quality, education, and training. For those patients that live in remote areas, where education about a condition or access to care is difficult to obtain, health and wellness information can be delivered via mobile phones. Accordingly, physician services can be delivered via mobile solutions such as monitoring of blood sugars associated with diabetes or blood pressure levels associated with hypertension. Moreover, data can be collected at the nearest health center and integrated into an electronic health record system to monitor patient status. Subsequently, quality of care can improve when sharing of information between patients and healthcare professionals is done efficiently and securely. Access to electronic information can additionally help to make better diagnostic and treatment decisions. Equally important, mobile health tools can provide learning and training for healthcare professionals. These mobile health approaches can allow patients to be educated and to take control over managing their health, thus decreasing risks associated with a chronic disease.

Objectives and Action Needed for Implementation

Involvement of Key Leaders and Stakeholders

There are multiple stakeholder interests for mHealth implementation in Belize. For the patient, improved care and taking responsibility of care is needed. For the healthcare provider, delivering quality care efficiently is paramount. For the government, equitable delivery of a national health system is a priority. For the mobile tech companies, there is great potential in emerging countries for providing equipment services and platforms.

For mHealth to be a viable solution for an emerging country such as Belize, it will be important to engage these healthcare stakeholders to develop a national strategy. Support will be needed from the Ministry of Health, given the government’s role in overseeing the national health care system. Support will also be needed from private healthcare companies, health educators at the universities, health care center workers, and regional overseers. Additionally, support from the Belize telecommunication providers such as Speednet or BTL Belize Telemedia Limited could not only assist with network connectivity, but these companies have a customer base and knowledge of consumer habits that will allow them the ability to market any new mHeatlh technologies with a large distribution network (Accenture, 2014). Additionally, mHealth technology companies are eager to enter and invest in emerging markets to provide products that focus on disease prevention, education, and data collection.

Action Steps

An mHealth implementation plan in Belize can be strategically designed using resources from the WHO’s (2012) “National eHealth Strategy Toolkit.” This toolkit provides a strategic framework for developing and implementing healthcare technology solutions on a national level. First and foremost, it will be important for the government to develop a national vision for mHealth. The Ministry of Health will be required to implement leadership and invest in technology and workforce training. It will be essential that the Ministry of Health forms alliances with technology companies and health workers to provide healthcare services using mobile devices. For example, mobile devices such as smartphones and tablets can be given to healthcare workers. Once a national strategy is developed, the government, private sector, and organizations working to bring development to Belize can pilot an mHealth program and move to a scalable solution for equitable healthcare.

 

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The Management Transformation and Innovation for Time-honored Brand Enterprises

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by Chenye Wang

August 15, 2017

Abstract

“Of the nation, of the world.”

— Qiejieting Prose Collection (Lu Xun, 1935)

The history of a famous distilled liquor, Niulanshan Erguotou, a product of Shunxin agriculture, can be traced back to the Qing Dynasty. According to Shunyi county records of this product, “The wine Erguotou tastes somewhat sweet and it is also the local specialty. It is very popular in the local area” (Beijing Shunxin Agriculture, 2017). During hundreds of years of development, they have been well received by consumers. Recently the product success of time-honored brands such as Erguotou wine has been a concern of several parties. Why is this old Chinese brand declining? How should we revitalize the old shops? What is the best way to approach branding?

According to Lu Xun’s statement, considering the time period, I believe this sentence intended to emphasize the importance of upholding one’s own culture first. In the case of Erguotou, we wish for this unique culture and brand to survive in the local and world markets. If such brands can maintain their own characteristics, the world will be colorful and full of variety. The research on innovation and development for this Chinese time-honored brand is both important and urgent, because it bears a rich agricultural and cultural heritage.

Introduction of the Chinese Concept of Time-honored Brands

Characteristics of a Time-honored Brand

In Chinese language and culture, the term time-honored brand connotes a particular type of Chinese business. Such a business would have these characteristics: a long history, use of ancient legend or skills, a unique business culture, and a people-oriented business philosophy. The term “is an official government distinction awarded to certain brand names and shops that have proven histories” (Killmer, 2011, para. 1).

The designation time-honored refers to products or practices that show the cultural creativity of the Chinese nation, with a distinctive Chinese traditional cultural background. Such products have a unique process or operating characteristics handed down over generations. Many of them have superior techniques compared to similar products, by which they have achieved wide social recognition and a good business reputation for the product or brand. Most of them have survived decades or even hundreds of years, so they are considered living cultural relics. The time-honored brand has accumulated profound cultural connotations of the Chinese nation (Jingjing, 2010). It has played an important role in the development of industry and agriculture, the prosperity of the market, the revitalization of the economy, the promotion of fine culture, and the rejuvenation of the Chinese national spirit.

The value of a time-honored brand is twofold (Zhang, 2011):

  • Economic value: A time-honored brand can bring not only a gilded signboard and great wealth, but also increases the value of intangible assets for enterprises.
  • Social value: A Chinese time-honored brand bears the essence of traditional culture, both the city culture and the national culture heritage. In this way such brands also affect the social atmosphere.

The Status of Chinese Time-honored Brands

Generally speaking, the operation of Chinese time-honored brands is not currently very effective (Hu, 2016). At the beginning of the founding of the people’s Republic of China, there were about 16,000 Chinese time-honored enterprises including diverse productions such as retail, catering, medicine, food processing, tobacco processing, photography, bookstores, silk, arts and crafts, and antiques.

Chinese time-honored brands have experienced two crushing influences (Win Business Network, 2013):

  1. Around 1950 of private/public partnerships became a prevailing trend. In 1954 the Chinese government had a regulation that all the capital corporations had to be operated both publicly and privately. Socialism plays the leading role at the same time that individuals’ rights should be protected.
  2. In the Great Cultural Revolution of the 1970s, many factories closed down. The production and management of time-honored brands were damaged. The prevailing sentiment was to favor the forward-looking and modern, so long-standing traditions were not esteemed.

The Economic Situation of Time-honored Brands in the Liquor Industry

During 2013 and 2014, liquor industry revenue and profit growth fell sharply due to a macroeconomic downturn and consequently, business expenses for business related entertainment have declined. For example, sales of catering service declined in Shanghai by 3.3%, about 5 million dollars (Jianglin, 2016). During the second half of 2015, the liquor business improved, but the whole industry was still at a low. By 2016, the liquor industry was in recovery. Generally speaking, many enterprises showed different degrees of income growth, but the statistics still painted a sobering picture. Some regional wine enterprises are still not optimistic.

In an increasingly competitive market, the technical requirements of the liquor industry were improved through government regulations. Government regulations are strict, so quality has to improve for consumer protection. The upgrades are costly for the producers. As a result, production costs continue to increase, so that those small and medium manufacturing enterprises that did not meet the technical requirements and did not have a solid economic position were forced out of the market.

Figure 1. Economic standing of time-honored brands in general (Network Media, 2016).

  • 10% Making profits

  • 20% Long-run loss

  • 70% Maintain the status quo

 

 

 

 

There are many reasons for the decline of time-honored brands. Although the external causes are a part of the decline, the most important factors are internal. Each of these influences will be discussed.

Challenges for Chinese Time-honored Brands

Outdated operating procedures. The era of the planned economy left a heavy burden. Many enterprises had too many employees relative to their accumulation of materials. Unlike in a market-driven economy, cultural expectations and government regulations prevented the balancing of workforce and materials, resulting in wages consuming more than business were able to bring in. Cash flow would then be stagnant or negative.

Under-utilization or misuse of Western business philosophies. Under the influence of western business philosophies and a variety of new business formats, many time-honored brands abandoned their former ways. While there is value in these western philosophies, they were developed in a different cultural context. At times these philosophies and the related practices are not ideal or even possible to implement in the current cultural and political context in China.

Lack of talent. With the development of a market economy, the traditional handicraft technicians engaged in labor-intensive work have been turned off, the backbone of technology has gone out, and the traditional crafts have been lost.

Technology versus tradition. For many time-honored traditional enterprise products, the traditional mode of production is very time consuming. This makes it difficult to compete with companies using mechanized operations and technological innovation. Such companies can out-compete those who maintained traditional ways, even if the time-honored brand product is superior. For example, for wine production, it may be impossible to maintain the old flavor without maintaining the old technology and processes that are labor-intensive and thus more expensive. Yet there is pressure to reduce costs and save energy.

Brand protection faces challenges. The enterprise’s own intellectual property rights (IPR) protection awareness is weak. Many time-honored brands have been slow to register trademarks, but many have done so in recent years. For those time-honored brands that do have registered trademarks, they are still susceptible to rampant product trademark counterfeiting by companies selling lower quality and cheaper products, creating unfair competition (Win Business Network, 2013).

Backward marketing concept. Many old enterprises still believe in the idea that “Good wine is not afraid of deep alley”. This proverb conveys the idea that if the wine is good, even though the place to sell wine is far and remote, customers like the wine and they will tell others about it, then more customers will come for a drink. This approach is not currently suitable for the market economy. Because other brands are good at advertising and have a modern sales strategy for a younger consumer and modern market characteristics, if time honored brands keep their traditional way to sell goods, they will not compete well (Ping, 2015).

The traditional concept of profitability. The content of the traditional profit concept make the time-honored enterprises lack of competitive pressures and consciousness, unable to cope with the fierce market competition. The economic situation in China has changed dramatically in the past decade, but time-honored brands tend not to adapt to these changes. In western countries and the United States especially, government strongly emphasizes individual rights. One result of this emphasis is that the distance between top tier earners and bottom tier earners has been smaller than it is in China, and personal status is considered more equal. However, our corporation managers are not good at giving rights to the lower tier earners because of traditional class status. Thus the wealth gap is large, and those at the top feel no pressure to share profits more equitably. Many time-honored businesses are not attracting the best talent because of this inequitable distribution of profits (Xiaojie, 2017).

The service model. Some old enterprises continue the same thinking and service mode of the seller’s market that existed under the former planned economy model. They lack enthusiasm and fail to create a comfortable and inviting environment for customers (Xiaojie, 2017).

The products. Most of the old enterprises have only one or two unique products, but enterprises that focus their resources on a small number of products will be high risk (Xiaojie, 2017). Sometimes the market situation is such that focusing attention on niche markets and doing one product well may not be profitable.

Market strategy. The main market for time-honored brands is the elderly. The biggest selling point for time-honored brands is the cultural story. Young people are less attracted to time honored brands because in general they do not identify with the old historical culture. Young people may agree that history and culture are good things, but consumers pay more attention to how a history and culture relates to themselves. Thus, these products have a local market, but typically they are not marketed to other areas.

Lack of established distribution channels. Many time-honored brands do not recognize or value the potential for international brand expansion. Under the trend of economic globalization, some old brands rely on small markets and do not seek out new markets.

Countermeasures: How to Revitalize the Time-Honored Brand

The biggest problem existing for the time-honored brands can be summarized as the rigid structures that no longer are optimal in the current economy and social climate. This weakness has resulted in widespread losses for China’s time-honored enterprises. Under the condition of market economy, China’s time-honored brand enterprises face many difficulties and challenges. Inefficient processes, aging mechanisms, and aging consumer groups are the most important factors hindering the development of time-honored brands. Possible solutions are as follows:

  1. Understand competitive forces.

Chinese time-honored brand enterprises must realize that competition among enterprises is the competition of brands. Therefore, under the circumstances that China’s time-honored brands do not have advantages in terms of product prices or widely-established selling channels, such enterprises must gain a share of the market in other ways. These enterprises would do well to develop special products and services to improve the core competitiveness of time-honored. These enterprises could keep the old goods and services and other traditional business modes, but also make full use of time-honored cultural resources by emphasizing the cultural importance of regional time-honored products. In this way, more traditional culture might be valued within modern life (Network Media, 2016).

  1. Enhance awareness of the value of conserving Chinese traditions.

The abuse and misappropriation of trademarks and trade names of old brands occurs frequently, which seriously hinders the healthy development of time-honored brands. One solution is emphasizing the history and culture of these products as linked to national identity rather than only local identity. With development of wider distribution of time-honored brand products, authorized distribution channels must be identified so that customers can know that they are getting the authentic version of the time-honored brand. Advertising could be developed to include photographs, historical descriptions of the historical processes and locations, emphasizing young people appreciating the unique cultural traditions (Network Media, 2016).

  1. Enhance brand awareness for the younger generations.

At the same time as focusing on publicity of its ancient culture, old brands must understand the integration of modern culture, so they can attract the attention of younger consumers (Network Media, 2016). This can help establish a new market base for young people to feel a need for the protection, inheritance, and development of time-honored history of their national culture. Old enterprises can publicize their corporate culture and core values, and transplant them to the general audience through a variety of media types including negotiating use of their products in film and television productions, as well as more conventional advertising. In addition, it is also an excellent form of publicity to connect with tourism and cultural management. Old enterprises should keep track of which channels of advertising are most effective, then focus on those. The old brand can also create an external design to establish a unique characteristic for itself, if no design currently exists.

  1. Advocate with government officials for preservation of old brands.

Affected by demolitions, rent increase, selective investment, and other objective reasons, many old brands are leaving their landmark positions. Directors of old enterprises should advocate for time-honored brands as conveying national cultural values. Some brands do not have enough money to compete successfully in the modern market, yet they are a cultural legacy that is valued nationwide. In such cases, individuals and government should lend a hand to foster the continuance of a symbol of national pride and identity. Government should allow trade secrets to be guarded. The government could build new buildings, give discounts to old brands, and attract them together to form an old style group. For example, if one shop has 10 customers, and if these shops are grouped together, there will be more customers coming. It will be a specialized market for certain customers, then these visitors will likely be attracted to the other old brand products that enhance perceptions of the national culture.

  1. Protect market share from dishonest competition.

The old brand is a kind of intangible asset. It has great commercial value. It is important for enterprises to establish a brand protection strategy. Old enterprises should learn to use relevant laws and regulations to protect trademarks, brands, trade secrets, and other intellectual property rights.

Criminals often imitate the old brands to sell cheap products for greater profit. A large number of fake goods flooded the market in the past, so that consumers’ confidence in the old brands has been reduced, resulting in serious damage to the old brands (South China Sea Network, 2014).

  1. Upgrade product positioning.

Consumers have increased options compared to the past. It is important to understand the needs of consumers. Time-honored brands also need to study the consumer to understand their product grade positioning (Network Media, 2016). While remaining true to their commitment to quality and the product’s reputation, they can make changes such as adding a line of smaller quantities that could meet a demand for a reduced price while maintaining a profit. In addition, some customers may be interested in buying in bulk at a discount, which could also be profitable.

  1. Improve service quality.

Old brands must change their former service model, focusing on serving customers and taking care of customers’ feelings. These enterprises should train their employees with service skills. They should study the changes in consumer preferences and consumer attitudes.

  1. Develop technological innovation.

Old enterprises should adhere to the combination of inheritance and innovation (Jing, 2017). Time-honored brands should promote their artisan spirit, but also actively use modern management and production technology when it improves their quality standards and when necessary to comply with government regulation. It is a necessary challenge to adapt to the forces of market competition and adhere to government guidance simultaneously. This will maintain a positive relationship with government and foster a supportive environment for enterprises.

  1. Show procedural compliance.

Directors of old enterprises should take a leadership role to guide the implementation of government regulations and standards. They can strengthen their industries’ understanding of how government policy is adhered to.

  1. Adopt innovative management concepts.

Many Chinese enterprises do not have systematic and scientific training methods. Old enterprises should actively expand the scale of operation where feasible and adopt the use of advanced technology to transform management skills and processes. Old enterprises generally have a strong family management model, which is beneficial in the early stage of enterprise development. With the expansion of management and production, this management model has become insignificant. Therefore, time-honored enterprises should innovate management mechanisms if needed. Best-qualified persons should be promoted rather than by family loyalty. Management should treat equally all staff, give opportunity for development, and reform the salary system to be merit-based rather than unequally rewarding family members.

Recovery Strategy for Shunxin Agriculture

For the recovery task, Shunxin agriculture proposed to make take many revitalization measures similar to those described above.

The following list replicates some of the categories in the list of revitalizing countermeasures in the previous section. This list, however, focuses on specific strategies and plans for Shunxin agriculture.

Understand competitive forces. In the liquor industry, one market risk is the current domestic low-end liquor market competition is becoming increasingly fierce. Shunxin agriculture is interested in expanding liquor products in overseas markets. At present, globalization is an inevitable trend (Dalun, 2008). Only by opening the door to the world can Chinese products achieve real prosperity. In the difficult year of 2016, the enterprise still finished the Sichuan Chengdu new production facility. It focuses on the western market of China, covering the southwest and northwest regions. It founded a five-hundred-million yuan provincial market in Hunan, Jiangxi, Hubei, Heilongjiang, and Shanxi. The national market strategy is rapidly advancing (Jianglin, 2016).

Enhance awareness of the value of conserving Chinese traditions.

Beijing Erguotou culture garden is a museum currently under construction that will promote Erguotou wine’s cultural traditions and sell their products (Sina Finance, 2017). It will open in 2018. The building has three floors, 25 thousand square meters, and will be the largest museum in the industry.

Upgrade product positioning. For 2017, the basic development of Shunxin agriculture must be innovative. The company for the first time announced the major strategic product lines: a high-end Erguotou product, the traditional Erguotou products, and a hundred-year liquor as a new product (Ganjiuhui, 2017; Sina Finance, 2017). The goal is that by 2020, the scale of liquor production performance will expand dramatically. The time-honored brands in the liquor industry should always keep the Chinese traditional values as central in their product positioning.

Adopt innovative management concepts. Shunxin agriculture understands the need for more human-centered management practices. By attending to the needs of the whole person—the material, spiritual, cultural, and psychological aspects of motivation—the company can inspire employees to create more wealth for the enterprise. Chinese enterprises should provide more comprehensive services for employees, so that they feel invested in the success of their workplace and put their full efforts and talents into their work (Ping, 2015).

References

Note. These references (with the exception of Killmer) were accessed in the Chinese language, and titles are Google translations of the originals.

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