This news entry was last updated on December 14, 2023.

APARC Communications Manager Michael Breger recently spoke with Dr. Soksamphoas Im, our Lee Kong Chian NUS-Stanford Fellow on Southeast Asia in fall 2023.

In this conversation, Im shares insights from her research on social welfare in Cambodia and how such public assistance is used by the ruling regime to establish legitimacy. You can listen to the interview or read the audio transcript.

On November 29, 2023, Dr. Im presented her research at a seminar hosted by the Southeast Asia Program. You can view the event recording on our YouTube channel.

On October 18, as part of its autumn 2023 seminar series on APEC in advance of the organization's meeting in San Francisco in November, Shorenstein APARC and its Asia Health Policy Program (AHPP) presented the series' second event, Asia-Pacific Digital Health Innovation: Technology, Trust, and the Role of APEC. The featured panelists were Kiran Gopal Vaska, Director of the National Health Authority of India, and CK Cheruvettolil, the Senior Strategy Officer, Digital Health and Artificial Intelligence, at the Bill & Melinda Gates Foundation. Siyan Yi, the Director of the Integrated Research Program at the National University of Singapore and a former AHPP fellow, moderated the conversation.

While India is not an APEC member, Indian initiatives are examples of leveraging technology to better the health of the most vulnerable citizens in low- and middle-income countries (LMICs). Kiran Gopal Vaska gave an overview of the Ayushman Bharat Digital Mission (ABDM), India's latest health initiative that focuses on the interoperability of health records, services, and health claims. He stressed that ABDM was built on previous digital infrastructure, like Aadhaar, the national digital identity system, and Digilocker, a digital storage scheme for citizens' health and other records.

The approach India has taken is for the government to build the rails—the infrastructure of the system—and create a space where the private sector can develop applications integrated with that space through application programming interfaces (APIs), avoiding the siloing that can hamper the interoperability of data.

Regarding health data, privacy is a crucial concern at the patient level. ABDM addresses this concern through the use of a consent artifact. Individuals decide whether hospitals or other medical service providers have access to their data, and this access has levels of granularity: you can share specific portions of 7 different data types, like immunizations or prescriptions. You can limit that sharing to a particular period, like one day.

Also participating on the panel was CK Cheruvettolil, who discussed strategies by the Bill & Melinda Gates Foundation in leveraging the power of mobile phones to augment the work of Accredited Social Health Activists (ASHAs), the more than one million female frontline health workers in India. ASHAs can use mobile phone cameras, sensors, and streaming data to better care for low-birth-weight babies and other patients. 

He explained the critical role of taking local context into account when developing software by using the example of pregnant Indian women in their third trimesters. The custom for Indian mothers, especially in rural areas, is for the child to be born in the maternal grandparents' home. If software were to store only the mother's address, healthcare workers in the grandparents' jurisdiction would not know that a pregnant woman in the critical third trimester would soon be giving birth at a local address.

Kiran Gopal Vaska noted that India had solved the technological issues, and now the task was to push for adoption. He emphasized that the technologies underlying India's digital health stack were created as public goods for the world, and for LMICs to support each other in advancing digital health technologies, the key was interoperability, "using standards that are accessible and acceptable worldwide."

U.S.-based donors and international organizations have long dominated the development sector, but their Asian peers are increasingly challenging Western hegemony in the field, argues APARC Postdoctoral Fellow in Contemporary Asia Mary-Collier Wilks.

Wilks is currently at work on a book project that examines variation in ‘aid chains,’ or the links through which programs travel from donors to international nongovernmental organizations (INGOs), and finally to implementing partners. Her ethnographic research examines two aid chains focused on the delivery of women’s health services in Cambodia. After completing her residency at APARC this summer, she will head to the University of North Carolina Wilmington to start a tenure track position at the Department of Sociology.

In the following Q&A, Wilks discusses her research and fellowship experience at Stanford. The interview was slightly edited for length and clarity.

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Your research centers on meaning-making and power dynamics in international organizations. What drew you to this topic?

Before going to graduate school, I worked at a Cambodian NGO, Social Services of Cambodia, that implemented social welfare programs for women and children. While there, I observed conversations between the foreign director, local staff, donors, and beneficiaries, and noticed how these interactions shaped SSC’s work. I was particularly struck by how differently donors from various nations defined gender empowerment. These questions evolved into a desire to go to graduate school and study how donor differences impact international development programs in Southeast Asia.

You are working on your first book. Can you tell us a bit about what to expect from it?

During my postdoctoral fellowship at APARC, I’m focusing on transforming my dissertation into a book. Learning to write a book is a difficult, unique, and rewarding process in and of itself! It’s still a work in progress, but the book argues that the global development sector is shifting. Donors and international organizations based in the United States, Europe, and Australia have long been dominant actors, producing prevailing global norms around “good development.” However, East Asian nations are increasingly vying for influence and offering new, alternative models for development. As a case study of these transformations, I conduct a multi-sited ethnography of two INGOs, one from the United States and the other from Japan, that implement development programs in Cambodia.

I see Cambodian practitioners render the above geopolitical transformations meaningful in their own lives by discussing two “development imaginaries” or narratives about the best way for society to develop, one “Asian” and the other “Western.” Consequently, I contend Cambodia is a case of a larger phenomenon in which Asian donors and development organizations are playing a more prominent role, challenging Western hegemony in the development sector and producing new development norms. This book is therefore trying to tell a dual story about the macro-level geopolitical transformations taking place in the development space in Cambodia, and Asia more generally, and the micro-level meanings, practices, and contradictions that these changes create in the lives of the people living through them.

You have mentioned your interest in how people encounter international development and foreign aid in their everyday lives. What are some aspects of those encounters that you find revealing about the dynamics of global development?

Cambodia is a nation where international donors have a lot of power. But, that’s never the whole story. Development is never just donor-driven. In my work, I try to center the ways Cambodian practitioners make sense of, adapt, or resist donor visions of their nation’s development.

For instance, during my fieldwork, I met an NGO director who I’ll call Rith and whose career trajectory can provide us with some insights. Rith was born in 1979, at the very end of the Khmer Rouge regime. In his twenties, he decided to become a monk to bring merit to his family. In the late 1990s, Rith started noticing the influx of foreign aid funding and the proliferating numbers of international and local NGOs in his country. In 2000, he decided to quit being a monk to open an NGO. He turned out to be a savvy fundraiser, securing funding for his NGO to implement multiple health, education, and economic empowerment projects. However, when I met him in 2019, Rith told me he thought “it might be time to change paths” because NGO funding from Western donors “is not like it was ten years ago.” Two years later, he became the co-CEO of a private construction and sourcing company that takes advantage of the numerous infrastructure development loans China provides to Cambodia.

You can therefore observe how the larger geopolitical changes Cambodia undergoes play out in a micro-way in Rith’s strategic career choices as he shifts from being a monk to an NGO director to a CEO.

What do you see as some of the biggest challenges to delivering aid via INGOs?

There are several answers to this question floating around in my data. One that immediately comes to mind is synchronization. Despite a shared aim of improving women’s health, INGOs from the United States and Japan implement very different kinds of programs in Cambodia. Japanese INGOs focus on strengthening government-provided maternal health services in Cambodia. In contrast, U.S. organizations are more likely to promote a diverse maternal and reproductive healthcare sector, including private providers and civil society advocacy. I’ve also found that INGOs that originate in the United States and Japan are unaware of each other’s distinctive projects. Often, U.S. INGO directors and donors don’t even know Japanese NGOs exist!

While they work with different stakeholders, I believe that projects that support a strong state and those that encourage the market and nonprofit actors could be synchronized for more effective aid. To start with, U.S.-based INGOs sometimes try to upgrade private clinics, provide education, and refer beneficiaries to women’s health services in the same regions where Japanese INGOs support public clinics. On a basic level, if you could just get the INGO directors from Japan and the U.S. organizations that are working in the same areas to sit down together, U.S. INGO health educators might be able to do things like referring to improved private and public clinics if they know which public clinics the Japanese INGO works with, or collaborate on healthcare provision training for private and public clinic doctors.  

Beyond your book project, what are you working on while at APARC? How has your time here advanced your research?

The main thing a postdoctoral fellowship affords is the privilege of time to read and write. Outside of the book project, I have been able to work on two other papers while here at Stanford. One article proposes to theorize the process of “script decoupling” and why INGOs might formally adopt the same global script but enact it very differently in implementation. The second paper investigates how the meanings of aid money in NGOs is shaped by the business cultures of donor and recipient nations. I plan to have both papers under review before I leave APARC at the end of July.

Being at APARC has provided me with numerous opportunities to discover insightful, new perspectives on my research projects and career prospects from my postdoctoral advisor, Kiyoteru Tsutsui, as well as various other faculty, fellows, and associates here. For instance, Kiyo is starting a Japanese studies lunch-and-learning session where fellows get to meet and discuss their research. I’m particularly interested in the policy-oriented lectures and learning how to articulate that side of my research since that’s something I wasn’t taught to do in graduate school. Overall, my time at Stanford has been invigorating for my research and writing process. I’ve enjoyed being part of the learning community at FSI and the university at large, and have greatly benefited from connecting with different scholars and working groups across campus.

Has the Covid-19 pandemic affected your ability to travel and do research? How have you adapted?

I was incredibly lucky because I completed my international fieldwork in the fall of 2019. So I was able to collect all the data I needed for my dissertation before the pandemic hit us hard. But, due to Covid, I was not able to do the follow-up field visits that I wanted to do in order to find out what happened when the two INGOs I studied completed their projects. Also, continuing connections in the field for new ideas and the next research project is important for an ethnographer. I have done what I could to catch up with Cambodian friends and practitioners over Zoom. Now that Cambodia has lifted its quarantine requirements, I may be able to return this summer. 

What is on the horizon for you? What's next?

As I have wanted to be a college professor since I was 19 (after I gave up my dream of being a pop singer), I’m extremely happy to share I was offered a tenure track position in the Department of Sociology at the University of North Carolina Wilmington! I’ll be starting there in the fall and continuing my research on international development and Southeast Asia.