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

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).


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.).


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.).


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.).


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.).


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.).


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.



Agrawal, N. (2017, May 1). Kalanick is caught on video berating a driver. Retrieved from

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.).  Retrieved from

Belize POLITICAL DYNAMICS – Flags, Maps, Economy, History, Climate, Natural Resources, Current Issues, International Agreements, Population, Social Statistics, Political System. (n.d.). Retrieved from

Culture of Belize – history, people, women, beliefs, food, customs, family, social, marriage. (n.d.). Retrieved from

Dickey, M. R. (2017, November 7).  These are Uber’s new cultural norms.  Retrieved from

Fowler, S. (2017, February 19). Reflecting on one very, very strange year at Uber.  Retrieved from

Gregory, J.R.. (1975, May 27).  The modification of an interethnic boundary in Belize. Retrieved from

Healthcare in Belize – International Living Countries. (n.d.). Retrieved from

International Agreements, Population, Social Statistics, Political System. (n.d.). Retrieved from

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

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

Retrieved from

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

by Theresa Dawson



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.


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 (, 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.


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.



Accenture. (2014). mHealth challenges and opportunities in emerging markets. Retrieved from (2018). Medical care in Belize. Retrieved from

Belize Ministry of Health. (2010). Belize: National health information system strategic plan

2010-2014. Retrieved from

Belize Ministry of Health. (2014). Belize health sector strategy plan 2014-2024.

Retrieved from Health Sector Strategic Plan 2014-2024-April 2014.pdf

Caribbean Development Bank. (2009). Belize country poverty assessment report. Retrieved from

Central Intelligence Agency. (2018). The world fact book. Retrieved from

Chang, K., & Ying, Y. (2006). Economic growth, human capital investment, and health expenditure: A study of OECD countries. Journal of Economics, 47(1), 1-16. Retrieved from

Gorski, I., Bram, J., Sutermaster, S., & Mehta, K. (2016). Value proposition of mHealth topics.

Journal of Medical Engineering & Technology, 40(7), 1-22. Retrieved from

Innovation and Technology for Development Centre. (2014). eHealth in rural areas: Access to medical care training and prevention in Guatemala. Retrieved from

Latif, S., Qadir, J., Rajib, R., & Ali, A. (2017). Mobile health in the developing world: Review of Literature and lessons from a case study. IEE Access, 5, 11540-11556.

Lauler, J. (2013, May 16). Mobile money: Transforming healthcare in emerging markets. Retrieved from

Lee, A., Kiyu. A., Milman, H.M., & Jimenez, J. (2007). Improving health and building human capital through an effective primary care system. Journal of Urban Health, 84(S1), 75-85.

Nickolas, S. (2018). How human capital and economic growth are related. Investopedia. Retrieved from

Pan American Health Organization. (2009). Health systems profile: Belize. Retrieved from

Parkin, D. (2017). Health economics index. Retrieved from economics/4d-health-economics/principles-he


Schmieder-Ramirez, J. H., & Mallette, L. A. (2007).

The SPELIT power matrix: Untangling the organizational environment with the SPELIT leadership tool. Charleston, SC: BookSurge Publishing.

United Nations. (2016). Human development report. Retrieved from http:/


Vital Wave Consulting. (2009). mHealth for

development: The opportunity of mobile technology for healthcare in the developing world. Washington, DC: UN Foundation-Vodafone Foundation Partnership.

Wasden, C. (2014). mHealth transforming healthcare

in emerging markets: Healthcare information and management systems society. Retrieved from http:/ markets

World Health Organization. (2015). Compendium of innovative health technologies for low resource settings, 2011-2014: Assistive devices, ehealth solutions, medical devices, other technologies, technologies for outbreaks. Retrieved from


World Health Organization. (2018). Health services

development health systems    framework. Retrieved from services/health_systems_framework/en/

World Health Organization. (2016). Medical devices:

 Call for innovative health technologies for low-resource settings. Retrieved from medical_devices/ innovation/call_2014/en/

World Health Organization. (2011). mHealth: New

horizons for health through mobile technologies: second global survey on eHealth. Retrieved from

World Health Organization. (2012). National eHealth

strategy toolkit. Retrieved from ehealth/ publications/overview.pdf