ICTworks

Digital financial services provide health programs with opportunities to accelerate progress toward global health goals and outcomes. Global health program managers can leverage digital financial services to improve health systems performance and support USAID programmatic outcomes such as:

• Financial protection for vulnerable groups
• Delivery of essential health services
• Improved reach to marginalized communities
• Increased health service demand and responsiveness

The new USAID brief “The Role of Digital Financial Services in Accelerating USAID’s Health Goals” is intended to engage and inform global health practitioners and implementing partners and demonstrate how:

• Digital financial services catalyze health results by supporting USAID’s Health Systems Strengthening core functions and strategic outcomes.
• Financial inclusion protects households and communities against financial shocks and catastrophic expenditures.
• Digital financial services are transformative and present opportunities to advance social outcomes.

The brief contains four case studies showing how digital financial services can support health systems strengthening core functions and outcomes in human resource for health, service delivery, and financial protection.

Digital Financial Services Support Safe Deliveries

In Zanzibar, D-tree International’s Safer Deliveries program used mobile technology to address multiple obstacles that pregnant women face when trying to go to a facility for delivery.

D-tree uses clinical protocols to develop clinical decision support software that can be loaded onto mobile phones for use by clinic staff and community health workers (CHWs) to help them accurately assess, diagnose, and treat patients. Zanzibar has high rates of antenatal care and relatively good access to facilities, yet over half of deliveries were at home, leading to preventable deaths.

Rather than using a siloed approach, Safer Deliveries works to address all barriers to accessing care simultaneously through a mobile application. The program empowers women to understand why a facility delivery is better for them and their baby, to develop a birth plan for where they will deliver, and to save money through a mobile savings system to pay for transport and other birth-related costs.

It empowers CHWs to provide effective advice to women and support the birth planning process, and it supports a community transport system using local drivers and vehicles to take women in labor to health facilities (think “Uber for mothers”).

DFS Promotes Access to Essential Services

Since October 2010, Marie Stopes Madagascar has contributed to national maternal health targets by establishing a subsidized voucher programme to increase access to voluntary family planning services.

Marie Stopes Madagascar trained CHWs to raise awareness about the voucher programme, to provide family planning counselling that help clients make an informed choice about which contraceptive method to use, and to distribute vouchers to eligible clients. Clients could give the voucher to one of Marie Stopes’ 42 social franchisees in exchange for family planning services.

Marie Stopes used mobile money instead of traditional payment methods to reimburse service providers. In doing so, the voucher programme demonstrated that mobile money can successfully reimburse health service providers in remote, rural, and urban settings. Marie Stopes reimbursed all of the unique codes submitted by social franchisees.

Furthermore, the voucher programme demonstrated that this method of reimbursement could be adopted by end-users and that, in some settings, mobile money can significantly strengthen the reach, efficiency, and sustainability of health services.

Marie Stopes would have had to reimburse social franchisees for each voucher in cash if it had not used mobile money. This would have significant disadvantages, as cash payments involve considerable travel costs and risk of fraud, theft, or personal injury to project staff.

Digitizing Salary Payments Improves Efficiency

The United Nations Capital Development Fund, in collaboration with the Government of Sierra Leone’s National Ebola Response Center (NERC) and with contributors from USAID and other partners, implemented the Payments Program for Ebola Response Workers to digitize hazard payments for health and frontline response workers during the height of the crisis.

Health and frontline response workers had to travel long distances to pay collection points, which was costly and took time away from their work. Weak systems for checking identification meant payments were claimed fraudulently, while managers sometimes also took a cut of worker compensation, resulting in a demotivated health workforce.

NERC and the Payments Program introduced mobile money payments to increase the speed, efficiency, and transparency of hazard payments to frontline health workers.

e-Salary Results

To make digital payments, the administrators registered 30,000 response workers across 14 districts and 1,000 medical units into a digital identification system, which eliminated over 3,000 ghost workers from payment rosters. NERC also established processes to regularly audit and update the list because the turnover among response workers was high (estimated at 30 percent).

Digital payments reached 98 percent of the 30,000 response workers. Salary digitization saved an estimated $10 million USD in security and other costs associated with moving cash. It also eliminated ghost workers and duplicate payments and reduced time and expense for health workers collecting pay. Digital payments reduced payment time for health workers from 1 month to 1 week, preventing the loss of an estimated 800 working days and saving over 2,000 lives by eliminating response worker strikes.

Remittance-enabled Health Savings Plans Increase Health Care Access

Safaricom, CarePay, and PharmAccess Foundation partnered to create M-TIBA, a digital health payments platform, with the goal of increasing health care inclusion and empowering low-income Kenyan households to visit a doctor. M-TIBA offers financial products, including commitment mobile savings accounts, health insurance for beneficiaries, and health funds and payments management services for donors and clinics.

M-TIBA’s platform lets users save, send, and spend funds for medical treatment. Beneficiaries use M-PESA to make deposits into and payments from their M-TIBA savings accounts, increasing convenience for clients by allowing mobile payments on a familiar platform.

Money saved or received on M-TIBA can only be spent at M-TIBA’s partner clinics and hospitals (i.e., commitment savings features). To incentivize its users to save money for health expenditures, M-TIBA adds a bonus top-up of KSH 50 (approximately $0.50 USD) for every KSH 100 saved monthly. M-TIBA also offers free personal accident insurance up to KSH 8,000 (approximately $80 USD).

M-TIBA is structured as a commitment savings account: beneficiaries forego bonuses if they withdraw funds for other purposes. In addition, M-TIBA enables beneficiaries to mobilize funds for care by requesting remittances directly into their health savings account to cover health care costs. This feature may help beneficiaries more frequently receive remittances for care, because research shows that remittance senders want to ensure their funds are being used for the purpose they intended.

M-TIBA subscribers can also choose and search for nearby in-network clinics using their mobile phones. M-TIBA affiliated clinics using internationally recognized SafeCare standards and work with enrolled clinics to improve their standards and administration. This intervention has benefits for individuals and implementing institutions. Institutions benefit from improved transparency and monitoring. Individual beneficiaries see improved well-being and affordability because poor quality of care can increase the frequency of visits, raising the overall cost of care.

Further, M-TIBA allows donors to channel funds meant for health services directly to recipients so they can more effectively track usage. Ten international donors and corporations are now using M-TIBA for disbursements. Health care providers, particularly smaller facilities, connected to M-TIBA benefit from increased business and reduced payment leakage. Smaller providers also gain access to a dashboard with data on health care utilization—including visits, treatments, and costs—without having to invest in their own technology platform.

Aggregated data from the M-TIBA platform can be used to monitor health care quality, impact, and trends. M-TIBA captures each transaction and the associated treatment/diagnoses and uses those data to develop a patient journey tracker (e.g., for HIV and maternal, newborn, and child health) to determine whether treatment adheres to medical protocols. Aggregated data captured on the platform can also potentially help track the emergence of epidemics.

Health Insurance Program Results

By March 2019, number of people connected to M-TIBA in Kenya has grown to almost 4 million and by November 2018 KSH 205.12 million (approximately $2 million USD) in medical payouts.

Four hundred and fifty connected health care providers have treated more than 100,000 patients, generating more than $1.4 million USD in medical transactions through M-TIBA. M-TIBA is still in its infancy, so it is premature to measure health impacts. However, there are some promising early results.

During a pilot in 2015, M-TIBA assessed 5,000 mothers with children under 5 years of age (10,000 beneficiaries in total) living in informal settlements in Nairobi. The results showed that 63 percent used the health wallet during the first 6 months of the pilot. In 14 percent of cases, users reported that they sought help sooner than they would have without M-TIBA.