mobile money for health
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Mobile Money for Health. Pamela Riley, Senior mHealth Advisor, Abt Associates Health Financing and Governance Project mHealth Working Group May 28, 2013. Meeting Overview. Pamela Riley, HFG project : Setting the context - PowerPoint PPT PresentationTRANSCRIPT
Abt Associates Inc. In collaboration with:Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
Mobile Money for Health
Pamela Riley, Senior mHealth Advisor, Abt AssociatesHealth Financing and Governance Project
mHealth Working Group May 28, 2013
Meeting Overview
Pamela Riley, HFG project: Setting the context Menekse Gencer, mPay Connect: How can mobile money improve
health outcomes? Andrew Karlyn, USAID Mobile Solutions: Why does mobile money
matter? Steve Ollis, D-Tree: Zanzibar use case for safer deliveries Judy Gold, Marie Stopes International: Madagascar family
planning voucher use case Hamilton McNutt, NetHope: Tools to support transition to mobile
money Wrap-up
Setting the context Mobile Money for Health
Mobile money defined mHealth relationship to
mobile money Objectives of Health
Finance & Governance project
What is mobile money?
Used for bulk payments, peer transfers, bill & loan payments, merchants
Licensed providers can be banks, mobile operators, software companies
Enroll •User registers phone number
Transfer •Sender sends funds via SMS
Access •User can store on phone or cash out with local agent
Digital platform for storing, sending, receiving money
Mobile number acts like a bank account, allows fund transfers via SMS
mHealth and mobile money currently perceived as parallel sectors
mHealth mFinance
BENEFICIARIES mBCC
PROVIDERS Mobile job aids
MANAGEMENT Data collection
≠
Repositioning mobile money for health = mhealth
BENEFICIARIESHealth insurance premiums
Health saving accountsConditional cash transfers
+MANAGEMENT
Voucher settlementPurchasing credit
Audit trails
mHealth is the use of mobile (communications or payments) to improve health outcomes
PROVIDERSPerf based incentives
Salary paymentsTraining per diems
Health Finance & Governance (HFG) project
HFG objectives
Improved health financing
Strengthened governance of health sector
Improved public health operations
Examples how mobile money can contribute
Expand health insurance access to advance UHC
Improve accountability, reduce leakage with automatic transaction records
Lower transaction costs, by driving cash payments out of system
HFG Mobile Money Illustrative Activities
COLLABORATE
GENERATERESOURCES
CATALYZE USE CASES
The Office of INNOVATION & DEVELOPMENT ALLIANCES
Office of Innovation and Development Alliances
(IDEA)Andrew Karlyn, USAID Mobile Solutions: Why does mobile money matter?
Development InnovationVenturesTurning bright ideas into global solutions.
Mobile SolutionsAccelerating mobile technology for development impact.
Local Sustainability Pioneering local capacity building for stronger communities.
Global PartnershipsBuilding public-private partnerships for sustainable impact.
IDEA
Office of Innovation and Development Alliances (IDEA)
IDEA/MS
IDEA/MS
Mobile Data
Mobile Money
Mobile Access
Leverages the power and reach of mobile technology to accelerate USAID’s development goals
MobileSolutions
(MS)
IDEA/MSWhy does mobile money matter?
Accelerates financial inclusion
Enables cross-cutting solutionsUnderpins good governance practices
Empowers entrepreneurs
Scale mobile money
IDEA/MS What is USAID doing to scale mobile money?
Programs
Partnerships
• USAID/Afghanistan worked with Central Bank to reduce regulatory barriers, move police and teacher payments onto mobiles.
• USAID/Philippines alongside its work with the Central Bank and G2P payments, it has integrated e-payment language into future procurements.
• USAID/Malawi is funding a program to provide TA, coordinate the ecosystem, and fund demonstration pilots that cut across sectors.
• Better than Cash Alliance: The Governments of Afghanistan, Kenya, Peru, Philippines, Colombia, Malawi and a host of organizations have committed to move toward a cash-lite society.
• USAID-Citi Mobile Money Accelerator: USAID/Indonesia and Citi are working with a fast-moving consumer-goods company to offer mobile banking services throughout its supply chain.
Creating an Enabling Environment for e/m-Payments1.Secure host country government participation in the Better than Cash Alliance
(BTCA)2.Provide technical assistance to host government on e/mMoney regulatory
environment3.Participate in or convene multi-sector, multi-stakeholder mMoney working
group that meets regularly and has clear objectives
Aggregate Demand / Accelerate Use of Mobile Money4.Collaborate with host government to identify and transition large cash-based
payment streams to mMoney5.Create a dedicated fund or mechanism to support actionable mMoney
programs6. Integrate language for e/m-payments into project design and acquisition and
assistance (A&A) planning documents, where appropriate
IDEA/MS USAID's strategic approach to mMoney adoption
Why does mobile access matterWhy does mobile access matter?
M4D appsGender equalityHealth servicesInclusive growthJob opportunitiesEducation contentFinancial servicesPrivate investment
Access enables:
IDEA/MS
Level tech playing field
IDEA/MSWhat is USAID doing to level the technology playing field?
GSMA mWomen Program
Alliance for Affordable Internet
• IDEA/MS is working with GSMA, AusAID, and Visa Inc. to reduce the mobile phone gender gap, by enabling mobile ownership and more effective use for women in emerging markets. Support goes for research, technical assistance grants to mobile operators and implementing partners, and design challenges. For more information, visit: www.mwomen.org.
• IDEA/MS is working with other donors, technology companies, and host country governments to dramatically increase the uptake and use of mobile broadband through the Alliance for Affordable Internet. The overall goal is to reduce costs of broadband to 5% of monthly income to bring the next two billion internet users online. For more information, visit: www.a4ai.org.
Why does mobile data matter
IDEA/MS Why does mobile data matter?• Improves data quality, reducing data
entry errors by up to 40%• Lowers costs up to 75%• Reduces turn-around time, returning
data 2x faster
• Makes data management and aggregation easier
• Improves decision-making by identifying trends across projects, sectors and countries
• Empowers citizens by facilitating feedback loops
Mobile data strategies
IDEA/MSWhat is USAID doing to increase adoption of mobile data solutions?
• IDEA/MS developed and delivered an online course with TechChange about mobile data solutions.
• IDEA/MS in conjunction with USAID/Afghanistan has launched an SMS-based technology platform to gather baseline information about payments to teachers and to evaluate the impact of transitioning them to e-payments.
• IDEA/MS is working with USAID/Kenya to develop a mobile-phone based platform that receives feedback from beneficiaries about service delivery, program impact and unmet needs and shares information with them.
Programs
• Five Steps for Success
Build knowledge and technical capacity Demonstrate effectiveness of solutions Improve technologies Develop policies Integrate platforms into Missions and Sectors
Actions
inside.usaid.gov/idea-mobile-solutions
How can we support your work in mobile
solutions?
Website title slide
Using mMoney and mHealth to improve women’s health in Zanzibar
Steve Ollis
Presentation to mHealth Working Group
28 May 2013
1. Develop high quality clinical protocols based on national guidelines
2. Design software to guide the user through correct use of protocols
3. Create Electronic Patient Record to ensure health information is accessible
What we do
chronic disease
child health
reproductivehealth
preventivecare
HIV/AIDS Diabetes Hypertension TB
pneumonia diarrhea malaria newborn nutrition
antenatal post natal family
plan safer
deliveries antenatal immunizations care and support
Develop clinical protocols that enable better quality care
mHealth for Safer Deliveries
Support from Gates Challenge Exploration grant and Jhpiego
Target areas: <50% facility deliveries Goal: Reduce the “3 delays” for mothers
during labor and deliveryDecision to seek careArrival at health facilityProvision of adequate care
Uses simple java-enabled Nokia phone
Piloted in 2 districts with 1,000 women 2011-2012
Being scaled up across Zanzibar – over 100 users currently – target of 350 by 2014
mHealth for Safer Deliveries
Screening and registering pregnant mothers to identify risk factors or danger signs
Agreeing on birth plans for facility delivery and securing permissions
Establishing community-based referral systems to transport women in labor or in emergency situations
Coordinating payment of transport to health facilities using mobile banking
Visiting the family 3 and 7 days after delivery to for postnatal follow-up for mother and baby
mHealth for Safer Deliveries
How we use mobile money
Transfer funds from D-tree to Community Birth Attendant (CBA) accounts
CBA pays drivers from account using mobile money
CBA withdraws their incentive at end of month
Audit transactions using application records, mobile money accounts and sign-in books at health facilities
Dramatic increase in facility delivery rates 82% of women had a higher risk condition
for which facility delivery is recommended Facility delivery rate increased from
approx. 30% to 72% Average cost per delivery $22 Use of mobile money is allowing faster
scale up, sharing of workload and improved security
Results: Facility Deliveries
• Past home deliveries were all unsuccessful
• Referred by TBA to Micheweni cottage where she had a prolonged labour.
• This time, she was induced and successfully delivered a healthy baby boy
• She indicated that she will not consider delivering at home during future pregnancies.
Stories from the field
• Unaware that she was pregnant with twins• When labor started her family called the TBA
who arranged transport immediately• She began to have blood pressure problems and
the hospital staff transferred her to Wete for a caesarean section
• She gave birth to two healthy baby boys, kept at the hospital for 5 days for continued evaluation
• She says that had she not been in the project, she would have given birth at home; was unsure if they would have found transport once problems began
Stories from the field
Lessons learned Wide network coverage ≠ wide mobile money
network Need to work closely with Telecoms to strengthen
network, market services Mobile money systems still have opportunity for
improvementOnline systems could be more user friendlySystems not always availableCash management at pay points
Learn about fees up front and be clear who will pay
Next steps Work with Zantel to obtain improved visibility
into user accounts Work with Zantel and software partners to
improve integration via mobile money APIs Continue to integrate operations into district
council health plans
For more information:
www.d-tree.orgSteve [email protected]+1.410.443.3916
Better Decisions Save Lives
Thank you!
Mobile Money @ MSI SLIDE 33
Using Mobile Money within Health ProgrammesJudy GoldInnovation and Best Practice [email protected]
mHealth Working Group MeetingTuesday 28th May 2013
Mobile Money @ MSI SLIDE 34
Acknowledgements Marie Stopes Madagascar
– Boni Ramanantsoa, François Gourraud, Lalaina Razafinirinasoa, Odile Hanitriniaina, Sylvie Ramandrosoa
Marie Stopes Kenya– Agnes Midi, Judy Ojwang
Marie Stopes International– Nick Corby, Anna Mackay, Meira Neggaz, SIFPO-MSI
USAID (SHOPS project)
Mobile Money @ MSI SLIDE 35
Marie Stopes International
Mobile Money @ MSI SLIDE 36
Example 1: Madagascar
Mobile Money @ MSI SLIDE 37
Voucher Payments Focused on family planning
– Variety of methods
Vouchers sold by Community Health Educators– Cost client MGA 200 (USD $0.10)
Redeemable at BlueStar social franchisees– Franchisee reimbursed MGA 7,500 (USD $3.70) for
service provision
Mobile Money @ MSI SLIDE 38
But how to reimburse? Limited banking facilities
– Only three bank branches in regions targeted
– Many social franchisees don’t have a bank account
Cash payments present problems– Time
– Staff travel, delay in reimbursements
– Security– Large amounts of cash, potential for fraud
Mobile Money @ MSI SLIDE 39
Voucher Payment Process
Provider sends SMS with voucher
code
Voucher code verified
(automated)
Internal voucher verification system
(manual)
Mobile phone number verified
(automated)
Mobile payment generated(manual)
Mobile Money @ MSI SLIDE 40
Results: Voucher Numbers March 2011 to December 2012
– 25,880 vouchers sold
Mobile Money @ MSI SLIDE 41
Results: Time to Payment
New rule introducedNew rule
introducedBut still much faster than paper systems….
Mobile Money @ MSI SLIDE 42
Key Benefits Faster payments to service providers
– Many voucher programs take one month+ from when service is delivered until providers are reimbursed
Increased financial and administrative efficiency– Reduced travel, access during rainy season
Availability of real-time redemption data – Improved program management
Mobile Money @ MSI SLIDE 43
Key Lessons Choose mobile finance provider(s) wisely
– Initially only reimbursing using Telma – Required non-Telma customers to collect payments within
seven days– Social franchisees would ‘batch’ voucher reimbursements
– Consider more than just cost of transfers– Network coverage, kiosk availability
Mobile Money @ MSI SLIDE 44
Key Lessons Consider all costs involved
– SMS data submission, cost of transferring payments
Electronic systems are not a panacea– Still involve people!
– May increase speed, but only up to a point
More detail of system available in 2011 report; planning 2013 updatehttp://www.mariestopes.org/data-research/resources/using-mobile-finance-reimburse-sexual-and-reproductive-health-vouchers
Mobile Money @ MSI SLIDE 45
Example 2: Kenya
Mobile Money @ MSI SLIDE 46
Community Agent Payments Currently using mobile money in ad-hoc way
– Requires withdrawal of cash and taking to physical agent– Only used in emergency / last minute situations
Planning move from cash to mobile money– Community health workers, youth peer educators
– Monthly stipend, activity and training payments
– Will integrate online payment system with financial operations
Mobile Money @ MSI SLIDE 47
Why Now? Delay in payments reaching workers
Security– Limit intermediaries involved
– Ensure beneficiaries receive payment directly
Accountability– Financial monitoring
– Increased transparency
Mobile Money @ MSI SLIDE 48
Why Now? Changes to community health programming
– Scaling up: expanding to more remote areas
– Increased coordination: new database of community health agents
Becoming more “digitally enabled”
Mobile Money @ MSI SLIDE 49
But why not everyone? (1) Not always clear motivation to change
– Requires time outside of ‘day-to-day’ tasks
Financial control is a tricky business– Comfort with old vs risk of the new
– Uncertainty about what auditors will accept
Mobile Money @ MSI SLIDE 50
But why not everyone? (2) Rapid increase in mobile phone use
– Far fewer of our workers would have owned phones just two years ago
– Health sector overall slow to adapt to mobile technology
Variations in use of mobile money– Kenya with mobile payments the norm vs Uganda
where available but not same level of use and demand– Easier to introduce (and more demand) where population
already familiar with service
Mobile Money @ MSI SLIDE 51
Next Steps Increase internal knowledge
– Does everyone know what mobile money is? – What challenges it could help address? What it involves to
use? What resources are out there to support use?
Ramp up internal advocacy– Showcase internal and external examples
– Bring together finance, management, auditors– Need to be ‘on board’ if not championing– Identify global lead
.
NetHope Payment Innovations Team
Making an informed decision about a transition towards electronic payments
Hamilton McNutt, NetHope
NetHope Payment Innovations Team
Our team supports USAID’s global efforts to encourage and support implementing partners use of e-payments – including mobile money – in their programs and operations.
Areas of Focus
Technical AssistanceTechnical assistance for USAID Washington and Missions to advance use of e-payments/collections by USAID implementing partners
ToolkitsDevelop and distribute tools that assist organizations in the transition from cash to e-payments
Resource BaseCollaborate with the NGO and development community to discuss, learn & share practices for accelerating the use of e-payments in the field
Process for making an informed decision and the tools to help you get there
56
5) If you do find provider capabilities and clear benefits to your program, develop an implementation plan and implement the transition.
Cash scoping survey template
Service provider due diligence; Internal controls/access points/product requirements (In Development)
Country wide e-payment services due diligence; regulatory policy/infrastructure data resources (in development)
Costing Utility Tool
Standard Operating Procedures Guidance
Costing Utility Analysis Tool
4) Analyze the comparative costs associated with cash management and e-Payments
Today’s Focus
Thank You
Find more resources at:http://cloudportal.nethope.org/programs/payment-innovation
[email protected]: @hamiltonmcnutt