wef he intersection mobile health mobile finance report 2011

8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011

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Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance

0C:2

Opportunities multiply

as they are seized. Sun Tzu


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Introduction:

In looking at the rapidly expanding adoption o

mobile communications, one o the most

promising opportunities or positive socio-

economic change lies in the scaling o mobilehealth and mobile fnancial services (MFS). In

act, more people today have access to a mobile

phone than to clean water or the electrical grid.1

By 2012, it is estimated that there will be 1.7

billion people who have mobile phones but nobank account. O those individuals, approximately

1 billion will also lack access to healthcare

systems. 2

Providing services in an aordable and sustainable

manner or these individuals is a signiicant

challenge. While reduced costs and advances

in network coverage are accelerating, the

underlying business models to sustain this growth

are unclear.


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It goes without saying that the issues o extremepoverty are highly complex and interconnected.

The World Health Organization (WHO) cites

inadequate healthcare fnancing mechanisms

as one o the two biggest challenges to improving

health outcomes or the poor. 3Both mHealth

and MFS are nascent industries and ragmented

along multiple dimensions. While there are now

well over 5 billion mobile subscribers in the

world, it arguably is still at subscale in terms

o the deployment o value-added services on

a global basis.

As an example, mobile nance has achieved

commercial scale (i.e. 1 million or more users)

in less than one out o 10 deployments globally.

While there has been widespread adoption

in the countries o Kenya and the Philippines

there are more than 100 deployments that

have not reached this level o scale.4

Mobile Health eorts are also highly ragmented.Because o the lack o platorm standardization,

many providers are building discreet and

independent systems rom the ground up. As a

result, systems are costly, inecient, unable to

achieve scale and oten not interoperable.

The aim o this paper is to help reduce some

o these uncertainties and reinorce dialogue

on how the mobile communications platorm

can be leveraged to strengthen mutually positive

outcomes related to both nancial inclusion

and health. With user-centric solutions that

leverage common technologies, new eciencies

and capabilities can be created that serve to

accelerate global scale.

Unlocking this potential will require the ollowing

questions to be addressed:

1. What will be the best method to drive

awareness and adoption o the sel-rein-

orcing dynamics o wealth and health?

Who will lead these eorts?

2. How will the integration and interoperability

o disparate technologies across multiple

industry and public sector domains occur?

3. Who will build and manage the common

inrastructure and distribution networks?4. How will the various points o policy coor-

dination work across sector domains?

Synergies Between mHealth and

Mobile Financial Services

At its core, the mobile communications plat-

orm reduces the time, distance and cost or

delivering inormation. As such, providers in

the healthcare and nance industries have a

globally ecient, innovative and cost-eective

channel or delivering new services.5 For banks,

the mobile platorm creates innovative ways to

deliver convenient branchless banking solutions

to geographically remote areas. Once in place,

these nancial services enable the creation

o new cost structures and micro-sevices.

Mobile-based remittances, micro-insurance

and savings accounts can all be oered to

those at lower socio-economic levels.

Because payments are also a vital component

throughout the healthcare delivery continuum,

a means to securely, reliably and cost-eectively

transact is valued by both industry sectors.

Along with the need to accelerate transactions,

both industries have common users, digital

inrastructure elements, business processes

and policy concerns. Recognizing these syner-

gies and working cross-sector, stakeholders

in both industries are positioned to achieve

greater impact, ultimately establishing a morerobust ecosystem or servicing the needs o

the poor.

Driving Demand: Mobile Financial

Services Spur mHealth Adoption

Mobile nancial services represent a tool that

acilitates remote payments or healthcare

services or those with and without bank

accounts. By leveraging MFS or healthcare

services, key stakeholders in the continuum o

care can benet rom improvements in quality,

accessibility and cost. MFS can apply to both

providers o health services as well as patients.

Mobile Financial Services or

Providers

Salary Disbursement: Healthcare

employers can pay a healthcare worker auto-

matically into the healthcare workers mobile

nancial service account rather than paying in

cash or cheque, which is both cumbersome

and costly to manage.

Healthcare providers ace the challenge o how

to pay unbanked and remote healthcare workers

in a timely and sae manner. In rural areas,

healthcare workers oten spend time walking

to other localities to pick up cash when they

are paid. The time spent on administrative

tasks could be better used serving patients.

Additionally, the potential o raud (cash leakage)

associated with salary disbursement to remote

employees is greater when there is no access

Defning e-/mHealth and Mobile

Financial Services

Mobile inancial services (MFS) is an

umbrella term, oten reerred to as

mobile money. MFS uses a mobile

wallet or a separate electronic money

account used or payments other than

prepaid or post-paid mobile airtime.

Within MFS, there are three main cat-

egories: mobile payments, mobile credit/

savings/insurance and mobile banking.

mHealth is loosely dened in this paper

as the use o inormation and commu-

nication technology to provide better

access to health services or practitioners

and patients. Payments in mHealth

roughly all into three main categories,

those or health services and supplies,

those associated with systems admin-istration and those associated with use

o the electronic healthcare record and

aggregated data.


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to a banking inrastructure. In Aghanistan,

when mobile nancial services inrastructure

was implemented or salary disbursement o

national police in lieu o cash, it became known

that at least 10% o the payments had been

going to ghost policemen and that middlemen

were pocketing the dierence. During this

time, most policemen believed they received

bonuses to their salaries, unaware o the raud

rampant throughout.6

Healthcare workers paid in cash in emerging

markets experience similar issues. Even in the

absence o raud, the time and cost o cash

disbursal o salaries create additional admin-istrative costs that burden the viability and

sustainability o healthcare business models.

Perormance-based Funding (PBF):

Providers o perormance-based unding can

pay healthcare workers electronically into their

mobile nancial services account based on

services that were perormed on patients.

As perormance-based unding becomes more

prevalent, those organizations paying caregivers

are burdened with complicated management

o variable payouts to caregivers. The system

quickly becomes too cumbersome to manage

costs eectively, particularly i done manually

through cheque and cash. Automating the

calculation and payout processes by combining

mHealth data with the mobile platorm creates

a way to reduce the complexity and scale new

capabilities.

An example o this is a public-private initiative

in Tanzania, where an SMS or Lie program

was established targeting data collection to

reduce pharmaceutical stock-outs or anti-

malaria drugs. The programme used SMS as

the method or data collection and motivated

pharmaceutical supply-chain workers to submit

inventory inormation via mobile phones.

In the absence o mobile nancial services to

provide payments, they motivated key personnel

to participate by pushing airtime minutes as a

bonus to workers or accurate data input. By

combining ICT or reporting o inventory and

motivating data submitters through a proto-

currency o airtime, the six-month trial reduced

stock-out rates rom 95% to 6%.

Due to this eort, 300,000 more people were

able to receive anti-malaria treatment in 150

health acilities servicing 226 villages.7 In this

example, e- and mHealth addressed the ques-

tion o how to make systems more ecient,

while mobile nancial services addressed

the question o how to motivate peopleto participate.

Vouchers or Conditional Aid: Mobile

nancial services can be the settlement

mechanism between payers and providers

o healthcare services or products given to

patients who use vouchers.

In the area o ood dissemination, or example,

mobile-enabled systems or ood voucher reg-

istration, claim and settlement are used by the

World Food Programme. In this system, World

Food Programme workers identiy and register

eligible recipients or ood.

Upon registration, the recipient receives a

scratch card with a code, which they use to

claim ood at nearby retailers. To veriy the

transaction, the retailer submits the code into

a mobile phone and receives verication rom

the system. When the retailer provides the

ood and perorms the transaction, the system

automatically settles the payment between the

World Food Programme and the retailer by

moving the money between mobile nancial

services accounts.

This automated system has signicantly reduced

the paperwork burden or all entities in the

supply chain while also motivating suppliers to

participate, as payment settlement occurs in

minutes rather than months. Such a systemcan be applied to healthcare services as well.

Supply Chain Settlement and Credit:

Supply chain participants can settle payment

electronically between their mobile nancial

service accounts. For example, this type o

payment settlement can be used in the phar-

maceutical supply chain to increase the speed

o payment settlement. In addition, providing

access to credit to buyers within the supply

chain will reduce inventory stock-outs oten

caused by lack o unds.8 While it remains to

be seen whether implementing mobile nancial

services in drug supply chains can assist in

reducing countereit drugs, what is certain is

mHealth and MFS are inextricably linked by common building blocks and cross-sector dependencies

(Source: mPay Connect)


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that when drugs are identied as countereit,digital money trails will assist in more eectively

locating criminals.

Mobile Financial Services or

Patients

Mobile Pre-paid Savings:The majority

o the worlds population has no access to

healthcare insurance. Access to mobile-based

savings may assist with this issue. Patients can

accrue assets in a prepaid mobile savings acc-

ount to prepare or upcoming healthcare costs.

Unlike cash stored under the mattress, these

accounts provide a sae, reliable place to store

and accrue their assets out o harms way. They

also can establish a fnancial history, which can

be used by fnancial service providers or uture

credit oerings.

New nancial services, such as mobile-enabled

savings accounts, assist patients in nancial

planning and saving or uture healthcare needs.

Serious injury and unerals are cited as the top

requent event causing nancial emergency

or the poor in Bangladesh, India and SouthArica.9

It has also been suggested that mobile money

systems like m-Pesa in Kenya may play a

signiicant role in reducing risk: as noted

by research rom Georgetown University

households who have access to m-Pesa

and are near an agent point are better able

to maintain the level o consumption expen-

ditures, and in particular ood consumption,

in the ace o negative income shocks. On

the other hand, households without access

to m-Pesa appear to be less able to protect

themselves rom such adverse events. 10

There are also examples o mobile nancial

services programs with prepaid savings being

tested within the context o maternal health.

For example, in Kenya only 5% o the populationhas medical insurance. Kenyans employed in

the ormal sector pay or mandatory health

coverage, but 11 million adults work in the

inormal sector with no such insurance.11

In Kenya, 56% o women give birth at home,mostly due to lack o access and economic

means to pay or delivery the in healthcare

acilities.12 Home birth increases maternal and

natal mortality rates. Those who seek better

healthcare and deliver their child in hospitals

risk the ate o imprisonment i they cannot

aord payment. As was noted by the Los

Angeles times in 2009, an increase in cases o

cash-starved public hospitals detaining patients

over unpaid bills spurred outrage in Kenya.13

One provider is addressing this issue through

various methods. On the logistics and access

side, they are developing a maternal health

clinic system o vans that can be standardized,

replicated and brought to expectant, low-income

urban mothers.

On the nancial side, this provider is assisting

amilies with nancial planning or upcoming

delivery by providing a prepaid savings ac-

count. The patients can move money into this

savings account any time and anywhere using

their mobile phones to trigger a money transer

using Kenyas mobile money transer system,

m-Pesa. The same account can be used to

pay delivery costs to the clinic.

In another example, a hospital began to issue

prepaid cards to expectant mothers, leveraging

m-Pesa so patients could move unds to their

prepaid savings cards.14

At the time o hospitaldelivery, patients use prepaid cards to pay or

their healthcare services at the hospital.

Mobile Micro-Insurance: In addition to

savings accounts, patients can pay or micro-

insurance premiums through a mobile phone

and receive claims into the mobile nancial

services account. By taking the riction out o

saving and making regular payments, oppor-

tunities are created or individuals to manage

small amounts o money more eectively.

In the Philippines, the national insurer introduced

SMS payments o insurance premiums on a

ractionalized basis. This enabled individuals to

Digital EfficienciesDigitization leads to increases in productivity and transparency and

decreases in crime and human error

Productivity Gains: The use o ICT and digitization o data and processes saves time on

administrative tasks in healthcare and nancial services. Whether it is the cost savings as-

sociated with retrieving patient data in a timely ashion or the time saved not having to walk

to a bank, the economic benets are signicant due to reduced shoe leather and opportu-

nity costs. In addition, digitizing manual processes and data reduces errors that ultimately

adversely aect productivity.

Improved Transparency: Digitization o patient medical treatments and money move-

ment creates a level o transparency that can reduce raud and thet by creating an audit-

able digital trail and reducing the number o participants in the value chain. For example,

digital money acilitates direct payments rom the payer to the remote recipient o payment,

cutting out the middle man handling cash. This, in turn, ensures that less money is pocketed, or

leaked during the transaction. In addition, accessing patient data directly rom the sourceurther reduces the chances o incorrect or missing healthcare inormation used or making

diagnoses.


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pay smaller amounts o money on a weekly/

monthly basis, rather than larger payments

on a quarterly or hal-yearly basis. With lower

costs and greater convenience, participation

rates increased.

In Bangladesh, health micro-insurance is

provided to poor patients who pay yearly pre-

miums. Co-payments are made by the patients

upon visits to health centres. MFS can be used

in the uture in lieu o cash or these payments.

Using a mobile phone or insurance payments

and payouts signicantly reduces the admin-

istrative costs associated with providing insur-

ance to these customers.

Conditional Cash Transers: Patients

can receive conditional cash transers instantly

and electronically into their mobile nancial

services account. Fast, sae and ecient pay-

ment motivates patients to participate in the

healthcare system.

Future Uses o Mobile FinancialServices or mHealth

As mHealth continues to gain momentum and

more advanced remote services are oered,

electronic payments will be needed to support

these services. Today, there are one- and two-

way communications and inormation-based

mHealth services in emerging markets, such

as health hotlines.

These services are oten ree o charge or rely

on de acto airtime top-up systems as the

method o payment whereby a payer purchases

additional airtime minutes to pay or the

mHealth service or receives payment through

airtime minutes.

This system works well or low-value purchases

(equivalent o one rupee per day). However, as

the mHealth industry matures in these markets

and the services oered become more sophis-ticated, the value o the services will increase

such that one rupee payments through airtime

will not suce. At the point, mobile nancial

services and more robust third-party settlement

systems will be required to enable payment.15

For example, in the uture, as patients begin to

receive diagnostic care through decision support

systems enabled through a mobile phone, how

will payment be made between the user and

provider? Similarly, i a eld healthcare worker

requests expert clinical diagnostics through the

mobile phone, how will payment o that service

be made? Neither cash nor banking systems

can support remote money movement o

unbanked people. Mobile nancial services will

be the method to enable and settle these types

o mHealth transactional payments.

Driving Demand: mHealth spurs

Mobile Financial Services

Still in the early stages o development, there

are a number o uncertainties on the business

models o mobile nance services. With more

than 164 MFS initiatives deployed worldwide,

Maternal HealthThe Case o Maternal Health

Maternal health could greatly benet rom the use o mobile nancial services. Along the

continuum o the 14-month cycle o healthcare, there are key points where mobile nancial

access could address key issues in the patient, provider or service, and HR or administrative

levels o support.

Pre-Pregnancy: During the pre-pregnancy phase o care, patients can receive education

on amily planning, sexually transmitted diseases and other healthcare matters through

their mobile phone, paying or such services through airtime top-up minutes to the mobile

network operator or through MFS to the third-party provider o these services.

Pregnancy: During the pregnancy phase o care, MFS can be used or remote payment

and settlement o testing, lab work and remote diagnostics. MFS can be used as the method

o supply chain payments or prenatal vitamins. In the uture, healthcare providers may

use MFS to pay or remote access to a pregnant mothers electronic healthcare records.

Patients can receive conditional cash transers or participating in healthcare services

oered to pregnant mothers and healthcare workers can receive perormance-based

unding or successully completing various healthcare services or the patient. For those

pregnant mothers without insurance, prepaid savings accounts can be oered in preparationor upcoming delivery expenses.

Birth:MFS can be used or direct payment, co-payment or or third-party settlement o all

healthcare services associated with birth, rom ambulatory transport to hospital care.

Post-Natal:Voucher-based or direct mobile payments can be triggered via mobile or services

associated with post-natal care, such as inant immunizations. In the case o voucher

payments, a mother could sign up or post-natal services and receive a scratch card or

identication code which she could then present to the immunization clinic. That clinic would

send that code using their mHealth application to the provider or verication. I the code is

veried, the clinic would provide the services and receive immediate payment by the third-

party payer or the perormed service through the mobile nancial services system.


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only 10 have achieved a subscriber-base o

more than 1 million users.16 As such, there is a

widely recognized need or a strong use case

to spur adoption and unlock greater capital

lows.

As one o the most important industries globally,

health services may spur mobile money adop-

tion in markets with lagging mobile nancial

services uptake.

To motivate new users, enterprises and

governments to adopt a payment system,

there must be signicant value and a compelling

reason to change. Receiving money is a moti-

vator to sign up or a system. Payers sending

the money become the infuencers in the

system, virally signing up receivers o payments.

Key stakeholders in the healthcare industry

can act as the infuencers that spur sign-up

and usage o the mobile nancial services

system by using it or salary disbursements,

perormance-based unding, conditional cash

transers and conditional aid.

Sharing Common Building Blocks

Both the inance and health sectors share

common customers, inrastructure, business

processes and policy concerns. These shared

elements, i addressed in an integrated and

holistic manner, can serve to reduce ineciencies

and costs.

The Same End-users

In terms o serving their end-users at the

base o the pyramid, the mHealth and mobile

nance sectors have overlapping constituencies.

As such, there are potential cross-sector

eiciency gains in better understandingcustomer needs.

There is surprisingly little known about thecomplex needs o the poor, although they

represent approximately 40% o the world

population. According to The Portolios o the

Poor, Large surveys give snapshots o living

conditions. They help analysts count the num-

ber o poor people worldwide and measure

what they typically consume during a year. But

they oer limited insight into how the poor

actually live their lives week by week how

they create strategies, weigh trade-os and

seize opportunities.17

The nuances surrounding culture, socio-eco-

nomic status, access and literacy are complex

and can only be appreciated at the personal

and community level. Those who interact with

end-users in the eld have a wealth o under-

standing that is required or service providers

to adequately tailor services to meet the needs

o their end-users.

Uses of MFS for future mHealth applications (Source: mHealth Alliance and mPay Connect)


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Some o the key questions on end-users include:

What are the dierences between rural

and urban dwellers in the region?

What are the degrees o health clinic and

bank access?

Who are the infuencers in the communitywho can spur adoption?

What are the nancial and health literacy

levels o the end-users?

What role does gender play in mobile ac-

cess and use o such services?

Collectively, the nancial services, communi-

cations and health sectors have a common

opportunity to develop a richer understanding

o their end-users. From a digital perspective,

analytics on the data (and metadata) generated

in the use o these services can help stakeholders

within the mHealth and MFS ecosystem to

better understand individuals, their needs,

and behaviours.

O course, the principles and trust rameworks

or the sharing and usage o personal data

must be addressed by all stakeholders. It will

be critical to understand and agree upon what

aspects o data can be shared or optimizinghealth and nancial services while also main-

taining customer rights and the security/stability

o nancial and health delivery systems.

Common Building Blocks:Technology Inrastructure

As ICT-based solutions, mHealth and mobile

nancial services share a number o common

inrastructure elements that can be leveraged.

By sharing a common underlying technology

platorm, not only do both sectors save on

operational expenses, but the ability o their

systems to scale and handle additional com-

plexity is extended.

Front-end Efciencies: Given that both

inancial and health systems leverage the

mobile handset, the usability, accessibility andBetter information sharing creates a richer understanding of the individual (Source: mPay Connect)

The Efficiencies of User Centricity

As patterns o behaviour and needs o the poor become better known within communities,

both MFS and mHealth benet rom cross-sector knowledge to build better services that

tailor to their needs. For example, a micronance institution that provides micro-credit or

Raina Kapur understands that she is an infuencer in her community, works many hours on

her business, and has a strong track record o micro-credit repayment. Her mobile operator

knows that she is a heavy user o SMS and uses her phone requently, but may not know that

her phone is used to conduct her entrepreneurial endeavours that are nanced through her MFI.

At the same time, her healthcare worker knows she is pregnant and is prescribed with

prenatal vitamins. A holistic snapshot o Raina could reveal that she is an ideal candidate

or mobile nancial services or healthcare since she is mobile-savvy, needs to plan or

upcoming delivery costs through a prepaid savings account, has a strong nancial history

o micro-credit repayment, is a time-constrained entrepreneur and needs an easy and sae

method to purchase her vitamins. Because she is an infuencer in her community, she mayalso help others to adopt MFS and mHealth services.

Access to additional cross-sector data can assist with proling customers or credit and

reducing insurance risk. Some rms are now investigating new modelling techniques o

mobile usage to help determine credit worthiness or segments o the population with no

credit histories. I mobile usage could be an indicator, could healthcare patterns be as well?

Could a consistent pattern o healthcare usage combined with steady usage o money

transers suggest a liestyle that should have access to premium insurance and credit?

In addition, combining mHealth data collected in the eld through the mobile phone can

provide more robust actuarial data or determining insurance risk. The benets o better

actuarial data provide or more ecient orecasting or design o benets, reimbursements

and government-proposed standards on healthcare costs. O course, dening customer

rights and establishing rameworks around data privacy will be vital to these eorts.


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reliability o applications is vital to ensureadoption. Both sectors are impacted by the

users preerred mobile user interace, their

understanding o the device, the aordability

o the mobile phone service (device, data and

voice network, and tari structure) and the

accessibility to a reliable electricity grid or

recharging phones.

Back-end Platorms: There are com-

monalities in the back-end requirements or

mHealth and MFS systems. Both e- and

mHealth and mobile nancial service rely on ID

management, authentication, raud detection

and security or their platorms. By understanding

common requirements between mHealth and

MFS, back-end systems can be built to leverage

these common building blocks. Standardizing

these common areas at the platorm level will

enable cross-industry cost savings and the

possibility or easier integration among service

providers within and between both industries

in the uture.

The historical lack o electronic healthcare

management systems and nancial services

inrastructure in many emerging markets may

provide a possible advantage when creating

cross-sector platorms rather than integrating

legacy systems. This will enable superior cost

benets, decreased time to commercialize and

better ability to integrate MFS with healthcare

payments throughout the continuum o care.18

Donors and governments have the potential to

play an important role in bringing together the

key stakeholders to dene a common technol-

ogy ramework that can benet all relevant

stakeholders.

ID management is one example o an element

in the technology platorm that can be leveraged

by multiple entities.

As various entities deliver services to the same

individual, each organization aces the chal-

lenging questions regarding identity, including:

1. How does one ensure that this person

exists?

2. How does one authenticate and ensure

that the person is who they say they are?

3. How does one veriy that it was really the

person stated who received treatment at

clinic X?

4. How does one ensure that the insurance

rm, the payment settlement system

and medical clinic all recognize the same

person as the same individual and that

co-payment is made accordingly?

5. How does one ensure there are not

redundant, raudulent or misspelled

data entries o the persons name in the

mHealth and MFS systems?

For the delivery o personalized services, the

secure, reliable and condential validation,

authentication and management o identitysystems is critical. Absent these core enablers,

the opportunity or error, corruption and raud

is rampant. For example, a recent survey done

by the Food and Supplies department o Delhi

government on ration cards revealed that, in

the absence o a robust ID system, over 1.7

million ration cards were being issued to bogus

individuals. In act, they ound 901 dierent

records or the same name and address.19

An open issue or discussion, however, is i

one common ID system is needed. The role o

shared trust rameworks that provide dierent

actors the ability to provide dierent levels o

authentication and control or dierent classes

o activities is a growing area o ocus.

Common Building Blocks: Similar

Business Operations and Business

Model Elements

Both sectors gain advantages by leveraging

common business operations. In addition to

the cost savings associated with sharing

operations and inrastructure, both industries

may beneit rom pricing that takes into

account the needs o both.

Business Operations Last Mile

Human Agent Network: In providing

services to the poor, both industries still require

last mile, in-person relationships to reach

their customers. Oten reerred to as agentnetworks or telecommunications operators or

community health workers or mHealth, they

have a high degree o local knowledge and the

trust o the community. Along with providing

eedback and insights or tailoring the design o

appropriate and aordable services, these

individuals can act as the liaisons to educate,

train and register users or services.

In some cases, these trusted agents perorm

the mobile unctions on behal o the customer,

who may not have the level o literacy to be

able to complete the task themselves. In addition,

they perorm certain in-person services. For

instance, in the absence o extremely expensive

Example: ID Management (Source: mPay Connect)


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ATMs, mobile network operator (MNO) agentsact as human ATMs, taking cash-in and

disbursing cash-out o the MFS system.

Microinance institutions use their agent

networks to disburse and collect micronance

loans. In mHealth, community healthcare workers

and traditional healers provide healthcare

screening to patients.

Business Model: Both mHealth and MFS

share common concerns regarding business

issues on revenue models, cost structures,

sustainability and scale. In serving the lower

socio-economic sectors, service providers are

still challenged to achieve sustainable business

models. What is the pricing structure and who

pays or services or people earning less

than US$ 2/day? Individually a new venture

in mHealth or MFS can be custom built and

achieve some level o protability. But scaling

these individual pilots on a global basis remains

a long-term challenge.

For service providers that are not acility-based

mobile network operators, how do the various

ees and taris associated with voice, text and

data aect end-user adoption rates? Developing

a balanced pricing structure so the ees imposed

by the incumbent industry do not constrain

others is an open issue and a constraint on

achieving scale.

Both in mHealth and in MFS, the question o

who leads is non-trivial. In healthcare, who

should maintain and host the electronic health-

care record is dicult to answer and may be

determined in part by evolving policy on who

owns the health record (and can move its

location/hosting) and who determines who has

access to the record.

Similarly, who leads in MFS varies rom one

market to the next. In the case o MFS, regula-

tory policies are being developed to clariy

the role that inancial institutions and mobile

operators can play in rolling out such services.

In dierent markets, varying business models

Efciency gains in cross-sector agent operations: Given that both mHealth and

MFS require eld personnel to interact with the same user base, there are opportunities to

identiy common or redundant tasks that can be done by a shared resource. For example,

the unctions o signing up users, checking their ID and registering the mobile numbers19

may be points o redundancy that can be done by one rather than two or three separate

agent networks. In addition, there may be opportunities to do cross-sector training with

these agents to educate them on the various mHealth and MFS services.

Healthcare workers could augment their income by providing cash-in and cash-out services

where appropriate. Organizations are now beginning to test this concept. In India, there are

examples where healthcare workers act both as a healthcare liaison and as the registrant

or micro-insurance services using a handheld device.

Efciency gains in business models: Both MFS and mHealth are inherently depen-

dent on aordable pricing. Naturally, this can either have a positive or negative eect on

adoption. Pricing may be eective or person-to-person money transers but ineective or

delivering mHealth. For example, i the end-user ees or transerring money exceed the

price or receiving a particular mHealth service, the value breaks down.


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11

issuers and banks all have distinct areas o

competence.

However, the boundaries distinguishing where

one service begins and the other ends has

become murky. A ew key uncertainties in this

area include:

I nancial or medical SMS messages are

not received, is the mobile network opera-

tor liable or the adverse consequences?

Does an application on a mobile phone

also require device certication?

Can a mobile network operator be heldliable or malpractice in the event o a

security breach?

The digitization o healthcare and nancial

services also leads to questions o data access

and consumer protections. A r icher under-

standing o who has rights to access and

share such inormation, the types o data that

can be analyzed and the policies governing

customer rights are in their nascent stages.

Proportionality: A Conceptual

Framework or Managing the Risks

and Complexities o Innovation. As

MFS and mHealth sectors begin to tackle

questions o proportional customer documen-

tation, liability within complex ecosystems and

customer protections, these policies shouldsupport one another. As such, it will become

increasingly important or regulatory bodies to

be knowledgeable o how their counterparts

have tackled similar issues.

For example, in MFS, a common practice is totreat risks with proportional regulatory policies

around customer documentation at registration.

Accounts with lower transaction volume limits,

perceived as lower risk or money laundering

and terrorism nancing, may require relaxed

data requirements on the user or account

registration. Such proportionality could apply to

healthcare services and the level o requirements

imposed on service providers based on the

established criticality o care to be provided.

In addition, it may become important to consider

the possibility o organizational alignment with

policy decision-making that is horizontal in

nature, cutting across multiple sectors rather

than vertically-ocused within one industry.

Without a doubt, the level o coordination,

knowledge transer and collaboration among

disparate policy-making entities will be increas-

ingly crucial.

Conclusion and Next Steps

This paper set out to identiy synergies between

the nancial services and health industries as

a way to improve the health and wealth o the

poor. By understanding the interdependences

among mHealth and mobile nancial services,

cross-sector eciencies, innovative delivery

options and increased end-user adoption were

some o the key beneits. Scaling together,

the socio-economic beneits ampliy one

another.

Going orward, it will be critical to address the

ollowing key questions to realize the synergies

between the evolving mHealth and mobile

nancial service ecosystems:

1. What is the best method to drive these

eciency gains? Who will lead these eorts?

2. Who will build and manage the common

inrastructure and distribution networks?

3. How will the various cross-sector policy

rameworks be coordinated and harmonized?

4. How will integration and interoperability o

disparate technologies across multiple in-

dustry and public sector domains occur?

How will these eorts be driven? What will

Key Stakeholders (continued)

tions are well capitalized to drive such eorts, although innovation is oten stymied

by the size o the organization. Start-ups oten move at the astest pace to drive

innovation, but lack the resources to achieve scale quickly. Banks look to participate

in the growing market o banking the unbanked by acting as the wholesale holder

o aggregate unds or a retail partner to mobile network operators or other third party

providers in reaching unbanked segments. Various models are being tested around

acquisition, partnership and joint ventures among these various constituents to bring

MFS to market.

Donor Communities: Donors provide grants or mHealth and MFS programmes that

enable access to critical health and nancial services or the poor. By supporting eorts to

pilot and commercialize mHealth and MFS initiatives, donors strive to achieve their missions,

whether the missions involve increasing the health or nancial quality o lie or the poor.

Health Service Agents (Community Healthcare Workers and Traditional Healers):

mHealth provides access to expert advice or community healthcare workers and enables

them to eciently transmit critical aggregate data back to centralized acilities or analysis.

MFS enables healthcare workers to received prompt payment or salary and services per-

ormed while reducing leakage associated with raud due to lack o traceability o cash.

Mobile Financial Services Agents (MNO Agents, MFI Agents and Others):

Independent airtime top-up agents are oten the points or cash-in and cash-out o mobile

nancial services systems driven by mobile operators. MFI community workers, retailers,

remittance operators and post oce workers are other orms o agents that can reach rural

communities and act as cash-in and cash-out points. These agents are motivated by the

commissions they receive or exchanging cash into digital mobile money and vice versa.


14/18


15/18

Continuous eort, not

strength or intelligence,

is the key to unlockingour potential.

Winston Churchill


16/18


14

1

1.5 billion people worldwide live without access toelectricity and many more whose energy services are either

sporadic or cost-prohibitive, New York Times, World

Bank Pressured on Clean Energy, 11 October 2010.

2 CGAP, Health Issues, Anup Shah, 2 October 2010.

3 Strategy on Health Care Financing or Countries o the

Western Pacic and South-East Asia Regions (2006

2010), World Health Organization.

4 GSM Association, Mobile Money Deployment Tracker,

2010.

5 Mobile penetration rates are orecast to rise rom 46%

in 2008 to 95% by 2013 according to a new survey o 34

emerging market countries, Tari Consultancy Ltd. By

2013 there will be well over ve billion mobile phones glob

ally. In contrast, there will be only 2 billion computers.

CGAP Banking on Mobiles: Why, How, and For Whom?

CGAP October, 2008.

6 M-Paisa: Ending Aghan Corruption, One Text at a Time,

Monty Munord, 17 October 2010.

7 Vodaone interview.

8

Drug countereiting is a particularly serious issue in thepharmaceutical industry. Mobile systems such as Sproxil

are now being used to identiy countereit drugs by en-

abling supply chain participants and patients to send a text

message through their mobile phone that contains the

code on the drug packaging or verication o authenticity.

To the extent that payments are made electronically rather

than in cash, combining systems like Sproxil with mobile

nancial service payments provides the ability to pinpoint

who paid, who purchased, and where countereiting issues

may have arisen throughout the supply chain.

9 Portolios o the Poor, Daryl Collins, Jonathan Morduch,

Stuart Rutherord, Orlanda Ruthven.

10 m-Pesa Marches on, on Financial Access Initiative by

Jake Kendall, 28 October 2010.

11 Kenya: Medical Smart Card Extended to Maternal

Care, Susan Anyangu-Amu, 15 August 2010.

12 Ibid.

13 In Kenya, Patients held hostage to Medical Bills,

Los Angeles Times, 28 June 2009.

14 Kenya: Medical Smart Card Extended to Maternal Care

by Susan Anyangu-Amu, 15 August 2010.

15 Note: It is also important to understand that airtime minutes

is not currently recognized as a true currency and, thereore,

has signicant regulatory limitations as the de acto method

o payment beyond certain uses.

16

GSMA Development Fund Mobile Money Tracker,December 2010.

17 Portolios o the Poor, Daryl Collins, Jonathan Morduch,

Stuart Rutherord, Orlanda Ruthven.

18 Note that one area specic to e-/and mHealth in the

platorm unction that is not directly addressed in MFS is

Access Control due to the dierent levels o data rights

and constituents associated with access to health care

records.

19 Ration card scam: Govt probe to gun or PDS maa,

Express News Service Posted: 9 July 2008.

20 Narayana Hrudayala Heart Hospital: Cardiac Care or the

Poor, Tarun Khanna, V. Kasturi Rangan, and Merlina

Manocaran. Harvard Business Review, 25 April 2006.

Copyright 2011 by the World Economic Forum All rightsreserved. No part o this publication may be reproduced,

stored in a retrieval system, or transmitted in any orm

or by any means, electronic, mechanical, photocopying

or otherwise without the prior permission o the World

Economic Forum.


17/18

Special thanks to:

Kaosar Asana, MD, MPH, PhD

Associate Director, Health Programme

BRAC

Samuel Agutu

Managing Director, CEO

Changamka

Ben Bellows, MPH, PhD

Associate and Program Manager

Population Council

Peter Berman, MSc., Ph.D

Lead Health Economist, HDNHE

The World Bank

Mohini BhavsarResearcher

MobileActive.org

Alison Bloch, MBA, MPH

Managing Partner, mHealth

Arc Spring Group

Karl Brown

Associate Director, Applied Technology

Rockeeller

Joaquim Croca

Head o Vodaone Health SolutionsVodaone

Jacques De Vos

Director, Business Development

GeoMed MIT

Melissa Densmore

PhD Candidate

UC Berkeley School o Inormation

Rose Donna

Director

DataDyne.org

Jonathan Donner, Ph.D

Researcher, Emerging Markets Group

Microsot Research, India

Daniel Feikin, MD

Johns Hopkins, Bloomberg School o

Public Health and Centers or Disease

Control and Prevention

Harry Greenspun, M.D.

Executive Director and Chie Medical Ocer

Dell Healthcare Services

Vicky Hausman

Associate Partner

Dalberg Global Development Advisors

Ashok Kaul

Vice President, Healthcare Convergence

Wireless Lie Sciences Alliance

Ramesh Kesanupalli

Chie Technology Oicer

Validity Inc.

Gavin Krugel

Senior Director

GSM Association

Raina Kumra

Senior New Media Advisor, Oice o eDi-

plomacy- Diplomatic Innovations Division

United States Department o State

Alain B. Labrique, MHS, MS, PhD

Assistant Proessor, Department o Inter-

national Health & Department o Epide-

miology (jt.), Program in Global Disease

Epidemiology and Control

Johns Hopkins Bloomberg School o Pub-

lic Health and Centers or Disease Control

and Prevention

Ben Lyon

Executive Director

Frontline SMS: Credit

Brad Magrath

Regional Director

Mobile Transactions

Rakesh Mahajan

Vice President, Marketing and Head o

VAS & Incubation

Bharti Airtel Limited

Kerry McDermett

Expert Advisor, National Broadband Task

Force, Oice o Strategic Planning and

Policy AnalysisNational Federal Communications Commission

Patricia N. Mechael, PhD MHS

Director o Strategic Application o Mobile

Technology or Public Health and Development

Center or Global Health and Economic

Development, Earth Institute, Columbia

University

Robin Miller

Senior Consultant

Dalberg Global Development Advisors

Josh Nesbit

Executive Director

Frontline SMS: Medic

Nick Pearson

Founder

Jacaranda Health

Jody Ranck, PhD

Executive Team Member

mHealth Alliance

Joel Selanikio, M.D.

Director

DataDyne.org

Mary Taylor

Senior Program Oicer

Gates Foundation

Ken Warman

Senior Program Oicer

Gates Foundation

Tim Wood

Director, Mobile Health Innovation, ICT Innovation

Grameen Foundation

Thierry Zylberberg

Executive Vice President, Head o Orange

Healthcare Division

France Telecom

At the World Economic Forum

Proessor Klaus Schwab

Executive Chairman

Olivier Raynaud

Senior Director, Head o Global Health and

Healthcare Industries

William Homan

Associate Director, Head o Telecommuni-

cations Industry

At the mHealth Alliance

David Aylward, JD

Executive Director

mHealth Alliance

Clive Smith

Executive Team Member

mHealth Alliance

Special Acknowledgement To:

Ms. Menekse Gencer o mPay Connect or

her support and authoring o this paper


18/18

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