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 Ollissollis@d-tree.org+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 Analystjudy.gold@mariestopes.org

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

.

Mobile Money @ MSI SLIDE 52

Thank you for your attention

judy.gold@mariestopes.org

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

Hamilton.McNutt@nethope.orgTwitter: @hamiltonmcnutt