Want to use digital financial services in health projects? Read this first

mSTAR and USAID will be hosting a webinar on how to incorporate digital financial services into health projects on April 4th. Register for the webinar here. 

By Ellen Galdava

The digital revolution is paving the way for development practitioners to use ICT to overcome economic and social challenges. More and more health initiatives are leveraging mobile and wireless technologies to improve outreach, data collection, communication with health workers, case management, referrals and much more. Governments are increasingly investing in health management information systems and open source human resource solutions to enable timely data access, inform resource allocation and intervention targets, and make decisions on performance objectives.

The application of digital financial services (DFS) in the health sector is also becoming increasingly wide-spread. To explore the ways DFS can be used to improve health outcomes, mSTAR and USAID wrote a brief on the role of digital financial services in accelerating USAID health goals. While DFS encompasses a variety of electronic payment channels, such as cards, computers and mobile-based payment platforms, most case studies in the health sector focus on mobile money via phones, given its wide reach into under-served segments and geographies. With 174 million active accounts worldwide, mobile money services are now available in two-thirds of low- and middle-income countries and have aided in the decline in the number of unbanked individuals.

By incorporating DFS and leveraging transaction data, donor-funded programs can improve program monitoring and gain valuable insights into the cost of health products and services. DFS can also improve access to insurance and health savings products (and consequently access to health care) by making financial transactions more convenient. DFS boosts resiliency and consumption in the face of economic shocks, including illness.

But how can donor-funded health projects use DFS? At a recent workshop mSTAR, USAID and members of the health and DFS sectors discussed and outlined five key considerations for implementing DFS in health projects.

  1. Create a regulatory framework

Unlike traditional financial services, DFS requires third-party agents or collaboration among banks and telecommunication companies. This collaboration across many stakeholders can increase chances of fraud due to more people and companies along the chain. Therefore, to safeguard customers from potential fraud, liquidity and other DFS-related concerns, effective and appropriate DFS regulations need to be in place before transitioning a project from cash. Additionally, without an appropriate regulatory framework, there is limited chance to create an innovative, sustainable and financially inclusive DFS ecosystem.

  1. Digitize the entire value chain

In order to successfully introduce digital financial services in cash-based projects, all business processes from payee registration and identification to delivery of funds should, ideally, be digitized. If back-end processes still require manual approvals and signatures, payment delays will continue to occur and beneficiaries or implementers will not be able to fully utilize the benefits of DFS.

  1. Empower governments for sustainability

The first stages of implementing DFS in any health-related project require partnering with, training and empowering government officials to ensure that they see the benefit of DFS and have stake in continuing the move towards a cashless society. The support from government and their active participation in the process provides implementing partners with important resources to support project transitions, from enrollment into dissemination of funds via DFS. This is well demonstrated in mSTAR’s Liberia project where the government of Liberia worked with the project team to onboard health and education workers onto mobile money salary payments, ultimately enrolling around 5,000 health and education workers into the program.

  1. Conduct a cost-benefit analysis of transaction fees

While DFS reduce costs associated with cash distribution to beneficiaries, there are transaction fees associated with DFS. When transitioning to mobile payment systems it is important to account for transaction fees, such as cash out fees for customers, since these fees might be a barrier to usage and might be viewed as an extra cost compared to making or receiving cash payments. To offset this, during the planning stage, programs should conduct a cost-benefit analysis to compare the cost of digital versus cash payments for all stakeholders involved. This type of analysis will also help demonstrate the relative cost savings of using digital channels and help justify government or donor subsidization of transaction fees for beneficiaries.

  1. Improve digital literacy

Although mobile payments improve convenience and lower expenses for health workers, beneficiaries in most markets lack familiarity with and trust in conducting financial transactions via mobile or other digital channels. Customers face numerous challenges, including connectivity disruptions, literacy issues that prevent reading text alerts and navigating mobile money menus, and potential fraud at agent outlets if customers are unfamiliar with processes or transaction fees. Initial training and ongoing support channels should be provided to beneficiaries to improve digital literacy and to help them to understand mobile money transactions and other related issues.

As demonstrated in the Role of Digital Financial Services in Accelerating USAID’s Health Goals brief leveraging DFS in health projects provides valuable benefits to projects and beneficiaries. In addition to those benefits already mentioned, DFS brings healthcare to vulnerable populations across the world. However, before introducing DFS in projects it is important to consider these five factors in order to successfully integrate it and realize its benefits.

To learn more on how to incorporate digital financial services into health projects, don’t forget to register for a webinar with mSTAR, Telenor Health and USAID on April 4th. Register for the webinar here. 

Ellen Galdava is a Program Officer at FHI 360. Ellen has been managing programs in international development and ICT4D for four years. At FHI 360, she manages an ICT for agriculture program and leads research related to digital financial services in education, health and youth, and ICT and agriculture. Prior to joining FHI 360, Ellen supported the development of an online class curriculum on Corporate Sustainability for undergraduate and graduate students from Eastern Europe. She holds a Master of Science degree from Conflict Analysis and Resolution, George Mason University.

A New Era in Agriculture is Underway – A Look at Digital Farmer Profiles with GSMA’s mAgri

The advent of digital farmer profiles might lead to a new era in agriculture. Mobile technology, remote sensors, blockchain and big data are beginning to transform the lives of smallholder farmers, changing how farmers grow food, access credit, apply pesticides and so much more.

mSTAR interviewed Daniele Tricarico from GSMA’s mAgri Programme. The mAgri Programme, profiled in the new report, Digital Farmer Profiles: Reimagining Smallholder Agriculture, forges partnerships between mobile operators, technology providers and agricultural organizations. By providing deep technical expertise to service providers, it supports scalable commercial mobile services that impact smallholder farmers and the agricultural industry at large. This interview is part of a 2-post blog series on digital farmer profiles.

mSTAR: What are digital farmer profiles in your own words, and what promise do they hold for smallholder farmers?

Daniele Tricarico (DT): With digital farmer profiles, we are looking at “functional identities” that are created via digital means. Functional identity can be defined as a form of identity that is created with a specific purpose in mind, such as enabling unbanked farmers to access financial services and therefore improving their livelihoods. A functional identity, developed and issued for a single, well-designed purpose or service, is usually created with the support of private organization (e.g. mobile operators, banks, agribusinesses). The purpose we are interested in, at the GSMA mAgri, is to enable access to financial services (e.g. credit, insurance). We are also interested in understanding how mobile-enabled digital profiles can help farmers comply with traceability and certification requirements in agricultural value chains, so they can improve their agricultural practices and products and have access to better prices. As private organizations play a key role in creating functional identities, we are working to understand how farmers can maintain visibility, control and ultimately ownership over their digital profile through mobile.

mSTAR: How does GSMA’s mAgri Programme help harness data for the benefit of smallholder farmers?

DT: The GSMA mAgri Programme is working to support the digitization of agricultural value chains. Our objective is to use mobile technology to address a number of pain points in the agricultural last mile, the final link in the value chain between buyers and sellers of crops. By digitizing the last mile, we want to address pain points associated with handling cash (risk and security) that are experienced by buyers (agribusinesses and cooperatives) and farmers in agricultural value chains. A key entry point to last mile digitization is the transition from cash to digital payments from agribusinesses to farmers for the procurement of crops. By facilitating this transition, we can address key business problems experienced by agribusinesses and generate crucial socioeconomic impact for farmers. Digitizing the main cash inflow of agricultural households (the agri payments) and moving physical cash into digital wallets in rural areas is fundamentally an entry point to financial inclusion for unbanked rural families. The transactional data that is generated in the last mile (e.g. mobile money transactions, digital receipts), as well agriculture-specific data and alternative datasets, such as mobile voice and data usage, can all be used to build an economic profile (or a functional identity) for the farmer, helping them over time to access formal financial services.

At the GSMA mAgri, we have unique relationships with agribusinesses and mobile operators that host a number of data points to create digital farmer profiles. At present, we are working very closely with our partners to develop a solid understanding of what kind of farmer and farm data is required for different purposes. Besides ensuring that farmers maintain overall understanding, visibility and control over the data they share with third parties, we also want to ensure that they are not overburdened to provide data that does not contribute significantly to the analytics behind the service and to the ultimate purpose of the service itself (financial inclusion, traceability and certification). When we try to build a farmer profile, we are aware that to date, there are no standardized components of what a given profile should be for a specific purpose, so there is risk of “over-collecting” data that is in fact not needed.

 

 

mSTAR: What are some of the drawbacks to digital farmer profiles? How is GSMA working to tackle these?

DT: We have mentioned above issues of data ownership and control. Simple awareness and education on the part of the farmer on how data is used by a third party is a fundamental issue, even before we start thinking about data ownership and control. To address these key challenges, we must build awareness and create a strong value proposition for farmers. At GSMA mAgri, through working on designing and developing information services (agricultural value-added-services) targeting smallholders, we have developed expertise on how to design mobile-based services around the specific needs of farmers. Based on this experience, we emphasize the importance of taking a human-centered design approach. We have also developed expertise on how to educate farmers on the value and purpose of digital services and on how to on-board them on the services. We are now taking the same approach into our new work on supporting the digitization of agricultural value chains and in developing digital farmer profiles.

Besides awareness, education, and data ownership and control on the part of the farmer, we also see some systemic challenges in creating digital farmer profiles mostly related to availability of data and maturity of certain technologies. When it comes to geo-data from satellites (e.g. vegetation indexes, land mapping), for example, there is data becoming available that can support digital farmer profiles. However, other technologies that can be used to generate farmer/farm profile components such as drones are not widely available or at scale yet.

mSTAR: USAID has identified sustainability as a main challenge to digital farmer profiles, for example, identifying how digital farmer profiles can be sustained without NGO or government support. Do you see sustainability as a challenge for digital farmer profiles and if so, how can this challenge be solved?

DT: Sustainability is certainly a major challenge, however if there are solid use cases for digital farmer profiles, the sustainability challenge will be eventually addressed. The strength of taking a value chain approach to digital intervention, which is what we are doing at the GSMA mAgri, is that we work in partnership with the buyers in agricultural value chains to implement digital tools that can address their pain points as well as those of the farmers they work with. Working with the value chain, digital farmers’ profiles can be sustained because there is a commercial interest for value chain actors to access and support the creation of these profiles. For example, there is commercial interest to support traceability and certification in agricultural value chains or to provide financial services and strengthen the productivity and output of the farmers the agribusinesses work with. Mobile operators can also play a key role in sustainability by providing centralized farmer profile storage.

Daniele Tricarico is the Insights Director at GSMA mNutrition, comprising of the mAgri and mHealth programmes. In his role, Daniele leads the insights and publications work stream for both programmes. This work stream includes intelligence and analysis on the opportunities within the mAgri and mHealth sectors, as well as monitoring, evaluation and learning (MEL) and user experience (UX) research for mNutrition partners. Prior to joining the GSMA, Daniele was a senior telecoms analyst at Pyramid Research and Informa Telecoms & Media, focusing on consumer services in emerging markets. Daniele holds an MSc in new media and information systems from the London School of Economics and an MA from the University of Bologna.

Additional Links

Photo credit: Morgana Wingard, USAID

Are the Days of Rotting Produce Behind Us? An Interview on Digital Farmer Profiles with Andrew Mack

An agriculture revolution may be on the horizon. Mobile technology, remote sensors, blockchain and big data are beginning to transform the lives of smallholder farmers, changing how farmers grow food, access credit, apply pesticides and so much more.

mSTAR interviewed Andrew Mack, the Founder and CEO of Agromovil and the Principal of AMGlobal Consulting. Agromovil, profiled in Digital Farmer Profiles: Reimagining Smallholder Agriculture, the new report from mSTAR, USAID, Feed the Future and Grameen Foundation, matches farmers, transporters and purchasers to get crops to market faster, capturing value for smallholders and consumers. Agromovil has won a World Bank-supported startup competition, graduated from USIP’s PeaceTech Accelerator and is set to launch in Colombia in early 2019. This interview is part of a 2-post blog series on digital farmer profiles.


mSTAR: What are key issues smallholder farmers face today?

Andrew Mack (AM): Farmers around the world are producing more and are more and more connected to “best practices.” But farmers today lack two key things:

1) An easy way to get products to market when products are at their freshest and most valuable, and

2) A simpler way to connect more directly with markets, bypassing some of the many intermediaries that siphon off the value of their production in the current agriculture ecosystem.

mSTAR: What is Agromovil and how does it use data to tackle those issues?

AM: Agromovil is an app-based platform that helps make the match between producers, transporters and offtakers. It allows farmers to match with the transport they need, when they need it and to find buyers that use the platform (called the MATCH). It enables transporters to build optimized routes picking up from various small farmers, making transport more efficient and profitable, and getting crops to market when needed (the BATCH). And, it enables all parties to pay on the platform, avoiding the need to take large amounts of cash to the field, making transactions safer and helping bring small farmers into the banking system and building credit histories (the PAY). Using data around location and production, our algorithms for optimized pickup and our matching functionality enable big efficiency gains. MATCH, BATCH and PAY is simple for everyone to understand.

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mSTAR: How did you come up with the idea for Agromovil?

AM: I have spent more than 30 years working around Africa and Latin America. Everywhere I go I have seen the same image — a smallholder farmer sitting by the side of the road with his or her bags of produce waiting for transport, waiting while the fruits of their labor and the economic future of their families go bad in the hot sun. After a particularly busy four years of travel, touching more than 20 global south countries, I created a team at the office to look into the issue and found two interesting things.

1) We found that that the market need for a solution was enormous (over 30 percent of crops never make it to market in nearly every emerging market and $150 billion in loss each year).

2) We found that new connectivity and demographic trends, like younger farmers returning to take over land farmed by their parents, meant that the underpinnings of a new dynamic were there. Three years ago, a solution like Agromovil wouldn’t have been possible, today it is.

We got to work, building partnerships with Carnegie Mellon University, the Toyota Mobility Foundation, co-ops and banks, and working with farmers, transporters and experts in the development agencies. We did a lot of listening and refined our ideas. It has been amazing.

mSTAR: What are keys to make digital farmer profiles successful for smallholder farmers?

AM: Digital farmer profiles need first and foremost to be relevant to the number one issue for farmers. The number one issue is not the quality or quantity being produced, it is income. Farmers are simply not earning what they should be earning. Transporters are working too hard to pick up too few goods and offtakers are paying too much — they would also like to get their goods more directly.

Profiles need to focus on production as a business. We do this by enabling ratings, helping create credit and payments histories and in other ways. There is tremendous value in the production and simple business data that is trapped (along with goods) inside the current inefficient ecosystem. This value needs to be captured more efficiently.

mSTAR: USAID has identified sustainability has a stumbling block for the success of digital farmer profiles. How do you see getting around this stumbling block?

AM: No part of technological innovation exists on its own. All pieces need to return to the key needs of producers and the parties that serve them, and this means money. Sustainability will come when farmers are able to unlock the “freshness premium” that consumers will pay. It will come when transporters can unlock a “route premium” and more efficiently serve small and remote communities. And it will come when farmers and buyers can capture a “directness premium,” bypassing intermediaries that cost a lot but add little value. Our goal is to create more than sustainability. We’re aiming to help the sector grow, and all of this depends on unlocking trapped value.

Andrew Mack is internationally-recognized for his work on corporate social responsibility, public-private partnership, and Internet policy, working with clients like Chevron, AT&T, Anheuser Busch, ICANN, the World Bank and Toyota. 

Watch mSTAR’s new video on digital farmer profiles below:

Additional Links

SMS Immunization Reminders Are Great, But Digital Financial Services Can Make Them Better

By Trinity Zan

On December 12th, mSTAR and USAID are hosting the launch of a guide detailing how digital financial services can accelerate USAID health goals. If you are interested in attending the launch, please register here.

As someone who works to expand access to quality health services in low- and middle-income countries, I’ve watched mothers waiting in line at immunization clinics stare at their mobile phone screens like in any waiting room around the world. Until recently, however, I didn’t fully realize that they just might be accessing a health savings account, checking their insurance, or paying a healthcare bill. I’ve noticed how mobile phones seem nearly universal in low- and middle-income countries and how easy it is now to use mobile phones to send money, settle a bill or even pay taxi fare, yet I haven’t been as familiar with how mobile phones and digital technology can enable financial services that improve health care services.  

My colleagues at the USAID-funded and FHI 360-led Mobile Solutions Technical Assistance and Research Project (mSTAR) have developed a forthcoming brief illustrating how digital financial services (DFS) — banking, insurance, and payment services (including savings, loans, remittances, and bill payments) that are enabled via electronic channels — can enhance and strengthen global health programs. The brief offers concrete examples in an easy-to-follow format organized around the USAID Health Systems Strengthening (HSS) Framework (which pulls directly from the WHO Health Systems Strengthening Framework). A workshop will be held on December 12 to dive into the guide and help health practitioners understand how to implement DFS in their work (email mSTAR_Project@FHI360.org to learn more or register here), but for now, here is a sneak-peak of how DFS can support two HSS components.

Human Resources

What if health workers could be paid via mobile money just as easily as you pay a bill online? In Sierra Leone, inefficient cash payment processes led to health and frontline response worker strikes during the 2014 Ebola crisis, crippling efforts to provide critical care and containment. The United Nations Capital Development Fund in collaboration with the Government of Sierra Leone’s National Ebola Response Center, implemented the Payments Program for Ebola Response Workers to digitize hazard payments for health and frontline response workers during the height of the crisis. Digital payments reached 98 percent of the 30,000 response workers (29,400 workers), saved an estimated $10 million USD in security and other costs associated with moving cash, and reduced payment time for health workers from one month to one week, preventing the loss of an estimated 800 working days and saving over 2,000 lives by eliminating response worker strikes.

Service Delivery

Could financial incentives delivered efficiently to hard-to-reach populations help improve uptake of critical health services? The Mobile Solutions for Immunization (M-SIMU) cluster-randomized controlled trial in Kenya tested whether SMS reminders and incentives motivate beneficiaries to get their children immunized. The trial successfully improved the timeliness of immunizations with SMS reminders coupled with monetary incentives delivered digitally. M-SIMU achieved these results despite the fact that over half of participants shared a mobile phone with another caregiver, demonstrating that digital payments can deliver behavior change incentives even among populations that may not own their own mobile phones.  

Could DFS help those at the bottom of the pyramid to save and pay for preventive and curative health services? Globally, micro-insurance via mobile channels is growing steadily, with 93 live services in 27 emerging markets as of 2018. Public and private insurance providers are using mobile payment channels to extend insurance to new markets and population segments. The Kenya National Hospital Insurance Fund (NHIF) used mobile money to facilitate premium collection among informal sector populations. To accommodate the irregular incomes of informal sector workers, NHIF used M-PESA to allow incremental payments for monthly premiums, which helped reduce penalty charges for missed payments. M-PESA also lets family and friends send remittances to cover premium payments.

Similarly, a company called MicroEnsure partnered with mobile operators to provide products including their mobile-based hospital cash insurance product and scaled to 63 million enrolled customers across 11 countries within four years. The hospital cash product provides a simple cash payout for a hospital stay of three nights or more and is paid directly to the patient instead of the provider. This allows the patient to use the funds to cover non-medical expenditures such as travel costs, which can be as much as 40 percent of the total cost associated with hospitalization. The service uses a simple digital registration and digital claims processing, including using WhatsApp to submit pictures of receipts.

As digital technologies become more ubiquitous, those working in the health sector are considering their use to help improve counseling, support adherence and change behaviors. However, this new brief suggests that we should begin paying attention to how digital financial services can reduce inefficiencies and strengthen systems, thereby helping us to achieve our ultimate health goals. Register for the workshop on December 12th to learn more!

TrinityZan

Trinity Zan, MA, has 17 years of experience working in international development in sub-Saharan and francophone Africa. As a Technical Advisor in FHI 360’s Research Utilization unit, she works on building research-to-practice linkages and promoting best practices in family planning and sexual and reproductive health. Her subject matter expertise also includes mHealth and scale-up. Trinity is a key member of the team that developed Mobile for Reproductive Health (m4RH), a mobile-phone based information service that has won several awards, including from Women Deliver and the African Development Bank. She serves as FHI 360’s lead for digital health under the USAID-funded Knowledge for Health II project. She is currently co-chair of the Global Digital Health Network.

Feature photo by Eric Podberesky/FHI 360

From Out of Reach to At Your Fingertips: How 1.4 Million Kenyans are Gaining Access to Healthcare

Digital financial services provide a way for practitioners to strengthen health programs and improve health outcomes, yet few have recognized their full value. In Kenya, where lack of money prevents two out of five people from seeking treatment, a new digital platform is helping to make healthcare affordable and accessible. Known as M-TIBA, the platform enables users to access health savings accounts and pay for insurance premiums, all at a low cost via the mobile phone. The platform has potential to offer more in the future, with the M-TIBA team currently working on an emergency loan for medical expenses. More than 1.4 million users have joined M-TIBA, with users and insurance policies growing each day.

mSTAR interviewed Kees Van Lede, CEO of CarePay Limited, the developer and administrator of M-TIBA, to illustrate how digital financial services like M-TIBA are changing the face of healthcare.

On December 12th, mSTAR and USAID are hosting the launch of a guide detailing how digital financial services can accelerate USAID health goals. If you are interested in attending the launch, please register here.


mSTAR: In your perspective, what is role of digital financial services (DFS) in strengthening health systems and what can be done to further its use?

Kees Van Lede (KL): In Kenya, two out of every five people who need healthcare do not seek treatment because they lack the money. Nearly half of all healthcare expenditures in Kenya are paid out-of-pocket, which is a burden for millions of Kenyans. Demand for health financing solutions, such as insurance, remains low – despite massive progress over the last few years.

Digitization and mobile money, in particular, has improved access to most of what we need in terms of goods, activities and services. For a few years now, this has also been happening in healthcare. Getting access to dedicated health savings accounts, being able to pay for insurance premiums and the ability to get an emergency loan for medical expenses all have been made available at low cost to the masses via the mobile phone, enabling more and more people to take control over their health expenditure.

mSTAR: Safaricom, CarePay and PharmAccess Foundation created M-TIBA, a digital health payment platform. Can you briefly explain M-TIBA? 

KL: M-TIBA manages healthcare payments and treatment data between funders, patients and healthcare providers. M-TIBA is a proven health payments integrator, revolutionizing the management of large-scale health schemes and supporting the drive for universal health coverage in Africa. Individuals are using their mobiles phones to save money for treatment and pay for health services and health insurance such as the NHIF (Kenya’s public health insurance agency) through the M-TIBA platform. M-TIBA can also be used by its members to transparently identify the care that can be accessed, and at what price, through a simple app that works on any phone (including non-smartphones). M-TIBA is also used by healthcare providers to submit medical claims digitally, allowing insurers to efficiently review and pay out claims even within a day after the treatment. The enrollment, financial and medical data gathered in all the outlined steps is then shared with key stakeholders in customized dashboards and reports, giving valuable insights into disease patterns, costs of treatment and health seeking behavior. M-TIBA now has 1.4 million users and is growing by thousands of new users and insurance policies a day.

PharmAccess and Safaricom are founding partners in creating M-TIBA. PharmAccess acts as  a thought leader in innovation on demand-side and supply-side financing and in improving the quality of healthcare in Africa, while Safaricom is the leading mobile telecommunications company in Kenya and has demonstrated market leadership in mobile payment services under their M-PESA brand. CarePay is the developer and administrator of the M-TIBA platform.

clinic picture2mSTAR: What are some of the major challenges and successes of M-TIBA? 

KL: M-TIBA has helped build improved insights into healthcare usage and the quality of delivery thereby changing behaviors amongst vulnerable and indigent groups by sensitizing them to making small, regular payments towards a health-financing scheme.

To date, more than 850 healthcare providers have been activated on the platform and a further 1,400 providers contracted. M-TIBA partners have recorded over 273,282 visits and paid out over Kshs. 476,453,810.

Despite the successful results, savings still present major challenges for individuals. A significant share of the population has no sufficient income to allocate savings regularly towards their health. There is also the fact that some individuals remain averse to using funds they feel are for a speculative need while they have other immediate needs for the money. With the help of the behavioral economists from the Center for Advanced Hindsight of Duke University, we are constantly trying to “nudge” people to do the right thing, despite these challenges described.

mSTAR: In developing countries, healthcare inclusion can be a challenge. How do you believe M-TIBA and other DFS systems can increase health care inclusion for low- and middle- income households?

KL: M-TIBA is transforming how low- and middle-income Kenyans are paying for and accessing healthcare. M-TIBA builds trust that resources are being spent for the right person, for the right care, at the right place, at the right time, at low transaction costs.

With the majority of Kenyans excluded from mainstream health insurance schemes, M-TIBA empowers them to take care of their own healthcare. It is providing long-term benefits to individual customers and the entire healthcare sector.

Users of M-TIBA can save for medical care and pay for and manage their insurance policy in a user-friendly way. For instance, we send regular reminders to people to pay their premium on time and make it a very simple process on their mobile phone to do so. They can also send healthcare funds from their own M-PESA accounts into the M-TIBA account of their dependents, specifically for healthcare needs. The platform channels funds for health services directly to recipients through the mobile platform, allowing them to track and monitor the use of funds effectively.

CarePay is working with a range of health financers on the M-TIBA platform, including government insurance agencies (e.g., NHIF), private insurance companies and brokers (e.g., AON/Minet, UAP), to develop applications for medical payments, remittances, savings and insurance. By working with public and private insurers alike, we aim to have the largest impact across all income groups in the population.

mSTAR: What do you see as the emerging trends in DFS and health?

KL: We truly believe that mobile phone is the key to not only unlock more pre-payments and risk pooling for healthcare in emerging markets, but also to build constant and engaging relationships between payers (public and private health insurers, but also donors) and their members/beneficiaries. If we get this combination of risk pooling and customer engagement right, we can both stimulate and even financially reward healthy behavior, while decreasing healthcare costs for the payer at the same time.

And the most exciting thing for us at CarePay is that, just like Africa led the way when it came to mobile payments, now Africa again may be able to leapfrog the developed world when it comes to such breakthrough innovations in mobile technology.

mSTAR and USAID will be releasing more blogs on the power of digital financial services to strengthen health outcomes. Stay tuned to learn creative ways health practitioners can implement digital financial services in their programming.

Website and Additional Links

Kees Van Lede is a Co-Founder of CarePay and has worked extensively in Africa and Europe in the FMCG and technology sectors. Prior to becoming CEO, Kees was the Chief Commercial Officer at Carepay. Kees was previously the mHealth (mobile health) Director of PharmAccess Foundation. In that position he led the organization’s mHealth activities in Kenya and the incubation of CarePay. Kees has also worked for Guidion and Unilever. He holds a Master’s degree in Applied Physics from Delft Technical University and an MBA from INSEAD Business School, France.

Here’s how getting a message across in the right way strengthens projects

By Clarissa Perkins, Communications Specialist, mSTAR

Funded by USAID and led by FHI 360, mSTAR/Liberia ended activities in May 2018 after enrolling 4,904 civil servants across Liberia into mobile salary payments and successfully handing the mobile salary payment program over to the government. This post is part of a blog series on mSTAR/Liberia: what went well and why, how we overcame challenges, and lessons for the future.  

“What! Three months now and I can’t get my salary? This thing is getting really serious ooo.”

On a dimly lit stage at the closeout event for mSTAR’s Liberia project, staff member, Florence Gbondo, plays the part of “Teacher Peppeh,” a teacher who struggles to get her salary. On stage, Florence walks back and forth shaking her head. The audience, leans in, rapt.

Florence acts out Teacher Peppeh’s bumpy motorbike ride from her small village in River Gee to the capital city of Monrovia. Through the five-minute “drama,” as they’re called in Liberia, the audience, encompassing high-level leaders across the Government of Liberia and USAID, at times laughs, at other times shakes their heads in commiseration, their eyes constantly trained on the actors.

Context and culture are paramount when sharing information. In office settings in the United States, people might share information at a closeout event through pie charts in PowerPoint presentations. In Liberia, it turns out, dramas are a major key.

The skit wove the benefits of the mSTAR activity into a witty, relatable story acted with gusto, large gestures and enthusiastic expressions. It ended with the value of mobile money salary payments and the systems mSTAR set up in Liberia evident as Teacher Peppeh resolves her salary issues. “Thank you, yaaaa!” she and the other actors exclaimed on stage as they throw their arms in the air.

In Liberia, a country rebuilding from two civil wars and the Ebola epidemic, the Mobile Solutions Technical Assistance and Research (mSTAR) project, funded by USAID and led by FHI 360, worked with the Government of Liberia to enroll civil servants into mobile money salary payments. For years, it has been typical for civil servants to spend a significant amount of time and money to pick up their salaries. Mobile money salary payments, however, have proven to reduce the time and money civil servants spend receiving their salaries.

At the beginning of the activity, it was clear that mSTAR’s mission would not be easy. Roads are few in Liberia and often untraversable during the rainy season. Cell coverage is spotty. Mobile money, while common in the capital city, is just taking off in rural areas, and trust in mobile money service providers is low.

With the obstacles apparent, mSTAR had to cleverly demonstrate the value of mobile salary payments to civil servants. To do this, mSTAR got to the heart of how information is relayed in Liberia. Senegalese President Leopold Sedar Senghor’s classic reframed version of “I think therefore I am,” to “I dance therefore I am,” only begins to shine a light on how European and North American cultures receive and express information differently than other cultures such as those in West Africa.

mSTAR worked with the Government of Liberia to build a communications plan with dramas at the core. From radio ads and cartoon posters to a training video and a map showing where civil servants enrolled, mSTAR worked the story of  two rural teachers, Nyemah and Kebbeh, who struggle to get their salaries and then sign up for mobile salary payments, into a host of materials targeted to the Liberian audience. Each piece mSTAR created aimed to tell a story.

And it seemed to work. Whether projected on a sheet at a training in a rural community center or on a TV in a government hall, each time the training video is shown, the audience leans in, laughing and relating to the struggles of Kebbeh and Nyemah. When surveyed by mSTAR, attendees overwhelmingly testified that they understood the program.

When communicating to donors and American audiences, mSTAR pivoted its communications, creating infographics and blogs which Americans gravitate towards: explanations of processes, pie charts and bar graphs.

In the end, mSTAR enrolled nearly 5,000 education and health workers in the mobile money salary program, reaching every county in Liberia. Through mobile salary payments, workers were able to spend 12 more hours per month at their job and save 60% in costs when retrieving their salaries. Mobile money salary payments are beginning to normalize mobile money in rural Liberia and build the mobile money ecosystem, setting the ground work for greater financial inclusion and economic development.

The development community knows that understanding local contexts and cultures is key for a successful project. mSTAR took that to heart, bringing all stakeholders into the creation of products to see it through authentically. When the activity ended, because mSTAR had worked with the government on each material, the government partners had the tools to continue to promote the program, using the story of Kebbeh and Nyemah. Paying attention to and incorporating local customs helped mSTAR succeed in Liberia, laying a foundation for buy-in by the government and trust with beneficiaries.

Clarissa Perkins is the Communications Specialist for the mSTAR project at FHI 360. She has experience conducting communications for a host of causes including economic empowerment and innovation, the protection of migrants and refugees, and uses of technology to increase food security, gender equality and economic growth. Clarissa has developed relationships and worked with foreign and local governments. She has experience communicating to audiences of various backgrounds using blogs, events, social media, digital, radio and print ads, infographics, videos, podcasts, op-eds and traditional press.

The Calculations Are In: Digitizing Salaries Can Save Governments Millions

By Zach Andersson, Acting Project Director, LIFT 2

Funded by USAID and led by FHI 360, mSTAR/Liberia ended activities in May 2018 after enrolling 4,870 civil servants across Liberia into mobile salary payments and successfully handing the mobile salary payment program over to the government. This post is part of a summer blog series on mSTAR/Liberia: what went well and why, how we overcame challenges, and lessons for the future.  

Exactly how much could government ministries save by digitizing salary payments? In Liberia, we do the math to find out.

The Government of Liberia, like many governments in developing economies, faces resource constraints which affect public service delivery. With an annual budget of $526 million, the lack of capital is evident across the country, from poor road quality to broken down ambulances.

Difficulties like bad roads, a lack of banks and low liquidity lead health and education workers to leave their shifts for hours and even days to pick up their salaries. From 2016 – 2018, mSTAR worked with Ministry of Health (MOH) and Ministry of Education (MOE) to digitize their workers’ salaries. We believed digital payments could not only save staff time and money spent when traveling to a brick-and-mortar bank each month, but could also keep workers from leaving work to do so. We collected data over the course of the two-year project to assess our progress and pivot, as required, to achieve high satisfaction of salary recipients and create a successful, sustainable system.

Standard survey tools developed and implemented by the mSTAR team demonstrated that when picking up salaries from mobile money agents instead of banks, health and education workers reduced the amount of money they spent by 58 percent and decreased the amount of time missed from their jobs by an average of 12 hours per month.

Going beyond the benefit of mobile money salaries for individuals, mSTAR sought to estimate the monetary value of the productivity lost when staff left work to collect their salaries each month.

How did we do this?

1. The first step was calculating the total self-reported hours missed away from work when collecting salaries via mobile money and direct deposit at the bank by the 194 MOE and 222 MOH staff surveyed. Using assumptions for both ministries of an eight-hour workday, five-day work week and four-week work month, the total number of possible hours per month MOE and MOH could spend on the job was also calculated (160). Keep in mind that banks have restrictive hours (normally 9am-2pm), whereas with mobile money there is more flexibility. Mobile money agents set their own schedules and usually are available after work, which allows health and education staff to remain on the job longer rather than leave their work to collect their pay.

2. With ministry survey samples for both the total hours missed collecting salaries via mobile money and direct deposit, a proportion of all possible work time missed was calculated. To do this, mSTAR aggregated the reported time missed away from work by staff surveyed and converted to hours, then divided by the total number of hours all those staff together could have worked. For the education sample, this came to 0.6 percent through mobile money and 10.9 percent through direct deposit, whereas for health, these were 0.7 percent and 5.9 percent respectively.

3. Referencing a UNCDF High Volume Payments Mapping presentation given June 28, 2017, we calculated the net salary paid for all staff each day.

ZachTable14. We then estimated the “cost” to both Ministries in terms of lost productivity resulting from staff absence from work to collect their salaries. We multiplied the net salary totals for the entire population by the proportions of all possible work time missed by staff surveyed (step #2 above).

ZachTable2.jpg5. Subtracting the mobile money estimated costs of work time missed from the direct deposit estimated costs, the total estimated savings for both Ministries are presented below by workday, work month and work year.

ZachTable3

So, what does this mean?

If all MOH and MOE staff transitioned to mobile salary payments, the government could potentially save around $4 million – the estimated value of the productive work time lost due to staff leaving their jobs to collect their pay.

While the findings provide food for thought for Government, there are a few critical limitations to keep in mind. The proportion of all staff surveyed by mSTAR from both ministries is small – only 3.1 percent of the MOH and 1.1 percent of the MOE. mSTAR cannot say with certainty that the staff surveyed are representative of the wider MOE and MOH populations. Staff surveyed by mSTAR opted into the mobile money salary payment – many other staff chose not to join. Therefore, surveyed staff may be predisposed to missing less time from work than others who have not yet joined (i.e. the rest of the ministry populations), which may reduce the utility of the multipliers.

The Government of Liberia seemed to take these results seriously. At the project closeout event in front of a large audience and media, the Director of Pay, Benefits and Pension at the Civil Service Agency, Roland Kallon, spoke of mobile money as the way of the future. Referencing the savings, he said, “mobile money process is what everyone should be gearing toward because it makes a lot sense…if you compare mobile money with any other mode of payment, anyone will choose mobile money.”

Zach Andersson is a Monitoring and Evaluation Advisor at FHI 360 and an Acting Project Director for FHI 360’s Livelihood and Food Security Technical Assistance (LIFT II) project. Zach has over 10 years of experience in disaster relief and global development program design, operational oversight, research, M&E and information management, proposal development, and technical assistance with successful, extended field deployments to Uganda, Ghana, Haiti, India, Lesotho, Liberia, Malawi and Tanzania. He has produced and administered surveys, facilitated training and workshops, created assessment tools, edited and published guidance documents, built and maintained relationships with government and bilateral stakeholders, led research activities, and collaborated in the development of M&E indicators for disaster relief, economic strengthening and HIV work in several separate roles. 

100s of Youths are Using Tech to Connect Farmers to Resources – This 2017 Digi Winner is Building Opportunities in Uganda

We’re taking a behind-the-scenes look at the 2017 Digi winners. 2017 winner Feed the Future’s Uganda Commodity Production and Marketing Activity created EzyAgric, a massively successful digital platform which opened doors for both unemployed youth and smallholder farmers. Formerly unemployed youth are trained and serve as agents on the platform, helping farmers gain access to information and finances, increasing their production and resilience. EzyAgric’s results have been transformative, from empowering youth with tech skills to connecting farmers with deeply-needed resources. This interview was conducted with Robert Anyang, Chief of Party of the Commodity Production and Marketing Activity. Apply for the 2018 Digi Awards here by July 13th!

Q: What’s the project?

Robert Anyang (RA): Without access to formal financial services or transparent market information, smallholder farmers in Uganda struggle to obtain high quality inputs and agricultural financing. With support from the ag-tech start up Akorion, Feed the Future Uganda’s Commodity Production and Marketing Activity (CPM) developed a platform called EzyAgric for village agents to collect information on a farm’s location, soil properties and production activities, creating a digital profile to help farmers gain access to financial products and services. Since the pilot in 2014, CPM has exceeded most of its targets. The activity has profiled 130,253 farmers, allowing them to access more than $59 million in loans for crop production, creating employment opportunities for over 700 youth as village agents, enrolling thousands of farmers in crop insurance and providing more than 400,000 farmers with access to market information.

 

Q: What’s the local impact?

RA: 28-year-old Shallot Asimire was just an ordinary jobless young woman out of school doing regular home chores. Shallot was introduced to us through a colleague. We trained her in using various ICT applications and equipped her with a smartphone, which she used to start providing agricultural services to coffee farmers through EzyAgric. Shallot now earns over $4,000 per year and assists her husband.

Q: What surprised you most throughout the process of creating and implementing the tool?

RA: I was surprised by the quick uptake by some farmers and the government’s interest to build a similar project in the same line cutting across the whole country.

Q: What would you say to other projects to encourage them to use digital tools?

RA: I would encourage other projects to build sustainable innovations. Work with agile and self-driven youth to create an enabling environment to build innovations that are easily adaptable by the private sector.

Q: What does being a Digi winner mean to you?EzyAgric2

RA: The most important meaning of this to me is the deep knowing that I made a difference for others: seeing a group of youth grow a multi-billion company reaching out to more youth and farmers.

mSTAR and USAID developed videos of each winner, viewable here. All USAID projects and activities are invited apply to the 2018 Digi Awards.  

Learning from Ebola: How Mobile Money Can Prevent Health Crises

By Jonathan Kourgialis, Program Officer

mSTAR/Liberia ended activities in May 2018 after enrolling 4,870 civil servants across Liberia into mobile salary payments and successfully handing the mobile salary payment program over to the government. This post is part of a summer blog series on mSTAR/Liberia: what went well and why, how we overcame challenges, and lessons for the future. We’re writing from a management angle, monitoring and evaluation angle, a communications angle and a digital financial services angle. 

The Ebola outbreak hit Liberia hard. From 2014 to 2016, there were 10,678 cases and 4,810 lives claimed. Weakened from a protracted civil war, Liberia’s healthcare system struggled to keep up with the epidemic. Failures in the health system created severe consequences on the ground. One of those failures, with dire ramifications, revolved around payments.

As the Ebola outbreak raged, the Government of Liberia and partners introduced new financial incentives to compensate frontline health workers for the severe risks encountered when combatting the disease. However, the government and its partners were not able to transfer these new payments reliably to frontline staff, who were often placed in remote areas with limited access to banks. The government and its partners relied on cash, which was disbursed throughout Liberia by “pay teams,” who drove cash to rural towns. A pile of factors including quarantines, poor road and banking infrastructure amidst the ongoing crisis, low liquidity, and fear of the disease made pay teams inefficient and slow. Delays in the disbursement of payments contributed to health worker strikes, further crippling response efforts. The difficulties in making payments and the ensuing health workers’ discontent highlighted the critical role that efficient payment processes play in mobilizing health workers during a health emergency.

ClinicLofa

A clinic in Lofa County, Liberia, one of the first counties in Liberia hit with Ebola.

To avoid the recurrence of a payment breakdown like this, mSTAR worked with the Government of Liberia’s Ministry of Health (MOH) to build a set of standard operating procedures (SOPs) for payments to health workers through mobile money. When working efficiently and smoothly, mobile money has proven to make a significant impact on health crisis outcomes. At the height of the Ebola crisis in Sierra Leone, for example, the digitization of salary payments is estimated to have saved 2,000 lives in Sierra Leone by eliminating strikes by unpaid response workers. This is estimated to have saved almost $11 million in security and other costs related to moving cash. The SOPs mSTAR created for the MOH ensure the MOH’s payment functions will be strong enough that if a future emergency occurred, whether it was Ebola or another epidemic, health workers at the frontline would be compensated for their contributions and willing to stay on the job.

CarClaraKMallah_GrandGedeh

Navigating rural Liberia’s roads.

To create the SOPs, mSTAR first mapped MOH’s complicated payment types, systems, and streams. This included salaries paid to MOH employees through traditional government payment systems, incentive payments to contract workers paid directly by the MOH, and allowances to health workers paid directly by the MOH, each differentiated by funding stream. MOH staff are paid through funds from the GOL and funds from donors, so systems and streams are unconnected and not interoperable. Taking this into account, and utilizing mSTAR’s data systems, interoperability and mobile money expertise, mSTAR and the MOH came up with the three key tasks for the MOH to complete in the case of a health emergency:

  1. Coordinate data exchanges of staff and payment information between the MOH’s unconnected databases;
  2. Register health workers for mobile money payments within GOL systems and with the mobile money service providers (if necessary); and
  3. Disburse mobile money payments across the various payment streams.

The SOPs outline how to accomplish these tasks and graphical flows and steps breaking down each. This included recommendations on how mHero, a two-way mobile phone-based communication system, can efficiently register staff for mobile money payments and alert the MOH to mobile payment issues.

mSTAR built in recommended safeguards for the success of the SOPs such as the creation of a mobile money payments emergency committee to oversee the implementation of the SOPs during an emergency and the establishment of mobile money payment accounts specifically for MOH payment streams prior to an emergency.

While theses SOPs are tailored to the Liberian MOH’s systems, the collaborative effort to develop SOPs for the scaling of mobile money payments for health workers, or any type of emergency responder, is replicable in other contexts. It is a necessary endeavor for governments of any country vulnerable to health or natural disaster emergencies. As was seen in Liberia during Ebola, making sure that those risking their lives to save others are compensated in a timely and efficient manner is vitally important to overall emergency response efforts and is worth investing in prior to an emergency. While we hope that the Liberian MOH does not have to use these SOPs in the future, they are now prepared to pay frontline staff if the need arises again. We recommend that other governments prepare themselves in a similar manner where possible.

Jonathan Kourgialis is a Program Officer at FHI 360. He has focused on mSTAR’s work in Liberia, building and strengthening the Government of Liberia’s mobile money salary payment systems. Jonathan currently works on civil society and peace building projects.

‘I feel so proud when I wear it’ – How This 2017 Digi Winner’s SmartCard Won Over Hearts & Brought Results

We’re taking a behind-the-scenes look at the 2017 Digi winners. Hear from ADVANCE II on what it means to be a Digi winner and the hugely beneficial, but completely unexpected outcomes, of their digital solution. This interview was conducted with Emmanuel Dormon, Chief of Party of ADVANCE II. All USAID projects and activities are invited to apply for the 2018 Digi Awards here.

Q: What’s the project?

Emmanuel Dormon (ED): ADVANCE II works to improve the competitiveness of the maize, rice, and soybean value chains in Ghana. As part of this, the project provides training to farmers. But ADVANCE II struggled to get accurate registrations and data from the trainings, so we implemented a smartcard ID technology that stores and tracks data. The ID cards allowed USAID and project officers to see real-time results and build more effective programming. ADVANCE II has successfully tracked over 120,000 people who participated in 5,111 training sessions and increased the number of trainings tailored to female farmers, a previously underrepresented population in trainings.

Q: What’s the local impact?

ED: The tool is efficient and saves farmers’ time.

“The computer brings up my name. After training is over, I don’t have to sit down for long before they record my attendance. The card encourages us to attend the meetings and it saves our time,” says Meli Alhassan from Tamalgu Community in the Karaga District in the Northern Region.

“The card encourages us to attend the meetings and it saves our time.”

Beneficiaries receive more targeted trainings. With the smartcard, the project is able to target training topics to specific communities and smallholder farmers. The project has been able to accurately link the number and specific types of trainings to behavior change, and tailor specific topics to female farmers based on analysis of the data captured using the smartcards system. This means that female farmers who generally have less access to land and less time to manage their farms because of other household chores get the opportunity to improve their farming activities with targeted interventions as well as strategies to empower them to take more control over their lives and resources.

The tool has enhanced the confidence and reputation of women. The use of the smartcard has increased the confidence of women beneficiaries. It gives the women a sense of pride when others get to know their association with the project. “Formerly, as a woman you could have money but you could not get a tractor to plough for you until all the men’s fields had been plowed. But now, because of the USAID ADVANCE card, when you have it, they can easily plough for you,” Amama Sulemana from Tamalgu Community in the Karaga District in the Northern Region says. Memuna Adoku of the same community added, “whoever sees you with the card will know you are in USAID ADVANCE. That alone gives you some respect.”

“Formerly, as a woman you could have money but you could not get a tractor to plough for you until all the men’s fields had been plowed. But now, because of the USAID ADVANCE card, when you have it, they can easily plough for you.”

Increased sense of belonging and communal engagement. Socially, the smartcard improves engagement among farmers. It provides a form of identification to those without any formal ID, as is often the case in rural Ghana. The cards also provide a sense of belonging for the project beneficiaries especially at the community level. “The smartcard is very good. Anytime I attend a training, I put it on and it makes it easier to identify me. I don’t have to mention my name; the card gives my personal details, farm size, yield and other information. I feel so proud when I wear it. In fact, I even put it on when I am attending programs like outdooring, marriage ceremonies. We are able to flow well with each other,” says Fati Sulemana, a smallholder farmer in Nansoni community in the Northern Region.

This sense of identity that the card provides to the smallholder farmers was not anticipated but it has become a very important factor that enables them to access services more easily.

Q: What surprised you most throughout the process of creating and implementing the tool?

ED: The high level of appreciation of the tool by the farmers. Given the low level ADVANCEBabyof literacy and technology adoption in the rural areas, we were not certain as to how readily the farmers would accept the use of the smartcards. It was surprising to see how quickly they welcomed it.

We were also surprised by the pace of learning by project officers. Most (about 80 percent) of project staff accepted and learned to use the tool within the first month of its introduction. About 10 percent of staff, mostly the older ones, took a longer period to fully embrace the tool and use it fully.

Q: What would you say to other projects to encourage them to use digital tools?

ED: The smartcard improves data capturing and monitoring, thereby eliminating the risk of double counting. The use of the smartcard is good. It enables the project to determine the training attendance rate of farmers and follow up on beneficiaries with poor attendance. As of March 2018, the project had effectively tracked 129,900 beneficiaries who have attended trainings within the four years of use, and provides almost real-time data for analysis and effective management decision making.

Data analysis is faster and easier with the smartcard. 

ADVANCEwomen

The tool helps to accurately update information on the farmers with respect to their crop yield, household, and other participants in the household. On a weekly basis, we can know how many farmers have been trained and in what topics. We are able to track which particular training a farmer has received, the percentage change in the yield and then, a percentage change in the income of the farmer. We are able to cross tabulate various elements to determine which assumptions about training (and specific topics) are correct and which ones are not, thereby enabling project managers to decide on necessary changes and adaptations.

The smart card system guides some operational decisions. The smartcard makes community engagement more efficient. Before we engage community members, we know how many resources we need because we know the total number of farmers that are in the community. High data quality is assured with less effort and time in addition to easy identification of beneficiaries because they are assigned unique ID numbers.

Q: What does being a Digi winner mean to you?

ED: All of us working for the project feel very proud being a Digi winner. It shows that being proactive, innovative and technology-driven is recognized and it is the way to go as a project. When we used paper rosters, we were not able to correlate the training activity with the farmers and harvesting data because we couldn’t uniquely identify farmers. We also recognize that having been winners, a lot is expected from us and we are redoubling our efforts to remain leaders in the field of adopting digital tools to improve the effectiveness and efficiency of our interventions to attain the desired project results and goals. Winning the Digi award also increases our credibility as a project.

mSTAR and USAID developed videos of each winner, viewable here. All USAID projects and activities are invited apply to the 2018 Digi Awards.