Two examples of how mobile technology can support cash for health programmes and how financial payments have led to the emergence of “results-based financing” (RBF) mechanisms as an alternative financing model for healthcare.
By Paola Fava
‘Although the quality of health services is an essential condition for the success of any health action, underutilisation of health services is more often influenced by demand-side barriers rather than supply-side limitations’.
This statement is extracted from the ‘Cash-based Interventions for Health programmes in Refugee Settings’ review by UNHCR. However the document concerns specifically Refugees, I believe that it can be applied to the overall population, particularly in vulnerable contexts.
Interventions in the healthcare sector have been historically focusing on providing solutions to the supply-side of healthcare (healthcare providers) rather than the demand-side (access to health services by patients), except to provide access to health-related products (such as insecticide-treated bed nets) or to support nutrition.
However, in the last few years, we have seen a gradual shift towards addressing some of the challenges that vulnerable parts of the population face when in need of healthcare services. One of these challenges is the cost of basic health services, such as antenatal care or delivery care. Although there is still little documented evidence of the use of cash-based interventions for health services in the humanitarian context, some interesting examples are involving the use of mobile technology.
In this post, I am describing two examples of mobile applications of cash for health.
M-TIBA, a mobile wallet for medical treatment
‘In Kenya, 85% of women wants to give birth in a formal clinic, but only 44% do so. The number one reason cited by women is the difficulty of accumulating the US$ 40 needed to pay. In other words, poor access to financial services is a big part of why there is a healthcare access problem.’
M-TIBA is a mobile-based health wallet, that allows anyone to send, save and spend money specifically for medical treatment. Individuals can save money for themselves, for a family member or friends. Money stored on M-TIBA can only be used to pay for treatment and medication in selected partner clinics and hospitals.
Furthermore, in order to guarantee and monitor the quality of the provided healthcare services, partner clinics need to be recognised by the SafeCare standards.
If you would like to know more about this technology and its impact on the society, watch this video about M-TIBA being a supportive tool for pregnant women in Kenya.
Mobile money as incentive for health operators
In Tanzania, traditional birth attendants (TBAs) are typically paid to assist deliveries. It’s, therefore, a financial disincentive for them to refer their patients to health facilities, since this would represent a loss of income. However, health risks increase when deliveries are not performed in appropriate facilities.
In 2011, D-tree International, has launched a program in Zanzibar that provides TBAs with a mobile-enabled clinical guide to help them treat women and identify cases who should be referred to health facilities. Beside the medical aid tool, the system also includes an SMS-mobile money payment system that it’s used as an incentive for TBAs to assist and refer pregnant women to health facilities for clinical check-up and safe deliveries. Through mobile money, ‘TBAs are able to make prompt payment for transport for the woman to deliver in a health facility or in case of any complications for both mother and baby that require medical attention.’
TBAs’ mobile money accounts are used to transfer money to the drivers’ accounts at preset rates to carry the women to the appropriate facility for referral. After the TBA’s last follow-up visit, D-tree pays each TBA US$6 per facility delivery through mobile money as well, which is higher than the amount the TBA would make from an assisted delivery.‘