The power to access and send funds through a cell phone is a game-changer for many health programs across the developing world. Mobile money, or financial transactions conducted using a mobile phone, is rapidly replacing cash-based payments and growing as a means to improve efficiency, management, and transparency of healthcare financing and transactions. A recent analysis of the CHMI database, which profiles over 1400 health programs in LMICs, found 34 programs reporting use of mobile money.
Mobile money transactions – across all sectors - are rising globally. In 2014, GSMA reported that there are 299 million registered mobile money accounts, of which 103 million are estimated to be active.  Mobile payments are particularly taking off in Sub-Saharan Africa; for example, a 2013 Pew research poll found that an incredible 68% of cell phone owners in Kenya and 50% in Uganda regularly make or receive payments on their phones.
Chart: Number of registered and active mobile finance accounts by region
Below are some highlights on how programs in the CHMI database are using mobile money:
The use of electronic vouchers, transferred through mobile phones, has been documented in 7 programs on the CHMI database. E-vouchers are usually transferred from clinic to patient to pharmacy or shop, after which the shop will redeem the e-voucher with the original clinic or health program. The E-voucher represents real value to the shopkeeper, and can be traded in for cash.
MEDA Bednets, for example, issues e-vouchers to expecting mothers during health clinic visits for bednets to protect pregnant women from malaria. The e-vouchers can be presented at any of over 5,500 participating retailers and provide a significant discount towards the purchase of a long lasting insecticide treated net (LLIN). The consumer does pay part of the cost of the net (30 cents) to the participating vendor, which promotes ownership and use of the bednet. MEDA then reimburses vendors for the collected e-vouchers.
Micro-insurance through phones:
Eight programs in the CHMI database are using mobile money to facilitate micro or community-based health insurance payments, most of which allow customers to send their premium payments in via SMS. One Indonesian insurance agency, Asuransai Central Asia (ACA), has designed a unique micro insurance product, the Dengue Fever Insurance Card. Consumers purchase the card at participating vendors for a low cost (3 months for $1 USD, or 1 year for $5 USD). To claim their insurance customers need only text their pin number from the purchased card to an SMS center which follows through with verification and payout. Depending on the purchased plan consumers are covered for up to $100 or $200 USD.
Payments for health programs and commodities:
CHMI has identified 6 different health services chains and networks which have adapted mobile money to more efficiently manage the flow of funds towards health services or commodities within their organization, such as Bluestar Pilipinas and Jacaranda Health.
Bluestar Pilipinas, a family planning franchise run by licensed midwives in the Philippines uses mobile money to make payments for stock orders, such as contraceptives, and for membership dues from franchisees which are paid weekly through their phones. Blue Star Pilipinas reported to CHMI that this mobile money system has allowed them to greatly improve finance tracking and to streamline operations.
Jacaranda Health of Kenya, a chain of low-cost clinics, is similarly streamlining finances by allowing clients to pay for services through a mobile payment service, which is particularly useful if the patient doesn’t have cash readily available.
Improving Referrals through Financial Incentives:
Two programs working independently from each other in Tanzania are using mobile money to improve referrals through financial incentives. Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) and D-Tree International are both offering money transferred through mobile phones to healthcare workers and/or volunteers for referring patients with specific conditions to their organization.
CCBRT partners with “ambassadors” – mainly health workers but also volunteers - throughout Tanzania to identify women suffering from fistulas. The ambassador makes the initial call to CCBRT, at which point CCBRT transfers funds to the ambassador to cover the woman’s cost of transportation to the CCBRT health center. Once the woman arrives CCBRT transfers an additional 5,000 Tanzanian shillings (US $3.50) to the ambassador as a gesture of appreciation, and incentive to send additional fistula patients for care.
Through a similar model D-tree International is working with traditional birth attendants (TBAs) to refer women with obstetric emergencies for delivery in health care facilities. TBAs receive a mobile money payment that compensates for the lost income of not performing the birth themselves, with some extra to encourage future referrals.
Financial incentives are not only being provided through mobile money to CHWs, but also to patients. X Out TB seeks to reduce the necessity of daily health worker monitoring of TB patients by using urinalysis tests strips and cell phones to remotely confirm adherence to medication. Urinalysis strips which test positive when the patient has taken their medication reveal a code which the patient sends via SMS to their CHW. Positive compliance is rewarded with a small monetary credit to the patient’s phone.
More on Mobile Money:
To learn more about how health programs are using mobile money, be sure to visit CHMI’s recently launched mobile money topics page for a full list of programs.