This document discusses how a mobile health wallet can help achieve universal health coverage in Africa. It summarizes that African health systems are stuck in a low demand, low supply cycle due to high costs, low access, and low quality of care. It proposes that a mobile health wallet, building on the widespread use and trust of mobile money platforms, can help by allowing governments, donors, insurers, employers, and individuals to contribute to healthcare costs in a unified system. This could increase access and demand while improving supply through faster provider payments, lower administration costs, and better data collection. The document outlines an existing partnership testing this approach through a program providing health vouchers to 10,000 mothers via their mobile phones.

1. How a Mobile Health Wallet can allow all
stakeholders to contribute towards UHC
Kigali, 18h May 2015

2. Health in Africa – a vicious cycle
African health systems are stuck in a vicious cycle of low demand and poor supply of health care.
Trust in the system is low
Low
Trust
Demand
• High out-of-pocket
expenses
• Low Access
• Low ownership
Supply
• Low quality health
care
• Low efficiency
• High risk
• Scarce Data
Patient
• Catastrophic spending
• No prepayments

3. 2
M-PESA – the impact of mobile money
• Used by 85% of population
• 66% of Kenya’s electronic
payments
• USD 1.3 b per month
transaction value
• Instant transaction
• No 1 brand in Kenya
• Banks the unbanked
• Remittances from higher to
lower income groups
Widely used Income redistribution Trusted
Source: Central Bank of Kenya, Safaricom financial results H1 2015, Centre for Brand Analysis

4. Health in Africa – The idea
Create transparency in the system with trusted Mobile Telcos
Demand
• High out-of-pocket
expenses
• Low Access
• Low ownership
Supply
• Low quality health
care
• Low efficiency
• High risk
• Scarce Data
Patient
• Catastrophic spending
• No prepayments
M-Health Wallets
Mobile Money Infrastructure

5. Health Wallet allows government, donors, insurers,
employers, individuals to all contribute towards UHC
4
Benefits
Insurance IP
Maternity
Med. Savings /
remittances
Credit
Hospital Cash
Inpatient cover from NHIF
Insurance top up insurance company X
Medical (group or individual) savings for e.g.
OOP + incentives paid for by donors
Access to credit based on medical savings and
contribution payment history
Government entitlement
Employer benefit Entitlements funded by employer
Example of what a Mobile Health
Wallet could look like in Kenya
Platform built in close cooperation
with Safaricom

6. Health Wallet used at Healthcare Facilities

7. Higher
Higher
Higher HigherTrust
Demand Supply
Patient
The Result – building trust
Health
insurance/savings
Loans for
providers
Equity
investments
Peer to peer
financing
Quality
standards
Leverage
Trust

8. Organization Description Role
 The world's second-largest mobile
telecommunications company
Product Design &
Executive Support
 Dutch NGO dedicated to strengthening
health systems in resource-poor settings
Product & Program Design
Implementation Lead
 Largest operator in Kenya
 35-35% owned by Vodafone & GoK
Product Design, Network & Infrastructure,
Payments (via M-PESA platform)
Our Mobile Health program is run by a strong
partnership of multiple organizations (since 2013)
 International financing institution that
fights AIDS, tuberculosis and malaria
Pilot investments
Lead donor partner
March 2013: MOU signed between Safaricom, M-Pesa Foundation and PharmAccess
May 2014: MOU signed between Vodafone, Global Fund and PharmAccess

9. Mobile Health Research Lab: Rapid testing of
various prototypes in Kenya (since August 2013)
Core principles:
1.Test multiple different
prototypes at the same
time
2.Use small test groups
3.Collect data from many
angles
4.Collect data online,
real-time
5.Collect user feedback
Chamas Tests with different
incentive models
Leverage on existing
fundraising structures
Cash Advances to providers
Cashless clinics
SMS Loyalty

10. Large scale test: MTIBA program with 10,000
users and 44 clinics in 5 Nairobi slums
9
• MTIBA program with health vouchers
launched with Safaricom in March
• Rolled out to 44 clinics and 10,000
mothers in 5 slums in Nairobi
• Voucher to be spent on the healthcare
for children under 5 years old
• For each MTIBA transaction clinic
submits relevant medical & financial
data in real-time
• Administration costs radically reduced
and pay-out times significantly
shortened vs traditional voucher or
insurance schemes  clinic is paid
within days instead of months

11. Real-time data collection provides a wealth of
health-related and finance-related insights
10

12. Key messages
11
• To make mHealth a success, strong partnerships with mobile network
operators, donors and public sector are critical
• Key to success (especially also with private sector companies such as
Safaricom) is involving these stakeholders at an early stage
• First experiences with a mobile health wallet suggest it can:
• Unify contributions from government, donors, employers, insurers
and individuals directly in the mobile phone of the end-beneficiary
• Radically reduce administration costs
• Radically speed up pay-out times to healthcare providers
• Generate real-time medical data from the most remote locations