Mobile phones and money transfers help empower rural health workers in Bihar, India. Accredited Social Health Activists (ASHAs) use mobile phones to receive performance-based incentive payments for their work promoting public health initiatives. Previously, ASHAs had to wait for long periods to receive small paper checks, standing in queues at banks, which undermined their status. Now, a new system allows payments to be directly transferred via mobile phones to ASHAs' bank accounts. They receive SMS notifications of payments and can withdraw money at their convenience from local customer service points. This new system has increased ASHAs' independence, connectivity, and dignity through timely digital payments.

1. How Cell Phones help Empower Rural India

2. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 ASHA stands for Accredited Social Health Activist
 ASHAs are a new band of female community-based functionaries
conceived and funded by National Rural Health Mission (NRHM)

3. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 ASHAs are semi-literate (i.e. formal education up to class eight) married
women in the 25-45 age range
 Empowered with knowledge and a drug-kit to deliver first-contact
healthcare, every ASHA is expected to participate in public health
initiatives in her village
ASHAs receiving training at a session
in Sheikhpur

4. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 There were more than 830,000 ASHAs across 18 Indian states (till 2010)
 The ASHAs receive performance-based incentives for promoting
universal immunization, referral and escort services for Reproductive &
Child Health and other healthcare interventions like tuberculosis and
leprosy
 For example, an ASHA receives Rs. 200 for every PHC delivery she helps
facilitate
 71,350 ASHAs in were instrumental in the safe delivery of 1.1 million
babies in Bihar alone

5. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 Pain Points:
 The Bihar State Health Society, was in search of a process to help them
1. Receive their payments on time,
2. Bring the women dignity in their community,
3. Ensuring equity amongst everybody

6. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 The accounting process at the PHCs was manual because of poor power
connectivity
 PHC needed to prepare 500 cheques per month for each district block
 They are separate cheques because incentive schemes differ based on
the types of services rendered by ASHAs
 To further complicate things, the cycle of payments is longer than a
month for some health interventions provided by ASHAs
 Also, 11 bank accounts need to be maintained because program funding
comes from different sources
Add 7 cheques per ASHA, 11 bank accounts per PHC, and a manual
accounting process and you have a perfect storm of inefficiency!

7. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 The Consequence:
1. ASHAs had to wait to meet the PDS accounts officer
2. They ended up standing in long queues at the bank to cash several
small-amount cheques
3. They would be ridiculed (and sometimes persecuted) by family
members for not getting paid on time
 This beat the government’s
purpose of offering equality of
employment clubbed with
dignity.

8. Empowering Bihar’s rural health workers with mobile phones
and money transfer
The Solution:
 Sheikhpura’s District Health Society (DHS) along with Sadar PHC and
Chewara PHC began a pilot program in Jan 2011 in partnership with SBI
Patna and Eko Financial Services to test mobile payments to the district’s
440 ASHAs.

9. Empowering Bihar’s rural health workers with mobile phones
and money transfer
 The new mobile money transfer works in just four easy steps:
PHC compiles an Excel sheet with [Name, mobile#, service-delivered, amount]
and forwards to DHS and Eko.
DHS verifies and transfers the requisite funds to a specially created SBI
Account.
Within 24 hours of funds transfer, Eko transfers appropriate amounts to each of
the individual ASHAs on the Excel sheet.
Each ASHA receives an SMS with their updated bank balance. She can then go
to the nearest Eko CSP (Customer Service Point) to withdraw the
money whenever she wants

10. Empowering Bihar’s rural health workers with mobile phones
and money transfer
Conclusion:
 Besides staying connected with their families, ASHAs now
1. interact with their supervisors as needed,
2. help colleagues, and most importantly,
3. communicate with the mother and their families – providing
information on nurse visits, reminders on immunization schedules, etc.
 The ASHAs can withdraw their money on all days, including holidays,
weekends and even late evenings. Basically any time the CSP location is
open
 No more trips to banks

11. Empowering Bihar’s rural health workers with mobile phones
and money transfer
“Although we share details on the total incentives earned with
our family and husband and subsequently the money itself, we
still feel the power of having the code give us an identity. Using
the special pin code is in my hands; if I do not want to, I need not
withdraw cash .”

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