wef he intersection mobile health mobile finance report 2011
TRANSCRIPT
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
1/18
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
2/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
0C:2
Opportunities multiply
as they are seized. Sun Tzu
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
3/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
01
Introduction:
In looking at the rapidly expanding adoption o
mobile communications, one o the most
promising opportunities or positive socio-
economic change lies in the scaling o mobilehealth and mobile fnancial services (MFS). In
act, more people today have access to a mobile
phone than to clean water or the electrical grid.1
By 2012, it is estimated that there will be 1.7
billion people who have mobile phones but nobank account. O those individuals, approximately
1 billion will also lack access to healthcare
systems. 2
Providing services in an aordable and sustainable
manner or these individuals is a signiicant
challenge. While reduced costs and advances
in network coverage are accelerating, the
underlying business models to sustain this growth
are unclear.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
4/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
02
It goes without saying that the issues o extremepoverty are highly complex and interconnected.
The World Health Organization (WHO) cites
inadequate healthcare fnancing mechanisms
as one o the two biggest challenges to improving
health outcomes or the poor. 3Both mHealth
and MFS are nascent industries and ragmented
along multiple dimensions. While there are now
well over 5 billion mobile subscribers in the
world, it arguably is still at subscale in terms
o the deployment o value-added services on
a global basis.
As an example, mobile nance has achieved
commercial scale (i.e. 1 million or more users)
in less than one out o 10 deployments globally.
While there has been widespread adoption
in the countries o Kenya and the Philippines
there are more than 100 deployments that
have not reached this level o scale.4
Mobile Health eorts are also highly ragmented.Because o the lack o platorm standardization,
many providers are building discreet and
independent systems rom the ground up. As a
result, systems are costly, inecient, unable to
achieve scale and oten not interoperable.
The aim o this paper is to help reduce some
o these uncertainties and reinorce dialogue
on how the mobile communications platorm
can be leveraged to strengthen mutually positive
outcomes related to both nancial inclusion
and health. With user-centric solutions that
leverage common technologies, new eciencies
and capabilities can be created that serve to
accelerate global scale.
Unlocking this potential will require the ollowing
questions to be addressed:
1. What will be the best method to drive
awareness and adoption o the sel-rein-
orcing dynamics o wealth and health?
Who will lead these eorts?
2. How will the integration and interoperability
o disparate technologies across multiple
industry and public sector domains occur?
3. Who will build and manage the common
inrastructure and distribution networks?4. How will the various points o policy coor-
dination work across sector domains?
Synergies Between mHealth and
Mobile Financial Services
At its core, the mobile communications plat-
orm reduces the time, distance and cost or
delivering inormation. As such, providers in
the healthcare and nance industries have a
globally ecient, innovative and cost-eective
channel or delivering new services.5 For banks,
the mobile platorm creates innovative ways to
deliver convenient branchless banking solutions
to geographically remote areas. Once in place,
these nancial services enable the creation
o new cost structures and micro-sevices.
Mobile-based remittances, micro-insurance
and savings accounts can all be oered to
those at lower socio-economic levels.
Because payments are also a vital component
throughout the healthcare delivery continuum,
a means to securely, reliably and cost-eectively
transact is valued by both industry sectors.
Along with the need to accelerate transactions,
both industries have common users, digital
inrastructure elements, business processes
and policy concerns. Recognizing these syner-
gies and working cross-sector, stakeholders
in both industries are positioned to achieve
greater impact, ultimately establishing a morerobust ecosystem or servicing the needs o
the poor.
Driving Demand: Mobile Financial
Services Spur mHealth Adoption
Mobile nancial services represent a tool that
acilitates remote payments or healthcare
services or those with and without bank
accounts. By leveraging MFS or healthcare
services, key stakeholders in the continuum o
care can benet rom improvements in quality,
accessibility and cost. MFS can apply to both
providers o health services as well as patients.
Mobile Financial Services or
Providers
Salary Disbursement: Healthcare
employers can pay a healthcare worker auto-
matically into the healthcare workers mobile
nancial service account rather than paying in
cash or cheque, which is both cumbersome
and costly to manage.
Healthcare providers ace the challenge o how
to pay unbanked and remote healthcare workers
in a timely and sae manner. In rural areas,
healthcare workers oten spend time walking
to other localities to pick up cash when they
are paid. The time spent on administrative
tasks could be better used serving patients.
Additionally, the potential o raud (cash leakage)
associated with salary disbursement to remote
employees is greater when there is no access
Defning e-/mHealth and Mobile
Financial Services
Mobile inancial services (MFS) is an
umbrella term, oten reerred to as
mobile money. MFS uses a mobile
wallet or a separate electronic money
account used or payments other than
prepaid or post-paid mobile airtime.
Within MFS, there are three main cat-
egories: mobile payments, mobile credit/
savings/insurance and mobile banking.
mHealth is loosely dened in this paper
as the use o inormation and commu-
nication technology to provide better
access to health services or practitioners
and patients. Payments in mHealth
roughly all into three main categories,
those or health services and supplies,
those associated with systems admin-istration and those associated with use
o the electronic healthcare record and
aggregated data.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
5/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
03
to a banking inrastructure. In Aghanistan,
when mobile nancial services inrastructure
was implemented or salary disbursement o
national police in lieu o cash, it became known
that at least 10% o the payments had been
going to ghost policemen and that middlemen
were pocketing the dierence. During this
time, most policemen believed they received
bonuses to their salaries, unaware o the raud
rampant throughout.6
Healthcare workers paid in cash in emerging
markets experience similar issues. Even in the
absence o raud, the time and cost o cash
disbursal o salaries create additional admin-istrative costs that burden the viability and
sustainability o healthcare business models.
Perormance-based Funding (PBF):
Providers o perormance-based unding can
pay healthcare workers electronically into their
mobile nancial services account based on
services that were perormed on patients.
As perormance-based unding becomes more
prevalent, those organizations paying caregivers
are burdened with complicated management
o variable payouts to caregivers. The system
quickly becomes too cumbersome to manage
costs eectively, particularly i done manually
through cheque and cash. Automating the
calculation and payout processes by combining
mHealth data with the mobile platorm creates
a way to reduce the complexity and scale new
capabilities.
An example o this is a public-private initiative
in Tanzania, where an SMS or Lie program
was established targeting data collection to
reduce pharmaceutical stock-outs or anti-
malaria drugs. The programme used SMS as
the method or data collection and motivated
pharmaceutical supply-chain workers to submit
inventory inormation via mobile phones.
In the absence o mobile nancial services to
provide payments, they motivated key personnel
to participate by pushing airtime minutes as a
bonus to workers or accurate data input. By
combining ICT or reporting o inventory and
motivating data submitters through a proto-
currency o airtime, the six-month trial reduced
stock-out rates rom 95% to 6%.
Due to this eort, 300,000 more people were
able to receive anti-malaria treatment in 150
health acilities servicing 226 villages.7 In this
example, e- and mHealth addressed the ques-
tion o how to make systems more ecient,
while mobile nancial services addressed
the question o how to motivate peopleto participate.
Vouchers or Conditional Aid: Mobile
nancial services can be the settlement
mechanism between payers and providers
o healthcare services or products given to
patients who use vouchers.
In the area o ood dissemination, or example,
mobile-enabled systems or ood voucher reg-
istration, claim and settlement are used by the
World Food Programme. In this system, World
Food Programme workers identiy and register
eligible recipients or ood.
Upon registration, the recipient receives a
scratch card with a code, which they use to
claim ood at nearby retailers. To veriy the
transaction, the retailer submits the code into
a mobile phone and receives verication rom
the system. When the retailer provides the
ood and perorms the transaction, the system
automatically settles the payment between the
World Food Programme and the retailer by
moving the money between mobile nancial
services accounts.
This automated system has signicantly reduced
the paperwork burden or all entities in the
supply chain while also motivating suppliers to
participate, as payment settlement occurs in
minutes rather than months. Such a systemcan be applied to healthcare services as well.
Supply Chain Settlement and Credit:
Supply chain participants can settle payment
electronically between their mobile nancial
service accounts. For example, this type o
payment settlement can be used in the phar-
maceutical supply chain to increase the speed
o payment settlement. In addition, providing
access to credit to buyers within the supply
chain will reduce inventory stock-outs oten
caused by lack o unds.8 While it remains to
be seen whether implementing mobile nancial
services in drug supply chains can assist in
reducing countereit drugs, what is certain is
mHealth and MFS are inextricably linked by common building blocks and cross-sector dependencies
(Source: mPay Connect)
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
6/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
04
that when drugs are identied as countereit,digital money trails will assist in more eectively
locating criminals.
Mobile Financial Services or
Patients
Mobile Pre-paid Savings:The majority
o the worlds population has no access to
healthcare insurance. Access to mobile-based
savings may assist with this issue. Patients can
accrue assets in a prepaid mobile savings acc-
ount to prepare or upcoming healthcare costs.
Unlike cash stored under the mattress, these
accounts provide a sae, reliable place to store
and accrue their assets out o harms way. They
also can establish a fnancial history, which can
be used by fnancial service providers or uture
credit oerings.
New nancial services, such as mobile-enabled
savings accounts, assist patients in nancial
planning and saving or uture healthcare needs.
Serious injury and unerals are cited as the top
requent event causing nancial emergency
or the poor in Bangladesh, India and SouthArica.9
It has also been suggested that mobile money
systems like m-Pesa in Kenya may play a
signiicant role in reducing risk: as noted
by research rom Georgetown University
households who have access to m-Pesa
and are near an agent point are better able
to maintain the level o consumption expen-
ditures, and in particular ood consumption,
in the ace o negative income shocks. On
the other hand, households without access
to m-Pesa appear to be less able to protect
themselves rom such adverse events. 10
There are also examples o mobile nancial
services programs with prepaid savings being
tested within the context o maternal health.
For example, in Kenya only 5% o the populationhas medical insurance. Kenyans employed in
the ormal sector pay or mandatory health
coverage, but 11 million adults work in the
inormal sector with no such insurance.11
In Kenya, 56% o women give birth at home,mostly due to lack o access and economic
means to pay or delivery the in healthcare
acilities.12 Home birth increases maternal and
natal mortality rates. Those who seek better
healthcare and deliver their child in hospitals
risk the ate o imprisonment i they cannot
aord payment. As was noted by the Los
Angeles times in 2009, an increase in cases o
cash-starved public hospitals detaining patients
over unpaid bills spurred outrage in Kenya.13
One provider is addressing this issue through
various methods. On the logistics and access
side, they are developing a maternal health
clinic system o vans that can be standardized,
replicated and brought to expectant, low-income
urban mothers.
On the nancial side, this provider is assisting
amilies with nancial planning or upcoming
delivery by providing a prepaid savings ac-
count. The patients can move money into this
savings account any time and anywhere using
their mobile phones to trigger a money transer
using Kenyas mobile money transer system,
m-Pesa. The same account can be used to
pay delivery costs to the clinic.
In another example, a hospital began to issue
prepaid cards to expectant mothers, leveraging
m-Pesa so patients could move unds to their
prepaid savings cards.14
At the time o hospitaldelivery, patients use prepaid cards to pay or
their healthcare services at the hospital.
Mobile Micro-Insurance: In addition to
savings accounts, patients can pay or micro-
insurance premiums through a mobile phone
and receive claims into the mobile nancial
services account. By taking the riction out o
saving and making regular payments, oppor-
tunities are created or individuals to manage
small amounts o money more eectively.
In the Philippines, the national insurer introduced
SMS payments o insurance premiums on a
ractionalized basis. This enabled individuals to
Digital EfficienciesDigitization leads to increases in productivity and transparency and
decreases in crime and human error
Productivity Gains: The use o ICT and digitization o data and processes saves time on
administrative tasks in healthcare and nancial services. Whether it is the cost savings as-
sociated with retrieving patient data in a timely ashion or the time saved not having to walk
to a bank, the economic benets are signicant due to reduced shoe leather and opportu-
nity costs. In addition, digitizing manual processes and data reduces errors that ultimately
adversely aect productivity.
Improved Transparency: Digitization o patient medical treatments and money move-
ment creates a level o transparency that can reduce raud and thet by creating an audit-
able digital trail and reducing the number o participants in the value chain. For example,
digital money acilitates direct payments rom the payer to the remote recipient o payment,
cutting out the middle man handling cash. This, in turn, ensures that less money is pocketed, or
leaked during the transaction. In addition, accessing patient data directly rom the sourceurther reduces the chances o incorrect or missing healthcare inormation used or making
diagnoses.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
7/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
05
pay smaller amounts o money on a weekly/
monthly basis, rather than larger payments
on a quarterly or hal-yearly basis. With lower
costs and greater convenience, participation
rates increased.
In Bangladesh, health micro-insurance is
provided to poor patients who pay yearly pre-
miums. Co-payments are made by the patients
upon visits to health centres. MFS can be used
in the uture in lieu o cash or these payments.
Using a mobile phone or insurance payments
and payouts signicantly reduces the admin-
istrative costs associated with providing insur-
ance to these customers.
Conditional Cash Transers: Patients
can receive conditional cash transers instantly
and electronically into their mobile nancial
services account. Fast, sae and ecient pay-
ment motivates patients to participate in the
healthcare system.
Future Uses o Mobile FinancialServices or mHealth
As mHealth continues to gain momentum and
more advanced remote services are oered,
electronic payments will be needed to support
these services. Today, there are one- and two-
way communications and inormation-based
mHealth services in emerging markets, such
as health hotlines.
These services are oten ree o charge or rely
on de acto airtime top-up systems as the
method o payment whereby a payer purchases
additional airtime minutes to pay or the
mHealth service or receives payment through
airtime minutes.
This system works well or low-value purchases
(equivalent o one rupee per day). However, as
the mHealth industry matures in these markets
and the services oered become more sophis-ticated, the value o the services will increase
such that one rupee payments through airtime
will not suce. At the point, mobile nancial
services and more robust third-party settlement
systems will be required to enable payment.15
For example, in the uture, as patients begin to
receive diagnostic care through decision support
systems enabled through a mobile phone, how
will payment be made between the user and
provider? Similarly, i a eld healthcare worker
requests expert clinical diagnostics through the
mobile phone, how will payment o that service
be made? Neither cash nor banking systems
can support remote money movement o
unbanked people. Mobile nancial services will
be the method to enable and settle these types
o mHealth transactional payments.
Driving Demand: mHealth spurs
Mobile Financial Services
Still in the early stages o development, there
are a number o uncertainties on the business
models o mobile nance services. With more
than 164 MFS initiatives deployed worldwide,
Maternal HealthThe Case o Maternal Health
Maternal health could greatly benet rom the use o mobile nancial services. Along the
continuum o the 14-month cycle o healthcare, there are key points where mobile nancial
access could address key issues in the patient, provider or service, and HR or administrative
levels o support.
Pre-Pregnancy: During the pre-pregnancy phase o care, patients can receive education
on amily planning, sexually transmitted diseases and other healthcare matters through
their mobile phone, paying or such services through airtime top-up minutes to the mobile
network operator or through MFS to the third-party provider o these services.
Pregnancy: During the pregnancy phase o care, MFS can be used or remote payment
and settlement o testing, lab work and remote diagnostics. MFS can be used as the method
o supply chain payments or prenatal vitamins. In the uture, healthcare providers may
use MFS to pay or remote access to a pregnant mothers electronic healthcare records.
Patients can receive conditional cash transers or participating in healthcare services
oered to pregnant mothers and healthcare workers can receive perormance-based
unding or successully completing various healthcare services or the patient. For those
pregnant mothers without insurance, prepaid savings accounts can be oered in preparationor upcoming delivery expenses.
Birth:MFS can be used or direct payment, co-payment or or third-party settlement o all
healthcare services associated with birth, rom ambulatory transport to hospital care.
Post-Natal:Voucher-based or direct mobile payments can be triggered via mobile or services
associated with post-natal care, such as inant immunizations. In the case o voucher
payments, a mother could sign up or post-natal services and receive a scratch card or
identication code which she could then present to the immunization clinic. That clinic would
send that code using their mHealth application to the provider or verication. I the code is
veried, the clinic would provide the services and receive immediate payment by the third-
party payer or the perormed service through the mobile nancial services system.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
8/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
06
only 10 have achieved a subscriber-base o
more than 1 million users.16 As such, there is a
widely recognized need or a strong use case
to spur adoption and unlock greater capital
lows.
As one o the most important industries globally,
health services may spur mobile money adop-
tion in markets with lagging mobile nancial
services uptake.
To motivate new users, enterprises and
governments to adopt a payment system,
there must be signicant value and a compelling
reason to change. Receiving money is a moti-
vator to sign up or a system. Payers sending
the money become the infuencers in the
system, virally signing up receivers o payments.
Key stakeholders in the healthcare industry
can act as the infuencers that spur sign-up
and usage o the mobile nancial services
system by using it or salary disbursements,
perormance-based unding, conditional cash
transers and conditional aid.
Sharing Common Building Blocks
Both the inance and health sectors share
common customers, inrastructure, business
processes and policy concerns. These shared
elements, i addressed in an integrated and
holistic manner, can serve to reduce ineciencies
and costs.
The Same End-users
In terms o serving their end-users at the
base o the pyramid, the mHealth and mobile
nance sectors have overlapping constituencies.
As such, there are potential cross-sector
eiciency gains in better understandingcustomer needs.
There is surprisingly little known about thecomplex needs o the poor, although they
represent approximately 40% o the world
population. According to The Portolios o the
Poor, Large surveys give snapshots o living
conditions. They help analysts count the num-
ber o poor people worldwide and measure
what they typically consume during a year. But
they oer limited insight into how the poor
actually live their lives week by week how
they create strategies, weigh trade-os and
seize opportunities.17
The nuances surrounding culture, socio-eco-
nomic status, access and literacy are complex
and can only be appreciated at the personal
and community level. Those who interact with
end-users in the eld have a wealth o under-
standing that is required or service providers
to adequately tailor services to meet the needs
o their end-users.
Uses of MFS for future mHealth applications (Source: mHealth Alliance and mPay Connect)
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
9/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
07
Some o the key questions on end-users include:
What are the dierences between rural
and urban dwellers in the region?
What are the degrees o health clinic and
bank access?
Who are the infuencers in the communitywho can spur adoption?
What are the nancial and health literacy
levels o the end-users?
What role does gender play in mobile ac-
cess and use o such services?
Collectively, the nancial services, communi-
cations and health sectors have a common
opportunity to develop a richer understanding
o their end-users. From a digital perspective,
analytics on the data (and metadata) generated
in the use o these services can help stakeholders
within the mHealth and MFS ecosystem to
better understand individuals, their needs,
and behaviours.
O course, the principles and trust rameworks
or the sharing and usage o personal data
must be addressed by all stakeholders. It will
be critical to understand and agree upon what
aspects o data can be shared or optimizinghealth and nancial services while also main-
taining customer rights and the security/stability
o nancial and health delivery systems.
Common Building Blocks:Technology Inrastructure
As ICT-based solutions, mHealth and mobile
nancial services share a number o common
inrastructure elements that can be leveraged.
By sharing a common underlying technology
platorm, not only do both sectors save on
operational expenses, but the ability o their
systems to scale and handle additional com-
plexity is extended.
Front-end Efciencies: Given that both
inancial and health systems leverage the
mobile handset, the usability, accessibility andBetter information sharing creates a richer understanding of the individual (Source: mPay Connect)
The Efficiencies of User Centricity
As patterns o behaviour and needs o the poor become better known within communities,
both MFS and mHealth benet rom cross-sector knowledge to build better services that
tailor to their needs. For example, a micronance institution that provides micro-credit or
Raina Kapur understands that she is an infuencer in her community, works many hours on
her business, and has a strong track record o micro-credit repayment. Her mobile operator
knows that she is a heavy user o SMS and uses her phone requently, but may not know that
her phone is used to conduct her entrepreneurial endeavours that are nanced through her MFI.
At the same time, her healthcare worker knows she is pregnant and is prescribed with
prenatal vitamins. A holistic snapshot o Raina could reveal that she is an ideal candidate
or mobile nancial services or healthcare since she is mobile-savvy, needs to plan or
upcoming delivery costs through a prepaid savings account, has a strong nancial history
o micro-credit repayment, is a time-constrained entrepreneur and needs an easy and sae
method to purchase her vitamins. Because she is an infuencer in her community, she mayalso help others to adopt MFS and mHealth services.
Access to additional cross-sector data can assist with proling customers or credit and
reducing insurance risk. Some rms are now investigating new modelling techniques o
mobile usage to help determine credit worthiness or segments o the population with no
credit histories. I mobile usage could be an indicator, could healthcare patterns be as well?
Could a consistent pattern o healthcare usage combined with steady usage o money
transers suggest a liestyle that should have access to premium insurance and credit?
In addition, combining mHealth data collected in the eld through the mobile phone can
provide more robust actuarial data or determining insurance risk. The benets o better
actuarial data provide or more ecient orecasting or design o benets, reimbursements
and government-proposed standards on healthcare costs. O course, dening customer
rights and establishing rameworks around data privacy will be vital to these eorts.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
10/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
08
reliability o applications is vital to ensureadoption. Both sectors are impacted by the
users preerred mobile user interace, their
understanding o the device, the aordability
o the mobile phone service (device, data and
voice network, and tari structure) and the
accessibility to a reliable electricity grid or
recharging phones.
Back-end Platorms: There are com-
monalities in the back-end requirements or
mHealth and MFS systems. Both e- and
mHealth and mobile nancial service rely on ID
management, authentication, raud detection
and security or their platorms. By understanding
common requirements between mHealth and
MFS, back-end systems can be built to leverage
these common building blocks. Standardizing
these common areas at the platorm level will
enable cross-industry cost savings and the
possibility or easier integration among service
providers within and between both industries
in the uture.
The historical lack o electronic healthcare
management systems and nancial services
inrastructure in many emerging markets may
provide a possible advantage when creating
cross-sector platorms rather than integrating
legacy systems. This will enable superior cost
benets, decreased time to commercialize and
better ability to integrate MFS with healthcare
payments throughout the continuum o care.18
Donors and governments have the potential to
play an important role in bringing together the
key stakeholders to dene a common technol-
ogy ramework that can benet all relevant
stakeholders.
ID management is one example o an element
in the technology platorm that can be leveraged
by multiple entities.
As various entities deliver services to the same
individual, each organization aces the chal-
lenging questions regarding identity, including:
1. How does one ensure that this person
exists?
2. How does one authenticate and ensure
that the person is who they say they are?
3. How does one veriy that it was really the
person stated who received treatment at
clinic X?
4. How does one ensure that the insurance
rm, the payment settlement system
and medical clinic all recognize the same
person as the same individual and that
co-payment is made accordingly?
5. How does one ensure there are not
redundant, raudulent or misspelled
data entries o the persons name in the
mHealth and MFS systems?
For the delivery o personalized services, the
secure, reliable and condential validation,
authentication and management o identitysystems is critical. Absent these core enablers,
the opportunity or error, corruption and raud
is rampant. For example, a recent survey done
by the Food and Supplies department o Delhi
government on ration cards revealed that, in
the absence o a robust ID system, over 1.7
million ration cards were being issued to bogus
individuals. In act, they ound 901 dierent
records or the same name and address.19
An open issue or discussion, however, is i
one common ID system is needed. The role o
shared trust rameworks that provide dierent
actors the ability to provide dierent levels o
authentication and control or dierent classes
o activities is a growing area o ocus.
Common Building Blocks: Similar
Business Operations and Business
Model Elements
Both sectors gain advantages by leveraging
common business operations. In addition to
the cost savings associated with sharing
operations and inrastructure, both industries
may beneit rom pricing that takes into
account the needs o both.
Business Operations Last Mile
Human Agent Network: In providing
services to the poor, both industries still require
last mile, in-person relationships to reach
their customers. Oten reerred to as agentnetworks or telecommunications operators or
community health workers or mHealth, they
have a high degree o local knowledge and the
trust o the community. Along with providing
eedback and insights or tailoring the design o
appropriate and aordable services, these
individuals can act as the liaisons to educate,
train and register users or services.
In some cases, these trusted agents perorm
the mobile unctions on behal o the customer,
who may not have the level o literacy to be
able to complete the task themselves. In addition,
they perorm certain in-person services. For
instance, in the absence o extremely expensive
Example: ID Management (Source: mPay Connect)
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
11/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
09
ATMs, mobile network operator (MNO) agentsact as human ATMs, taking cash-in and
disbursing cash-out o the MFS system.
Microinance institutions use their agent
networks to disburse and collect micronance
loans. In mHealth, community healthcare workers
and traditional healers provide healthcare
screening to patients.
Business Model: Both mHealth and MFS
share common concerns regarding business
issues on revenue models, cost structures,
sustainability and scale. In serving the lower
socio-economic sectors, service providers are
still challenged to achieve sustainable business
models. What is the pricing structure and who
pays or services or people earning less
than US$ 2/day? Individually a new venture
in mHealth or MFS can be custom built and
achieve some level o protability. But scaling
these individual pilots on a global basis remains
a long-term challenge.
For service providers that are not acility-based
mobile network operators, how do the various
ees and taris associated with voice, text and
data aect end-user adoption rates? Developing
a balanced pricing structure so the ees imposed
by the incumbent industry do not constrain
others is an open issue and a constraint on
achieving scale.
Both in mHealth and in MFS, the question o
who leads is non-trivial. In healthcare, who
should maintain and host the electronic health-
care record is dicult to answer and may be
determined in part by evolving policy on who
owns the health record (and can move its
location/hosting) and who determines who has
access to the record.
Similarly, who leads in MFS varies rom one
market to the next. In the case o MFS, regula-
tory policies are being developed to clariy
the role that inancial institutions and mobile
operators can play in rolling out such services.
In dierent markets, varying business models
Efciency gains in cross-sector agent operations: Given that both mHealth and
MFS require eld personnel to interact with the same user base, there are opportunities to
identiy common or redundant tasks that can be done by a shared resource. For example,
the unctions o signing up users, checking their ID and registering the mobile numbers19
may be points o redundancy that can be done by one rather than two or three separate
agent networks. In addition, there may be opportunities to do cross-sector training with
these agents to educate them on the various mHealth and MFS services.
Healthcare workers could augment their income by providing cash-in and cash-out services
where appropriate. Organizations are now beginning to test this concept. In India, there are
examples where healthcare workers act both as a healthcare liaison and as the registrant
or micro-insurance services using a handheld device.
Efciency gains in business models: Both MFS and mHealth are inherently depen-
dent on aordable pricing. Naturally, this can either have a positive or negative eect on
adoption. Pricing may be eective or person-to-person money transers but ineective or
delivering mHealth. For example, i the end-user ees or transerring money exceed the
price or receiving a particular mHealth service, the value breaks down.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
12/18
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
13/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
11
issuers and banks all have distinct areas o
competence.
However, the boundaries distinguishing where
one service begins and the other ends has
become murky. A ew key uncertainties in this
area include:
I nancial or medical SMS messages are
not received, is the mobile network opera-
tor liable or the adverse consequences?
Does an application on a mobile phone
also require device certication?
Can a mobile network operator be heldliable or malpractice in the event o a
security breach?
The digitization o healthcare and nancial
services also leads to questions o data access
and consumer protections. A r icher under-
standing o who has rights to access and
share such inormation, the types o data that
can be analyzed and the policies governing
customer rights are in their nascent stages.
Proportionality: A Conceptual
Framework or Managing the Risks
and Complexities o Innovation. As
MFS and mHealth sectors begin to tackle
questions o proportional customer documen-
tation, liability within complex ecosystems and
customer protections, these policies shouldsupport one another. As such, it will become
increasingly important or regulatory bodies to
be knowledgeable o how their counterparts
have tackled similar issues.
For example, in MFS, a common practice is totreat risks with proportional regulatory policies
around customer documentation at registration.
Accounts with lower transaction volume limits,
perceived as lower risk or money laundering
and terrorism nancing, may require relaxed
data requirements on the user or account
registration. Such proportionality could apply to
healthcare services and the level o requirements
imposed on service providers based on the
established criticality o care to be provided.
In addition, it may become important to consider
the possibility o organizational alignment with
policy decision-making that is horizontal in
nature, cutting across multiple sectors rather
than vertically-ocused within one industry.
Without a doubt, the level o coordination,
knowledge transer and collaboration among
disparate policy-making entities will be increas-
ingly crucial.
Conclusion and Next Steps
This paper set out to identiy synergies between
the nancial services and health industries as
a way to improve the health and wealth o the
poor. By understanding the interdependences
among mHealth and mobile nancial services,
cross-sector eciencies, innovative delivery
options and increased end-user adoption were
some o the key beneits. Scaling together,
the socio-economic beneits ampliy one
another.
Going orward, it will be critical to address the
ollowing key questions to realize the synergies
between the evolving mHealth and mobile
nancial service ecosystems:
1. What is the best method to drive these
eciency gains? Who will lead these eorts?
2. Who will build and manage the common
inrastructure and distribution networks?
3. How will the various cross-sector policy
rameworks be coordinated and harmonized?
4. How will integration and interoperability o
disparate technologies across multiple in-
dustry and public sector domains occur?
How will these eorts be driven? What will
Key Stakeholders (continued)
tions are well capitalized to drive such eorts, although innovation is oten stymied
by the size o the organization. Start-ups oten move at the astest pace to drive
innovation, but lack the resources to achieve scale quickly. Banks look to participate
in the growing market o banking the unbanked by acting as the wholesale holder
o aggregate unds or a retail partner to mobile network operators or other third party
providers in reaching unbanked segments. Various models are being tested around
acquisition, partnership and joint ventures among these various constituents to bring
MFS to market.
Donor Communities: Donors provide grants or mHealth and MFS programmes that
enable access to critical health and nancial services or the poor. By supporting eorts to
pilot and commercialize mHealth and MFS initiatives, donors strive to achieve their missions,
whether the missions involve increasing the health or nancial quality o lie or the poor.
Health Service Agents (Community Healthcare Workers and Traditional Healers):
mHealth provides access to expert advice or community healthcare workers and enables
them to eciently transmit critical aggregate data back to centralized acilities or analysis.
MFS enables healthcare workers to received prompt payment or salary and services per-
ormed while reducing leakage associated with raud due to lack o traceability o cash.
Mobile Financial Services Agents (MNO Agents, MFI Agents and Others):
Independent airtime top-up agents are oten the points or cash-in and cash-out o mobile
nancial services systems driven by mobile operators. MFI community workers, retailers,
remittance operators and post oce workers are other orms o agents that can reach rural
communities and act as cash-in and cash-out points. These agents are motivated by the
commissions they receive or exchanging cash into digital mobile money and vice versa.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
14/18
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
15/18
Continuous eort, not
strength or intelligence,
is the key to unlockingour potential.
Winston Churchill
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
16/18
Ampliying the Impact:Examining the intersection o Mobile Health and Mobile Finance
14
1
1.5 billion people worldwide live without access toelectricity and many more whose energy services are either
sporadic or cost-prohibitive, New York Times, World
Bank Pressured on Clean Energy, 11 October 2010.
2 CGAP, Health Issues, Anup Shah, 2 October 2010.
3 Strategy on Health Care Financing or Countries o the
Western Pacic and South-East Asia Regions (2006
2010), World Health Organization.
4 GSM Association, Mobile Money Deployment Tracker,
2010.
5 Mobile penetration rates are orecast to rise rom 46%
in 2008 to 95% by 2013 according to a new survey o 34
emerging market countries, Tari Consultancy Ltd. By
2013 there will be well over ve billion mobile phones glob
ally. In contrast, there will be only 2 billion computers.
CGAP Banking on Mobiles: Why, How, and For Whom?
CGAP October, 2008.
6 M-Paisa: Ending Aghan Corruption, One Text at a Time,
Monty Munord, 17 October 2010.
7 Vodaone interview.
8
Drug countereiting is a particularly serious issue in thepharmaceutical industry. Mobile systems such as Sproxil
are now being used to identiy countereit drugs by en-
abling supply chain participants and patients to send a text
message through their mobile phone that contains the
code on the drug packaging or verication o authenticity.
To the extent that payments are made electronically rather
than in cash, combining systems like Sproxil with mobile
nancial service payments provides the ability to pinpoint
who paid, who purchased, and where countereiting issues
may have arisen throughout the supply chain.
9 Portolios o the Poor, Daryl Collins, Jonathan Morduch,
Stuart Rutherord, Orlanda Ruthven.
10 m-Pesa Marches on, on Financial Access Initiative by
Jake Kendall, 28 October 2010.
11 Kenya: Medical Smart Card Extended to Maternal
Care, Susan Anyangu-Amu, 15 August 2010.
12 Ibid.
13 In Kenya, Patients held hostage to Medical Bills,
Los Angeles Times, 28 June 2009.
14 Kenya: Medical Smart Card Extended to Maternal Care
by Susan Anyangu-Amu, 15 August 2010.
15 Note: It is also important to understand that airtime minutes
is not currently recognized as a true currency and, thereore,
has signicant regulatory limitations as the de acto method
o payment beyond certain uses.
16
GSMA Development Fund Mobile Money Tracker,December 2010.
17 Portolios o the Poor, Daryl Collins, Jonathan Morduch,
Stuart Rutherord, Orlanda Ruthven.
18 Note that one area specic to e-/and mHealth in the
platorm unction that is not directly addressed in MFS is
Access Control due to the dierent levels o data rights
and constituents associated with access to health care
records.
19 Ration card scam: Govt probe to gun or PDS maa,
Express News Service Posted: 9 July 2008.
20 Narayana Hrudayala Heart Hospital: Cardiac Care or the
Poor, Tarun Khanna, V. Kasturi Rangan, and Merlina
Manocaran. Harvard Business Review, 25 April 2006.
Copyright 2011 by the World Economic Forum All rightsreserved. No part o this publication may be reproduced,
stored in a retrieval system, or transmitted in any orm
or by any means, electronic, mechanical, photocopying
or otherwise without the prior permission o the World
Economic Forum.
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
17/18
Special thanks to:
Kaosar Asana, MD, MPH, PhD
Associate Director, Health Programme
BRAC
Samuel Agutu
Managing Director, CEO
Changamka
Ben Bellows, MPH, PhD
Associate and Program Manager
Population Council
Peter Berman, MSc., Ph.D
Lead Health Economist, HDNHE
The World Bank
Mohini BhavsarResearcher
MobileActive.org
Alison Bloch, MBA, MPH
Managing Partner, mHealth
Arc Spring Group
Karl Brown
Associate Director, Applied Technology
Rockeeller
Joaquim Croca
Head o Vodaone Health SolutionsVodaone
Jacques De Vos
Director, Business Development
GeoMed MIT
Melissa Densmore
PhD Candidate
UC Berkeley School o Inormation
Rose Donna
Director
DataDyne.org
Jonathan Donner, Ph.D
Researcher, Emerging Markets Group
Microsot Research, India
Daniel Feikin, MD
Johns Hopkins, Bloomberg School o
Public Health and Centers or Disease
Control and Prevention
Harry Greenspun, M.D.
Executive Director and Chie Medical Ocer
Dell Healthcare Services
Vicky Hausman
Associate Partner
Dalberg Global Development Advisors
Ashok Kaul
Vice President, Healthcare Convergence
Wireless Lie Sciences Alliance
Ramesh Kesanupalli
Chie Technology Oicer
Validity Inc.
Gavin Krugel
Senior Director
GSM Association
Raina Kumra
Senior New Media Advisor, Oice o eDi-
plomacy- Diplomatic Innovations Division
United States Department o State
Alain B. Labrique, MHS, MS, PhD
Assistant Proessor, Department o Inter-
national Health & Department o Epide-
miology (jt.), Program in Global Disease
Epidemiology and Control
Johns Hopkins Bloomberg School o Pub-
lic Health and Centers or Disease Control
and Prevention
Ben Lyon
Executive Director
Frontline SMS: Credit
Brad Magrath
Regional Director
Mobile Transactions
Rakesh Mahajan
Vice President, Marketing and Head o
VAS & Incubation
Bharti Airtel Limited
Kerry McDermett
Expert Advisor, National Broadband Task
Force, Oice o Strategic Planning and
Policy AnalysisNational Federal Communications Commission
Patricia N. Mechael, PhD MHS
Director o Strategic Application o Mobile
Technology or Public Health and Development
Center or Global Health and Economic
Development, Earth Institute, Columbia
University
Robin Miller
Senior Consultant
Dalberg Global Development Advisors
Josh Nesbit
Executive Director
Frontline SMS: Medic
Nick Pearson
Founder
Jacaranda Health
Jody Ranck, PhD
Executive Team Member
mHealth Alliance
Joel Selanikio, M.D.
Director
DataDyne.org
Mary Taylor
Senior Program Oicer
Gates Foundation
Ken Warman
Senior Program Oicer
Gates Foundation
Tim Wood
Director, Mobile Health Innovation, ICT Innovation
Grameen Foundation
Thierry Zylberberg
Executive Vice President, Head o Orange
Healthcare Division
France Telecom
At the World Economic Forum
Proessor Klaus Schwab
Executive Chairman
Olivier Raynaud
Senior Director, Head o Global Health and
Healthcare Industries
William Homan
Associate Director, Head o Telecommuni-
cations Industry
At the mHealth Alliance
David Aylward, JD
Executive Director
mHealth Alliance
Clive Smith
Executive Team Member
mHealth Alliance
Special Acknowledgement To:
Ms. Menekse Gencer o mPay Connect or
her support and authoring o this paper
-
8/6/2019 WEF HE Intersection Mobile Health Mobile Finance Report 2011
18/18
World Economic Forum
91- 93 route de la Capite
CH 1223 Cologny/Geneva
Switzerland
Tel.: +41 (0) 22 869 1212
Fax: +41 (0) 22 786 2744
E-mail: [email protected]
www.weorum.org
mHealth Alliance
1800 Massachusetts Avenue, N.W.
4th Floor
Washington, DC 20036
Tel. +1 202.887.9040
www.mhealthalliance.org