PharmAccess’ session at this year’s Afrikadag focused on the topic "Digital health financing and delivery: What can the Netherlands learn from Africa?” Mobile communication is transforming African society in ways that nobody could have imagined a few years ago. More than 90% of Africans today own a mobile phone, which creates opportunities to reach individuals at a larger scale for lower costs than ever before.
Achmea’s Jeroen Kemperman argues that digital innovations in healthcare develop faster in countries like India and Kenya because “Scarcity forces you to be more creative in order to find the big solutions to the main challenges”. Aaltje De Roos from the Dutch Ministry of foreign Affairs agreed: “It allows the exploration of new ways to innovate, of doing things differently, not hampered by any old system which sometimes prevents us from thinking out-of-the-box.”
According to the two other panelists, the World Bank’s Khama Rogo and PharmAccess’ Monique Dolfing-Vogelenzang, this thinking is indeed what is needed to tackle the most urgent challenges and make healthcare work for long excluded groups. PharmAccess’ moderator Kwasi Boahene added that “The right mix of people is needed to execute these changes, like the partners we have in the panel today.” These changes require a mix of international, local, public, private, innovative and political partners.
“The poorest people pay the most money for the worst care,” said Khama Rogo, “More people fall ill because of ill health than through revolutions and corruption”. He explained that Africa has a population of 1,3 billion people that is growing rapidly, consisting of mostly young people. This climate creates a heavy disease burden on an economy that is mostly dependent on extracting raw materials. In this context Universal Health Coverage has to be created.
Rogo argues this can only be done using mobile technology: “Everyone has a mobile phone, yet the taxman is only able to reach fifteen percent of the population to raise taxes to build public services.” People trust their phone and it can be used to reach people for healthcare, including the 80% of people working in the informal sector, at low costs and in a sustainable way. According to Rogo, “we always looked to the West for answers, now we look at the cell phone. It has become the interface for health and financing”
Kemperman, who is the author of the book Brilliant Business Models in Healthcare, sees four clear advantages the mobile phone has to offer. Number one is financing and paying for healthcare. A mobile health wallet allows you to start pooling out-of-pocket expenses and start sharing risk among a larger group. Kemperman: “These shared out of pocket payments can lead to the development of health insurance.” The second benefit is access to information which enables people to make an informed decision about whether to go to the doctor. The third benefit is that it allows distant monitoring. “Instead of setting up more physical hospitals we can create virtual ones,” explains Kemperman. And lastly, the mobile phone allows people to order drugs directly. According to Kemperman this takes out the middle man, which means that “this will allow to cut prices and create transparency in the whole supply chain.”
Monique Dolfing-Vogelenzang made Kemperman’s examples more concrete by showcasing M-TIBA. “The M-TIBA health wallet allows people to save, receive and remit money earmarked for healthcare,” she explained. M-TIBA has been developed by PharmAccess, Safaricom, M-PESA, and CarePay, with support by the Dutch Ministry of Foreign Affairs and the Dutch Postcode Lottery. M-TIBA won the 2017 Financial Times/ IFC Transformational Business Award in Health.
According to Dolfing-Vogelenzang one of the biggest challenges in healthcare is financing; of getting more money in the system. “Healthcare financing is hugely fragmented. The M-TIBA health wallet allows you to pool all these different sources.” A patient can open his wallet and pay with his entitlements, which can be savings, vouchers, insurance or support from a relative.
“It creates transparency for patients, doctors and funders plus the digital component allows for it to be scaled at no marginal costs,” explains Dolfing-Vogelenzang. The wallet creates a safety net for when people fall ill, but “the good thing is that it can also be used for prevention. The data online can track you and support the people in making the right decision. We are now doing this for pregnant women.”
To make full use of the potential of the mobile phone and innovations like M-TIBA, De Roos sees that the Ministry can play an important role “to bring partners together and work with governments to improve policies to make the innovations embedded in the local contexts.” She sees that her Ministry can contribute to creating an enabling environment for these innovations to flourish and on developing regulations that protects those people using public services. For instance, in the whole privacy debate.
As Rogo concluded during this debate, the system that “will be developed to deliver healthcare in Africa will look very different from the healthcare system in the Netherlands.”
All photo’s shown were made by Roos Trommelen and Emmy de Graaf
Moderator Kwasi Boahene (PharmAccess’ Director of Advocacy & Program Development)
Prof. Dr. Khama Rhogo (Lead Health Sector Specialist World Bank; Head World Bank Group’s Health in Africa Initiative), and Ministry of
Foreign Affair’s Aaltje de Roos
PharmAccess’ COO Monique Dolfing-Vogelenzang