Brazzaville – In 2020, the World Health Organization (WHO) Regional Office for Africa pioneered mobile money transfer system under the Polio Eradication Initiative programme essentially to pay vaccination campaign workers. So far eight African countries have adopted the payment system, with others working to deploy mobile-based cash transfers in health programmes beyond polio. Dorcas Karimi, Digital Finance Officer with the WHO Regional Office for Africa, explains the progress achieved so far.

So, why has mobile cash transfer been adopted in health programmes?

Mobile cash transfer is a prominent payment system in sub-Saharan Africa, which boasts 469 million active accounts—nearly half the world’s total—and US$ 1.3 billion in daily transactions, according to the 2019 State of the Industry Report on Mobile Money by GSMA, a global mobile operators body. WHO in Africa, with the support from the Bill and Melinda Gates Foundation, has committed to introducing digital payments as a specific area of operational support to the 47 countries in the region in line with the Global Strategy on Digital Health.

A key consideration in adopting mobile cash transfer is because cash payments pose operational problems such as the risk of diversion and fraud, delays in paying field workers, security risks associated with the physical transportation of large sums and high administrative costs,  in particular the costs of transporting funds to the field, as well as the processes of justifying expenses.

Crucially, with the advent of COVID-19, every measure to prevent infection is lifesaving. The use of contact-free digital payments plays an important role in ensuring the safety of health and workers who risk their lives to provide lifesaving vaccines and treatments.

What barriers have had to be overcome?

First, change is never easy. WHO country offices have advocated strongly with health ministries to include mobile money transfers in their existing payment systems and processes. They have amplified the benefits of cash transfer systems in health programmes such as efficiency, timely payments that have a positive impact on workers’ motivation, as well as transparency and accountability issues.

Efforts are also being made to set up accurate and complete health worker databases in countries. WHO has partnered with a United States-based software company to develop an application to set up databases and is working closely with ministries of health to establish accurate health worker information.

Despite the widespread use of mobile money transfer in Africa, low mobile network coverage in some regions, weak systems in ensuring proper identification, verification and knowledge of cash transfers recipients continue to pose challenges. Efforts are underway to overcome these barriers such as by negotiating with mobile phone providers to issue free SIM cards to the community health workers involved in polio vaccination drives.

What progress has been made?

The pilot test phase of mobile money transfers in polio vaccination campaigns in the eight countries has shown positive results. In Liberia, for instance, payment timelines have been significantly reduced, with more workers preferring mobile payments over cash, according to a recent survey.

Secondly, health worker database and financial transparency have improved. In the pilot countries, databases now exist for all vaccination campaign workers with vital information such as name, gender, worker designation in the campaign, health district, mobile number and the amount paid. Once a payment is processed, a report can be extracted from the payments portal and shared with all partners.

Finally, mobile payments are cost-saving. A United Nations report after the 2014—2016 Ebola outbreaking West Africa found that mobile money transfers were significantly cost-effective in Sierra Leone in terms of money, time and lives saved. For WHO in Africa, cost-savings are already being realized under the mobile cash payment programmes. For example, programme assistants now do not need to travel to remote districts to deliver cash for health worker payments, saving travel and per diem expenses.