By David South, Development Challenges, South-South Solutions
Pioneers in Africa are experimenting with new ways to fund the delivery of healthcare that is affordable and sustainable and not dependent on foreign aid and donations. A South African company is prototyping the selling of pre-payment healthcare services through mobile phones with a range of vouchers that can be bought and downloaded at the tap of a keypad. They are priced at between US $12 and US $49 and cover medical and dental check-ups, tests, treatments, chronic care and medicines. They are flexible and can also be sent to friends and family who need help.
In South Africa, poverty is still widespread. The majority black population has a median income of US $2,000 a year (New Internationalist) and many still live in crowded townships and poor rural communities. Poverty has also increased for many white Afrikaner South Africans (http://en.wikipedia.org/wiki/Afrikaner). A study by the Standard Bank of South Africa found the number of whites earning less than US $80 a month grew from 2000 to 2004 by more than 50 per cent. In the government capital of Pretoria, 50 Afrikaner squatter camps have emerged in recent years. For many, affordable healthcare is a critical issue.
The story of healthcare in Africa is not a linear one of constant progress. The continent as whole achieved its lowest child mortality rates in the 1970s. But after that, the quality of healthcare declined as a result of various factors including economic crises and the HIV/AIDS crisis – both of which overwhelmed public systems. In sub-Saharan Africa, health systems reached rock bottom in the late 1990s.
“Few people could afford annual check-ups, medicines or user fees at hospitals,” wrote Dr. Ebrahim Malick Samba in the paper “African health care systems: what went wrong?” for News Medical (www.news-medical.net). “One result was the resurgence of infectious diseases such as malaria, tuberculosis and cholera.
“Prior to the 1980s, the district hospitals, community health centres and other outreach health posts provided medical services and essential drugs free of charge. With reforms, user fees and cost recovery were introduced, and the sale of drugs was liberalized.
“Many governments discontinued budget support to the health sector which paralysed the public health system. There was no money for medical equipment and maintenance; salaries and working conditions declined.”
Things have been steadily improving from this low base through the 2000s, the result of increased aid funding for public health systems and greater national investments in staff, facilities and equipment. There is still a long way to go, but Africa is becoming a world leader in developing and deploying mobile phone applications for health and healthcare.
Despite dramatic improvements to the quality of hospitals and the number of qualified doctors, the continent’s healthcare services are still a patchwork, with rural and slum dwellers poorly served and the stresses of treating patients with contagious diseases like HIV/AIDS and malaria pushing resources to the limit.
Research has shown it is better and fairer to develop pre-payment mechanisms for healthcare than to just hit patients with fees when they are ill. With pre-payment, a person can buy care services when they are financially able to and bank up care for when they become ill and not able to work and save.
This is a crucial issue for people with low incomes who can quickly be devastated by their illness or that of loved one or family member.
The World Health Organization (WHO) has taken a firm stand against so-called out-of-pocket payments and encourages the growth in pre-payment methods. The World Health Report 2000 found that “Fairness of financial risk protection requires the highest possible degree of separation between contributions and utilization.”
South Africa’s Yarona Care (www.yaronacare.co.za/prepaid.html) – a health insurance provider network – is rolling out prepaid mobile phone vouchers, allowing patients to see doctors or dentists and even traditional healers for treatment. When a patient visits, the healthcare worker redeems the mobile phone voucher to get paid. One product, Impilo Go, allows people to pay for one visit to a doctor and seven days of medicine for R230 (US $34). For people on a tighter budget, there is Impilo Care for R80 (US$12). A patient can visit a nurse practitioner for a medical check-up and receive tests.
Impilo One offers medicines alone for R100, while Impilo Plus for R195 (US $29) is aimed at people with chronic conditions. They can get a prescription from the doctor and then go to a pharmacy participating in the scheme to receive medicines.
Dental work is also covered by the vouchers.
An online demonstration shows how the mobile phone process works (www.yaronacare.co.za/cellphonedemo.html).
The service is marketed at a mix of customers, from individuals to corporate clients looking to cover large numbers of people to government and NGOs. They can purchase services by voucher, payroll schemes or mobile phones.
Prepaid by mobile phone as a concept is already well established across Africa. It is a simple way to make payments and sell services. In the case of Yarona’s offering, the customer or patient uses their mobile phone to dial a code to pay for a service. When at the doctor or dentist’s office, he or she spends the voucher for the service by giving a unique code to the healthcare professional. Once this is done, Yarona Care pays the healthcare provider for the service.
The voucher approach allows customers to buy health services for family members for a defined period of time. Vouchers can also be sent to family members for emergencies.
Published: April 2011
1) South Africa’s Afridoctor mobile phone application claims to be Africa’s first personal mobile health clinic. It lets patients use its “SnapDiagnosis” system to submit photos of their ailments and in turn receive advice from a panel of medical professionals, or use the mapping feature to find doctors, clinics and health industry-related services nearby. Website: http://twitter.com/afridoctor
2) Ghana’s mPedigree uses cell phones to build networks to tackle and identify counterfeit drugs. Website: http://mpedigree.net
Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP’s South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South’s innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.
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ORCID iD: https://orcid.org/0000-0001-5311-1052.
© David South Consulting 2022
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