No treatment without money – a problem throughout Africa, many patients do not go to the doctor. The project mTOMADY in Madagascar wants to help with mobile mobile phone passbooks.

Bebiarisoa is relieved. The 36-year-old from Madagascar’s capital Antananarivo recently gave birth to twins Rija and Rajo. Both are healthy. Without her mobile health savings book that might not have been the case. Because after the birth, both children had to be hospitalized first. “I could not go to the nearest health center because one of the children had to go into the incubator after birth, so I went to the Befelatanana hospital,” says Bebiarisoa. But for the treatment there, she lacked the money. “I just saved 5000 Ariary,” she says – that’s 1.20 euros. A normal birth costs the relatives but between 20,000 and 30,000 Ariary. “mTOMADY helped me to get the rest together”,

The happy outcome was not self-evident. At her last pregnancy, Bebiarisoa underwent ultrasound for the first time. Although she had previously given birth to three children, she was always forced to cut costs. The Berlin neurologist Julius Emmrich can sing a song of such situations. Emmrich is chairman of the association Doctors for Madagascar. “If patients in Madagascar can not pay their hospital bill, then they will be held hostage until their relatives come to trigger it,” says Emmrich. “Many are not even treated because they can not pay in advance.”

Madagascar Bebiarisoa with her twins (mTOMADY)

Bebiarisoa with her twins

mTOMADY, a mobile savings account for health care

Emmrich is on medical trips to the island several times a year and knows the local situation well. Just like his colleague at the Berlin Charité Hospital Samuel Knauss. Both wondered why so little money is available for health care in Madagascar, even though international organizations spend millions each year on it. “We have found studies that show that 40 to 60 percent of health care funds simply disappear or are spent for other purposes,” says Knauss. Corruption, mismanagement, lack of infrastructure: There are enough reasons for poor health care in Madagascar and other African countries. But what could a solution look like? As part of an innovation program funded by the Charité and the Berlin Institute for Health Research, the two physicians began to search for solutions.

With an international team of doctors, software developers, economists and volunteers, Emmrich and Knauss began building a new IT infrastructure for Madagascar that would directly connect patients, health centers and funders. “There is no health insurance in Madagascar,” explains Emmrich. “So far, many just did not know how to save on their healthcare.” Because bank accounts have the fewest Malagasy. Covering money at home in a stocking would be far too uncertain, because cash can be stolen quickly. The mTOMADY (Malagasy for Healthy) project, which has since become known, wants to give people a safe option,

Low-tech, unbureaucratic help

“You do not need a smartphone for that and no internet connection,” Knauss explains. It’s enough every cell phone. “Everywhere traders sell small scratch cards, so when buyers enter the unlocked code, they can use it to send money directly to our health account.” With their low-tech mobile solution, virtually everyone in Madagascar has access to the new health account. “Since we started in October, over 500 pregnant women have already paid in their health accounts,” says Emmrich. And he is particularly proud of this: “We were able to finance the birth of 20 babies through our health account.”

mTomady Health Madagascar Berlin Workshop (Doctors for Madagascar eV)

Already 20 births were financed via mTOMADY

The 23-year-old Felana gave birth to a little boy on January 7th. She also used the mobile passbook. “I do not work, my husband is a site manager, I did not learn about mTOMADY until I was nine months pregnant, there were complications, I did an ultrasound scan, and then I decided to join.” On their own deposit of 60,000 Ariary, a German foundation struck half again – a subsidy scheme especially for pregnant women as an incentive to get as many as possible. 

Billing via health cloud

Because many patients in Madagascar and other African countries never know in advance how much they have to pay for treatment, they often do not even go to the doctor. The risk of ruining the whole family through high health costs is simply too great for them. In addition to the mobile health account, the project also includes quality management for the participating hospitals. In addition to medical quality criteria, a cost framework for each treatment was introduced. “Such a cost frame was theoretically before,” says Knauss with a smile. “Only a few clinics have adhered to it.”

Street scene in the capital Antananarivo |  Street scene (DW / E. Topona)

Many people in Madagascar can not afford health care

mTOMADY has therefore decided not only to pass on the collected funds from the mobile health accounts of the patients to the bank accounts of the health centers. The doctors also check according to their own data, whether the billing is right and the treatment costs remained in the frame. “Via a gateway, the mobile service providers in Madagascar send the data from the health accounts directly to our billing system on the Internet,” explains Niklas Riekenbrauck. “This allows us to manage all payments directly and view the treatment costs via our health cloud.” The software developer has set up the first direct connection between the mobile radio systems in Madagascar and the Internet. “In other countries, such interfaces have been around for a long time,” says Riekenbrauck. “

Clinics should benefit from quality management

For the clinics that are already working together with mTOMADY, the effect is clearly noticeable, according to the project team. “In some cases, the number of births per month has increased from 5 to 60 – even before our health account was unlocked,” says Emmrich. A hospital chain has already applied to be allowed to participate in the mobile savings accounts.

Collaboration: Philipp Sandner

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