Last week marked two years since the devastating earthquake in Haiti that, according to the Haitian government, took the lives of 316,000 people[1], injured 300,000[2]and displaced at least one million people[3]– more than 10% of its population[4]. Any country’s infrastructure would struggle with this, but in Haiti even some of the smallest problems were exacerbated by the fact that Haiti was (and still is) the poorest country in the Western Hemisphere[5]. Many Haitians do have access to mobile phones, though, so mHealth and mobile money services have enormous potential to fill the gaps and improve their lives.

The earthquake left Haiti’s already weak health and financial systems in tatters. It destroyed 30 hospitals, 21 clinics, 11 Ministry of Health facilities, and 22 health training centers, and it damaged 30-40% of all bank branches and ATMs in the zone of impact. From the very beginning of the recovery, mobile services showed what they could do.

A great deal of mHealth activity took place to bolster the relief effort and safeguard reconstruction, including the Fletcher School /Ushahidi’s crisis mapping and proactive messages delivered via SMS to warn about cholera outbreaks through a partnership between Voila and the International Federation of the Red Cross and Red Crescent Societies, and more. In 2009, the Bill & Melinda Gates Foundation and USAID launched a prize fund to accelerate the launch of mobile money services in Haiti, enabling the population to send, receive, and store money via mobile phones.  In the time that has followed, NGOs eagerly adopted mobile money as a safe, speedy way to distribute aid and pay people in cash-for-work programs. In fact, of the 14 mobile money use programs in the world, eight are in Haiti. These programs are realizing a range of benefits – including improved speed, efficiency, and security.[6]

This early flurry of activity is now giving way to longer-term questions. With the prize mechanism nearing completion, providers of mobile money services are looking for ways to expand them in a profitable, self-sustaining way. Haiti’s health system is rebuilding, and administrators are deciding how much to bring stopgap mHealth applications into the mainstream. And the opportunity to combine mHealth and mobile money through insurance plans, voucher programs, and other innovative services is just starting to open up.

Making these processes easier and realizing the long-term benefits of mobile services will require addressing a series of barriers in the public and private sectors:

1. Strategy to move from prize-led launch to sustainable scale.  Mobile operators and banks must now determine their strategies to reach the mass market and move beyond the prize-led launch to sustainable scale, avoiding the sub-scale trap which many deployments face globally. This will require the consortia to prioritize, penetrate, and capture profitable segments of the Haitian economy.
2. Interoperability and integration. The central bank in Haiti did mandate interoperability between mobile money services, but there is a continued need to integrate services, bridges, and open APIs – especially if mHealth and mobile money are to work together.
3. The policy environment.  At present, the lack of a national ID scheme and policies for data security and privacy are holding back the development of mobile services, particularly combinations of mHealth and mobile money. E-wallets have been used to register people in Haiti in place of national IDs, but the e-wallets are currently capped at US$250 by the central bank, limiting the usefulness of mobile services.
4. The evidence base.  Greater distillation and dissemination of the experiences of providers, users, and regulators would help the sector to develop in a more directed and way, avoiding repeated mistakes and redundancies.

Both the mHealth and mobile money ecosystems are at an inflection point in Haiti, and there is reason to be optimistic. Favorable regulatory approaches have led to the emergence of a spectrum of products, including payroll and merchant payments. For the sector to preserve its momentum, providers will have to find new ways to attract consumers, and policymakers will have to keep up with providers’ and consumers’ needs.