This is a guest post by Dr Ndunge Kiiti of Houghton College, New York and the GSMA mWomen programme.

M-PESA Responds

The M-PESA staff members were grateful for the feedback provided by the women’s groups. First, the workshop provided them with a broader context in which to understand how these groups were using their services in the rural areas. Second, they were able to spend quality time explaining how the women might confront and address some of the challenges they have faced as a result of the services. The challenges and M-PESA’s suggested responses are listed below.

Fraud

Several of the women had lost money to fraud. The M-PESA staff acknowledged the women’s concerns and highlighted that reported cases were always investigated. They emphasized several tips to prevent M-PESA fraud including:

• Calling M-PESA to confirm the request prior to responding to a text message regarding their account (the phone number, which would require a small fee, was provided)
• Checking to see if the text message is actually from M-PESA – if it was it would have the M-PESA logo and/or name)
• Being aware of their account balance
• Ensuring their pin number is always kept safe

It was also brought to the groups’ attention that M-PESA has introduced a new Safaricom SIM card which allows individuals to save the phone numbers used for M-PESA transactions. This enables the individual to just scroll and pick the accurate number instead of having to retype the number every time it is used. This reduces the problem of sending money to the wrong number. The M-PESA staff provided the SIM card service at the workshop and many of the women paid for the service and got their old SIM cards replaced. The women expressed gratitude for the service.

Network/Connectivity Problems

Why some areas face network problems was explained by the M-PESA staff. The company recognizes that network coverage is a problem in some rural areas. A key challenge for M-PESA is the platform or technology has faced limitations in keeping up with the demand, as the users of the service continue to increase across the country. The women were encouraged to report coverage issues to an M-PESA outlet, if there is one in their area, rather than an agent. They were also given a number to call or text, when they have access to service, to report these complaints to give the service provider the opportunity to rectify the problems. Again, this would require a small fee.

Cost

The challenge of cost for service was discussed; even though the service was deemed very useful by users, sometimes the costs involved proved challenging for them. The M-PESA staff explained their service costs, what they entail and how they have worked to keep them affordable for Kenyans. There was mutual agreement that M-PESA has tried to be fair in terms of pricing. In fact, it came out in the conversation that one of the reasons it was being used by all 21 women’s groups was because it was the most competitive in the mobile money market.

Services for Special Populations

In relation to services for special populations, such as the elderly, illiterate or visually impaired, there were no easy answers. M-PESA staff suggested that they would look into the possibilities of programs that might assist special populations to have positive experiences with their service.

Group Communication and Dynamics

On one hand, mobile money allows for money to be sent to facilitate planning at meetings, even if a member needs to be absent. However, some groups argued this can perpetuate the lack of meeting attendance, thus limiting the social aspects of the group meeting and affecting the socio-psychological support that comes from face-to-face group interactions. Since this issue relates more to the training and capacity building carried out by those running women’s groups, it was not addressed by the M-PESA in detail. However, representatives of the organization running the women’s groups encouraged members not to allow the use of technology to erode or limit their face-to-face communication by not attending meetings. The groups were encouraged to continue reminding members that a key part of their mission is being a support system for one another which require face to face communication.

Summary

Overall, despite the numerous challenges mentioned, the groups made it clear that the benefits of using mobile money services outweighed the disadvantages. In addition, bringing together M-PESA staff and their end users was mutually beneficial. The women’s groups were able to gain information, knowledge and services that will continue to help them with their poverty reduction activities. The M-PESA staff were able to garner insights and understanding that may contribute to framing policies and practice for mobile money services.

 

Qualcomm’s Wireless Reach™ initiative, the strategic initiative of the wireless chipset manufacturer, has partnered with Life Care Networks and the Community Health Association of China to start a mHealth project focused on improving prevention and care of cardiovascular diseases (CVD) in rural China. The project, Wireless Heart Health, was launched back in September in community health clinics in three provinces (Shandong, Anhui, and Sichuan) and one municipality (Chongqing).

In the past, most mHealth projects in rural areas have focused on acute diseases. These diseases are easier to handle via treatment and/or prevention, which allows for numerous mHealth interventions including appointment and pill reminders as well as data collection and information dissemination. But chronic diseases are becoming a larger public health issue in rapidly developing countries. Within China, CVD is the leading cause of death. By leveraging mobile technology to reach the rural community clinics, patients and health workers in rural areas can be connected directly with trained medical personnel in an urban area. While this type of connection is common in many countries (see MTN CareConnect in South Africa), the level of technology sophistication in this project allows for more in-depth data to be gathered and transferred to trained doctors.

 

Project Details

Life Care Networks developed a cardiovascular monitoring system that uses China Telecom’s 3G network to send heart data to cardiac specialists, who can provide rapid patient feedback. The system includes an electrocardiogram (ECG) senor on a smartphone, electronic medical record software, and workstations at the community clinics. The ECG-enabled smartphone has a gold rim around the outside part of it which is the senor. The patient simply holds the top and bottom of the phone in order for it to read their heart data. The medical records software is web-based and includes all past data collected in the clinic. This allows for both the community health workers and the doctors in the call center to have access to historical data in order to provide better care to the patients.

Within the project, the community health clinics are connected via the 3G network directly to cardiac specialists in the Beijing Life Care Networks Call Center. Using the ECG sensor along with the software and workstations, the patient data is sent to the call center and allows for real-time feedback either by SMS or voice. The call center is open 24-hours a day, and their services range from monitoring and diagnosis to treatment and referral. Referrals are especially important in these clinics as the clinic staff often do not have the knowledge and expertise to treat complicated cardiovascular issues. Because the smartphone sends the patient information directly to a trained doctor, it allows for referrals to happen swiftly, cutting down the time it usually takes. Also the smartphones are available for patients to rent in order to monitor their cardiovascular information.

 

Partnership Model

By leveraging a partnership model, Wireless Reach has been able to expand many services into rural or resource scarce areas by working with both for-profit and nonprofit organizations. With the Wireless Heart Health project, Life Care Networks is a for-profit company that has a commercially available ECG monitoring service as well as products and services for personal care. They offer different levels of service, depending on the needs and desires of their clients. The other project partner, the Community Health Association of China, is a nonprofit organization that supports the efforts of the Ministry of Health in helping to strengthen the Community Health Clinics throughout China.

Wireless Reach’s partnership model does not only include bringing together for-profits and nonprofits to strategically work together. An important aspect of all Qualcomm’s Wireless Reach projects is that they tie directly to government policies and initiatives. For example, this project addresses one of the specific issues outlined in the recent 2009 Chinese Health Care Reform, which focuses on strengthening the country’s grassroots medical institutions to provide equitable health care for all citizens.By partnering with Community Health Association of China, Qualcomm is able to engage in a project that supports the Chinese government’s efforts to develop a primary health care system.

 

Sustainability and Scale

Another important aspect of Wireless Reach projects is the goal for them to sustain as well as reach scale. In some cases, the project and its products/services become commercialized. In other cases, they have been sustained by the relevant country’s government. Since this project is only months old, the long-term model has not been decided yet. But there is a plan to create sustainability in the short-term and answers the age old question of “who pays?” In the model, patients are charged a small fee to its patients to rent the specialized phone. This allows the clinics to generate revenue and creates incentives to actively use the products and services.

 

Current Results

As mentioned before, each of Qualcomm’s Wireless Reach projects are focused on reaching sustainability and increasing scale. For this project, Wireless Reach is focused on gathering information and creating best practices in order to keep the project sustainable and eventually scale up.  New impact data has recently been received and ranges from September 2011 to the end of January.

• 46 community health clinic doctors have been trained on how to use the system.
•  A total of 1033 patients have participated in the project.
•  These patients have sent 2172 pieces ECG data.
•  Out of that data, 513 pieces were identified as abnormal.
• Out of all of the patient participants, 208 were screened for serious cardiovascular conditions and referred to higher-level clinics for further evaluation and testing.

 

Wireless Heart Health is an interesting example of how creating strategic partnerships, utilizing current technology and infrastructure (both telecommunications and health), and tying the project goals to current government policies can create a sustainable and scalable mobile health model.

The Centre for Development Informatics (CDI) at the University of Manchester with the support of the International Development Research Centre (IDRC) recently released a report on agricultural adaption for climate change. This report, “Using Radio to Improve Local Responses to Climate Variability,” focuses on a radio program made available to alpaca farmers in the Peruvian Andes.

Life of farmers in the Andes is difficult at times are made more volatile in light of climate vulnerability. Lately there have been unexpected cold spells coupled with heavy snowfall. Peru has the largest number of South American camelids (the animal group that includes llama, alpaca, vicuna and guanaco) in the world, providing a subsistence to 65,000 families at altitudes of 3,500 to 5,000 meters, where other forms of agriculture are impractical. With climate variations that have lead to below-average temperatures and water scarcity, there has been an increased death rate of livestock, the “main income source, this loss of animals condemns further those who are already living in conditions of severe poverty.”

The study notes a lack of adaptive capacity among farmers for short-term action. To address this, the CAMELTEC project was initiated from 2008 to 2010 by Peruvian NGO Desco with financial support of Oxfam GB.

CAMELTEC broadcasted technological, social, political, and institutional information with a heavy focus on meteorological warnings, market prices of alpaca wool and husbandry advice to remote communities. CAMELTEC also aired a weekly 20-minute broadcast called Amanecer Alpaquero (Alpaca Farmer’s Daybreak) that included more specific information and discussion on pertinent problems, the show “was popular with all members of Alpaca farming families not just because of the vital information provided, but also because of its use of humor and music in transmitting its message.”

Radio was chosen as the medium for engaging farmers because of its low setup, operating costs, and “the availability of cheap battery-powered AM radios means that the majority of Alpaca farming households have access to local radio broadcasts.” Radio is deemed the best option for communication because it has the best reception coverage in the andean topography where it has been “historically cost-prohibitive to construct infrastructure such as paved roads, electricity and fixed telecommunications up to the farmsteads.” Though most farmers have mobile phones, the utility is limited.

 

The CAMELTEC project had three goals:

– strengthen local organizations such as farmer-cooperatives to enable the introduction of sustainable (including climate-sustainable) livestock practices

– improve the quality and quantity of alpaca wool being produced, through good husbandry and reproductive management practices

– improve income through changes to wool output and through better market access

 

The project is deemed successful, decreasing livestock mortality by 12% and saving an equivalent of US $500 on average per farmer. Another benefit of the radio program was its access to females, addressing traditional gender barriers that make it difficult for women to be involved in community farming meetings. The program has encouraged “a more systematic approach to breeding, the utilization of farming cooperatives for marketing of alpaca wool, and a more commercial approach to farming; all of which have helped to either maintain or raise income levels.

What made CAMELTEC successful? “Deep local knowledge and experience were vital… building as it did on Demsco’s many years of working with local farmers” to gain trust and expertise. However the inability to deliver skill knowledge and the high price of batteries limited the project. The study concludes with the suggestion of strengthening radio programing related to climate change adaptation to improve institutional building.