A step towards health for all
In sub-Saharan Africa, less than 15% have access to health insurance. Millions die because they cannot pay for medical treatment. Social enterprise mTOMADY sets out to change that. Its new project with Bayer Foundation will impact the lives of 25,000 smallholder families in Madagascar.
The Organization
“Tomady” is Madagascan and means “strong & healthy”; the prefix “m” stands for mobile: Cooperating with health insurances, banks, ministries, donors, and scientists, mTOMADY’’s mission is to leverage mobile networks that improve access to healthcare in rural communities. "We launched mTOMADY in 2019. Since then, we've become the largest digital platform for healthcare related payments in Madagascar," says mTOMADY’s co-founder Dr. Julius Emmrich, and adds proudly: “After only 2 years, we are ready to scale the project. In March alone, we will have doubled the number of healthcare providers using our solution."
That is why in January 2021, Bayer Foundation signed a contract with mTOMADY to establish a health platform for farmer families in the poorest part of South Madagascar. In these communities, 97% of the population works in agriculture, less than 10% has a permanent job, health insurance is non-existent, and even basic medical care is unaffordable for most. Starting this February, the first step in the project will be to invite 25,000 smallholder farmers and their families to join mTOMADY and get donor support for basic medical care. In a second step, local community health workers will encourage them to make a small contribution towards their own health insurance, laying the groundwork for long-term, sustainable access to essential medical services. “We want to move fast,” says mTOMADY’s CEO and co-founder Elsa Rajemison. “Due to the Covid-19 pandemic, this remote region has become even poorer, and people are even less able to afford even the most basic health care, such as malaria treatment or maternity care.”
No cash and no red tape
The core of the project is a multi-payer mobile money platform that allows people (1) to save money for future treatment, (2) to retrieve personalized donor vouchers for medical services, and/or (3) pay flexible contributions to their personal health insurance scheme. Participating hospitals can be confident that they will receive reliable, quick, payments via mobile money for their patients’’ treatment via the mTOMADY platform , and they are guaranteed that invoices are settled without paperwork or bureaucratic hurdles. “The USP of the platform is its simplicity”, says Dr. Samuel Knauss, mTOMADY’s co-founder that leads the software development team. “Even owners of old Nokia cell phones without internet access can use it. All you need is a SIM card. In that way, we made the system scalable from the start.”
Together with Bayer Foundation, mTOMADY now plans to expand its platform to resource-poor communities in Uganda and Ghana. Dr. Monika Lessl, Executive Director of Bayer Foundation is delighted to support their effort: “mTOMADY is a perfect partner for us,” she says. “We share their vision of health for all, and we both have a strong focus on improving the livelihoods of rural communities through inclusive business models. Together, we will contribute to the #3 UN sustainability goal: ‘Ensuring healthy lives and promoting the well-being for all’.”
Patient
“I deposit cash to my mTOMADY account at a nearby vendor, and my family also sends money to my account. It is quick and easy, and most importantly, I can be sure the money is safe and available when I need to make a healthcare payment.”
"No cash, no treatment" - Interview
In sub-Saharan Africa, a disease can mean a devastating choice: seeing a loved one die or shouldering expenses that will drive the family into hunger and poverty. In an interview, Dr. Julius Emmrich, co-founder of Bayer Foundation’s partner mTOMADY explains how the social enterprise wants to change that.
Julius, when you and your colleagues Samuel Knauss and Elsa Rajemison decided to found mTOMADY, what was the trigger?
Each of us had our own trigger moments, but mine happened in Cameroon, where I spent parts of my clinical traineeship. One day, a young man was brought to our hospital. He had been run over by a truck and was bleeding heavily. The surgical team got ready immediately, waiting for him in the operating room, but the patient did not appear. When we finally checked outside, he was gone. He could not pay for the operation – either for lack of money, but maybe for the simple reason that he had no ready access to cash. Later he was found dead outside the clinic.
What a terrible tragedy! What did you learn from it?
We learned from experiences like these that out-of-pocket payments are a big barrier for healthcare access in sub-Saharan Africa. The equation is deadly simple: no cash, no treatment! Bear in mind that in the poorest regions of the world, people have no bank accounts, no access to health insurance providers, and they do not qualify for loans. That is why the core of mTOMADY is our mobile cash platform. It proves that you have access to funds, either your own, a donor’s, or your health insurance’s. In that way, the clinics get immediate confirmation that their treatment bills will be paid.
What is the impact of virtual money on the financial situation of the clinics?
When clinics go digital, revenues increase by a third: because more patients are health-insured and can afford treatments; because digital prices are more transparent, so that funds do not get lost in under-the-table transactions; because clinics do not need to waste their time arguing about prices or dealing with in-kind remunerations. After all, what will a clinic do with a hen or a cow?
Bayer Foundation has recently provided you with 250,000 Euros to scale your scheme to the poorest region of Madagascar. How will you go about this project?
Fast. We signed the contract on January 19 and started training the local community health workers right away. Back in their communities, where they are well known and respected, they are now explaining to the farmers how they can register on the mTOMADY platform to save up for their health care or claim a Bayer Foundation donor voucher for a specific treatment. Bayer Foundation will also contribute to their personal health insurance contribution to encourage them to register. First clinics are already on board, so things are well underway.
You already have several pilot projects up and running in other regions of Madagascar. When did you know that mTOMADY would be a success?
Some of the women on the mTOMADY platform were too poor to afford mobile phones, so they bought SIM cards only and now use them in someone else’s mobile to show the clinic they can pay. When these women started to create necklaces and bracelets to carry their precious SIM card with them all the time, I knew we had made it. The SIM card has become their key to a cherished treasure: healthcare.
Interview: Gabriele Schmitt-Bylandt
Photo Credits: mTOMADY
