This post originally appeared on the <a href="https://mstarproject.wordpress.com/2018/07/02/how-mobile-money-can-prevent-health-crises/">mStar blog</a>. FHI 360’s <a href="https://www.fhi360.org/projects/mobile-solutions-technical-assistance-and-research-mstar">Mobile Solutions Technical Assistance and Research</a> (mStar) project aims to foster rapid adoption of digital finance, digital inclusion and mobile data in developing countries. mSTAR/Liberia ended activities in May 2018 after enrolling <a href="https://mstarproject.files.wordpress.com/2015/11/liberia-infographic_april1.pdf">4,870 civil servants</a> across Liberia into mobile salary payments and successfully handing the mobile salary payment program over to the government.


&gt; By Jonathan Kourgialis, Program Officer, <a href="https://www.fhi360.org/">FHI 360</a>

The Ebola outbreak hit Liberia hard. From 2014 to 2016, there were 10,678 cases and 4,810 lives claimed. Weakened from a protracted civil war, Liberia’s healthcare system struggled to keep up with the epidemic. Failures in the health system created severe consequences on the ground. One of those failures, with dire ramifications, revolved around payments.

As the Ebola outbreak raged, the Government of Liberia and partners introduced new financial incentives to compensate frontline health workers for the severe risks encountered when combatting the disease. However, the government and its partners were not able to transfer these new payments reliably to frontline staff, who were often placed in remote areas with limited access to banks. The government and its partners relied on cash, which was disbursed throughout Liberia by “pay teams,” who drove cash to rural towns. A pile of factors including quarantines, poor road and banking infrastructure amidst the ongoing crisis, low liquidity, and fear of the disease made pay teams inefficient and slow. Delays in the disbursement of payments contributed to health worker strikes, further crippling response efforts. The difficulties in making payments and the ensuing health workers’ discontent highlighted the critical role that efficient payment processes play in mobilizing health workers during a health emergency.

To avoid the recurrence of a payment breakdown like this, mSTAR worked with the Government of Liberia’s Ministry of Health (MOH) to build a set of standard operating procedures (SOPs) for payments to health workers through mobile money. When working efficiently and smoothly, mobile money has proven to make a significant impact on health crisis outcomes. At the height of the Ebola crisis in Sierra Leone, for example, the digitization of salary payments is estimated to have <a href="https://www.usaid.gov/sites/default/files/documents/15396/The_Role_of_Digital_Financial_Services_-_Education.pdf">saved 2,000 lives in Sierra Leone</a> by eliminating strikes by unpaid response workers. This is estimated to have saved almost $11 million in security and other costs related to moving cash. The SOPs mSTAR created for the MOH ensure the MOH’s payment functions will be strong enough that if a future emergency occurred, whether it was Ebola or another epidemic, health workers at the frontline would be compensated for their contributions and willing to stay on the job.

To create the SOPs, mSTAR first mapped MOH’s complicated payment types, systems, and streams. This included salaries paid to MOH employees through traditional government payment systems, incentive payments to contract workers paid directly by the MOH, and allowances to health workers paid directly by the MOH, each differentiated by funding stream. MOH staff are paid through funds from the GOL and funds from donors, so systems and streams are unconnected and not interoperable. Taking this into account, and utilizing mSTAR’s data systems, interoperability and mobile money expertise, mSTAR and the MOH came up with the three key tasks for the MOH to complete in the case of a health emergency:
1. Coordinate data exchanges of staff and payment information between the MOH’s unconnected databases;
2. Register health workers for mobile money payments within GOL systems and with the mobile money service providers (if necessary); and
3. Disburse mobile money payments across the various payment streams.
The SOPs outline how to accomplish these tasks and graphical flows and steps breaking down each. This included recommendations on how mHero, a two-way mobile phone-based communication system, can efficiently register staff for mobile money payments and alert the MOH to mobile payment issues.

mSTAR built in recommended safeguards for the success of the SOPs such as the creation of a mobile money payments emergency committee to oversee the implementation of the SOPs during an emergency and the establishment of mobile money payment accounts specifically for MOH payment streams prior to an emergency.

While theses SOPs are tailored to the Liberian MOH’s systems, the collaborative effort to develop SOPs for the scaling of mobile money payments for health workers, or any type of emergency responder, is replicable in other contexts. It is a necessary endeavor for governments of any country vulnerable to health or natural disaster emergencies. As was seen in Liberia during Ebola, making sure that those risking their lives to save others are compensated in a timely and efficient manner is vitally important to overall emergency response efforts and is worth investing in prior to an emergency. While we hope that the Liberian MOH does not have to use these SOPs in the future, they are now prepared to pay frontline staff if the need arises again. We recommend that other governments prepare themselves in a similar manner where possible.

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Learning From Ebola: How Mobile Money Can Prevent Health Crises

Liberia

Sierra Leone

Mobile Banking

Blog Post

&gt; Posted by Aissatou Diallo, Special Assistant to the CEO, BRAC USA

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For the three countries most affected by Ebola – Liberia, Sierra Leone, and Guinea – the impact of the disease on society came in waves. The first wave happened around March, after the virus was first confirmed in the region. It was characterized by denial, disbelief, and a general numbness. The second wave, in May, happened as the disease spread geographically with a corresponding increase in cases and deaths. During this time, people felt overwhelmed. Even though a lot of people still doubted that the disease existed, they knew something was wrong because people were getting sick and dying at an alarming rate. The third wave, in August, blew the lid wide open on shortcomings and vulnerabilities in the region as Ebola spun out of control. Health systems collapsed, schools closed, communities were quarantined, and supply chain systems broke down. People lived in fear.

These factors <a href="http://cfi-blog.org/2014/09/18/microfinance-and-the-economic-toll-of-ebola/">contributed to severe economic losses in the region</a>, especially for actors in the informal economy (e.g. traders and farmers) who depend on moving freely to sell their goods at markets and have little financial flexibility or cushion to absorb a shock to the system.

I just returned from a five-week trip to Liberia. In the towns and villages I visited, people told me that August was characterized by bleakness and despair. Communities looked like ghost towns, social ties were weakened, and there were sick people dying on the streets because no hospitals or care facilities were available.

Microfinance organizations in the region were not spared either. BRAC, the organization I work for, operates one of the most robust microfinance programs in Liberia and Sierra Leone. It provides microloans and small enterprise development training to women and marginalized families to help them start businesses. In August, movement restrictions went into place and BRAC was forced to suspend operations and refocus its efforts to help stop the spread of Ebola.

At that time, the priority– at both the national and community level – was stopping the disease. As with other disaster relief operations, survival took precedence over economic impact. Countries focused on improving Ebola case management, which hinged on more Ebola Treatment Units (ETUs), better transportation for patients, and shifting community attitudes toward Ebola prevention measures such as safe burials. (See <a href="http://cfi-blog.org/2014/09/18/microfinance-and-the-economic-toll-of-ebola/">post</a> by Jeffery Riecke on our work in the region and activities during this period.)

It was a difficult time for many of BRAC’s borrowers. An initial assessment conducted in Liberia shows that 22 percent of BRAC borrowers were significantly affected by the effects of Ebola: they were forced to migrate, lost their businesses, got sick, died, or lost family members. An additional 33 percent experienced adverse impact on their businesses. For instance, I met a BRAC borrower in Liberia named Miatta who got sick, but survived. However, she lost six family members: her husband, three daughters, a grandchild, and a son-in-law. Her poultry business took a huge hit and one of her surviving daughters, also a borrower, lost her business because people refused to buy from her after she was released from the hospital.

Today, each of the three most affected countries has sufficient capacity to isolate and treat patients, with more than two treatment beds per confirmed, probable, and even suspected case. Each country also has the ability to bury everyone known to have died from Ebola. In addition, community engagement through Ebola messaging has taken root in the mainstream consciousness. Overall, things are, for the first time since the initial outbreak last March, under control.

The region is on a steady path for recovery. The big questions Liberians and Sierra Leoneans must now face are: In what position does this outbreak leave us? And where do we go from here?

These questions cover the immediate social and economic fallout from the disease as well as the long-term repercussions on health, food production and distribution, education, livelihoods, and financial inclusion systems in the region.

Short-term recovery is needed to boost households so they can survive. The national governments and groups like the World Bank have identified need for assistance to trigger economic recovery at the community and household level where the impact of the virus is severe. In addition, the Government of Liberia has publicly called for a redeployment of funds to long-term development initiatives like microfinance. BRAC is fully on-board with this call and has identified March 1, 2015 as the date to resume all operations in Liberia and Sierra Leone.

But what do you offer borrowers like Miatta? What contributions do you make to strengthen these fragile economies? You resume operations and provide financial relief to business people like Miatta who desperately need it. That means creating discrete loan write-offs to ensure borrowers like Miatta’s daughter who have lost their business don’t sink further into debt and can start contributing to the economy.

As a recent Devex <a href="https://www.devex.com/news/microfinance-programs-west-africa-s-next-task-force-85358">article</a> succinctly puts it: “With loans in hand, business owners can take the first steps toward rebuilding their lives — whether that involves buying chickens for poultry farms, hiring labor to work on family crops, or purchasing a reliable vehicle to make business deliveries.”

Aissatou is Special Assistant to the CEO, BRAC USA. A native of the Mano River Union, she earned her academic stripes at the University of Ghana Business School, UCLA School of Law, and New York University where she was part of the inaugural class of Reynolds Fellows. Prior to joining BRAC USA, Aissatou worked in the private and public sectors in Liberia, Ghana, Los Angeles and Washington D.C. before settling down in New York to qualify as a lawyer and briefly practice securities litigation.

Have you read?

<a href="http://cfi-blog.org/2014/09/18/microfinance-and-the-economic-toll-of-ebola/" target="_blank">Microfinance and the Economic Toll of Ebola</a>

<a href="http://cfi-blog.org/2014/07/11/brac-microfinance-director-shameran-abed-on-client-protection-balancing-credit-and-savings-and-the-evolving-financial-inclusion-landscape/" target="_blank">BRAC Microfinance Director Shameran Abed on Client Protection, Balancing Credit and Savings, and the Evolving Financial Inclusion Landscape</a>

<a href="http://cfi-blog.org/2014/04/09/microfinance-does-health-care/" target="_blank">Microfinance Does Health Care</a>

Picking Up the Pieces: The Role of Microfinance Institutions in Post-Ebola Recovery

Guinea

Sub-Saharan Africa

Credit

Microfinance Institutions

&gt; Posted by Jeffrey Riecke, Communications Associate, CFI

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New World Bank <a href="http://www.nytimes.com/2014/09/18/world/africa/ebola-world-bank-west-africa-economy.html">analysis</a> indicates that along with the already devastating loss of life, the Ebola outbreak could cause “potentially catastrophic” economic effects on West African countries, especially in the three hardest hit. According to the analysis, Liberia’s GDP could fall by 12 percent, Sierra Leone’s by 9 percent, and Guinea’s by 2 percent.

Efforts to contain the epidemic are fueling much of the economic slowdown, like the closings of businesses, transportation infrastructure, and critical air and sea links with other nations. As mentioned in a <a href="http://cfi-blog.org/2014/09/05/17th-microcredit-summit-ebola-crisis-mobile-money-update-top-picks-of-the-microfinance-blogosphere/">post</a> on this site a few weeks ago, microfinance institutions are being affected, too.

Between 80 and 90 percent of the economic losses suffered from Ebola are related to containment behavior, a dynamic consistent with recent SARS and H1N1 outbreaks. A lower supply of available workers – due to employee illness, death, and caregiving – is a smaller factor. At the same time, health systems are collapsing under the onslaught of the epidemic, leaving those with other serious illnesses unable to receive treatment. These conditions cause shortages, panicked buying, and speculation, which lead to rises in food prices and inflation. Economic life in the affected areas was already extremely tough to begin with. In Liberia, Sierra Leone, and Guinea, more than 50 percent of the population lives below the poverty line.

The World Bank analysis was based on World Health Organization (WHO) findings released several weeks ago. This week, WHO shared an updated, more severe report as the number of Ebola cases has doubled in the past three weeks. Liberia, Sierra Leone, and Guinea contribute a relatively small portion of the economic activity in West Africa. If the virus is not contained, the economic impact will be much larger, as it moves beyond those three countries, the World Bank stated. Still, President Kim indicated yesterday that 80 to 90 percent of the epidemic’s economic impact could be mitigated “if we get an effective response on the ground in the next few months.”

Like all else in the region, microfinance institutions have taken precautionary measures. BRAC Liberia, one of the country’s biggest MFIs, has reportedly suspended loan operations for at least a month. The case is the same for BRAC Sierra Leone. CARE Liberia has <a href="http://www.care.org/newsroom/press/press-releases/ebola-outbreak-care-enacts-preventative-measures-sierra-leone-liberia">limited</a> group meetings. Some lenders in the region who are continuing operations are easing repayment structures and granting forgiveness to clients when deemed necessary. The Liberian microfinance market has roughly 53,000 borrowers, Sierra Leone 110,000 and Guinea 117,000.

In the face of the devastation and the inability to fully continue financing efforts, many MFIs are leveraging their <a href="http://blog.brac.net/tag/liberia/">non-lending capacities</a> to help stop the virus’ spread and support community resilience. BRAC Liberia and Sierra Leone have offered health awareness communication through one-on-ones, group meetings, and even street theatre performances. <a href="http://sierraleone.brac.net/index.php?option=com_content&amp;view=article&amp;id=197:brac-responds-to-the-ebola-outbreak-in-sierra-leone&amp;catid=78:news&amp;Itemid=681">Hundreds</a> of community health workers have engaged in the effort. Posters, flyers, and hygiene kits have been distributed throughout communities.

More recently, as direct contact is no longer advisable, the BRAC MFIs are getting involved in other ways. Awareness campaigns are continuing using alternative means, such as over the radio. Some core staff at country offices have remained stationed, supporting the prevention efforts of authorities. Institutions have donated prevention supplies to ministries of health and sanitation.

In Liberia, the MFI Foundation for Women (FFW) is <a href="http://www.liberianobserver.com/business/dont-let-ebola-get-you-business">advising</a> the community to be smart in the fight against the virus, but to also properly manage their businesses. Charles Naiwah, Program Manager of FFW urged, “Don’t let Ebola put you out of business.” His MFI has disseminated core messaging and awareness materials to the community as well as preventative gear to combat the virus.

On Tuesday U.S. President Obama announced a “major increase” in the U.S. response to the epidemic. The U.S. could send up to 3,000 additional American troops to support civilian aims and build field hospitals with up to 1,700 total beds. In a recent statement, Margaret Chan, the World Health Organization's Director General said, "Today, there is not one single bed available for the treatment of an Ebola patient in the entire country of Liberia." The U.S. will also send 400,000 treatment kits for families and create a new training facility to train up to 500 health workers per week. The move by the United States is with the hope that it will trigger greater global action. Next week the U.N. Security Council will hold an emergency meeting to discuss a response to the crisis.

At least 2,400 people have died from the virus, and cases are now appearing in Nigeria and Senegal.

To support the continuing efforts of BRAC, CARE, and the Foundation for Women in West Africa, click <a href="http://www.brac.net/donate">here</a>, <a href="http://www.care.org/country/liberia">here</a>, and <a href="http://www.foundationforwomen.org/index.php">here</a>.

Have you read?

<a href="http://cfi-blog.org/2014/04/09/microfinance-does-health-care/" target="_blank">Microfinance Does Health Care</a>

<a href="http://cfi-blog.org/2014/08/04/integrating-health-and-microfinance-in-india/" target="_blank">Integrating Health and Microfinance in India</a>

<a href="http://cfi-blog.org/2014/07/11/brac-microfinance-director-shameran-abed-on-client-protection-balancing-credit-and-savings-and-the-evolving-financial-inclusion-landscape/" target="_blank">BRAC Microfinance Director Shameran Abed on Client Protection, Balancing Credit and Savings, and the Evolving Financial Inclusion Landscape</a>

Microfinance and the Economic Toll of Ebola

Senegal

<img class="alignright" style="border:0" src="http://centerforfinancialinclusionblog.files.wordpress.com/2011/08/disc-meter.jpg?w=300&amp;h=174" alt="" width="300" height="174" />&gt; Posted by Center Staff

This edition of top picks features posts highlighting discussions at the 17th Microcredit Summit, how the Ebola crisis is affecting microfinance in West Africa, and new statistics on the continued growth of the mobile money industry worldwide.

The 17th Microcredit Summit, this year’s iteration of the Microcredit Summit Campaign’s annual conference, is underway this week in Merida, Mexico. For those of us not in attendance, the Campaign is live streaming the sessions <a href="http://17microcreditsummit.org/watch-live/">online</a>. NextBillion is also sharing the experience through blog posts, including <a href="http://nextbillion.net/blogpost.aspx?blogid=4047">one published yesterday</a> providing a report-back on day one of the event. The post offers insights from the day, including notable quotes from keynote speeches and panel presentations, and themes that emerged across sessions.



A <a href="http://kivablog.kiva.org/kivablog/2014/09/02/ebola-crisis-affecting-kivas-west-african-field-partners">recent post</a> on the Kiva blog details how the devastating Ebola crisis is affecting Kiva field partners working in the West Africa region. Kiva operates in two of the countries hardest hit by the crisis, Liberia and Sierra Leone, where national state of emergencies have been declared and many banks, businesses, and schools have been closed. Kiva partners deciding whether to lessen loan repayment structures or grant forgiveness is being held on a case-by-case basis. Risk of loan delinquency or default is with the Kiva lender, not field partners, so institutions and their clients are not vulnerable. Some Kiva partners including BRAC Sierra Leone and BRAC Liberia have suspended operations for at least a month.

Sharing an update on the mobile money landscape since February’s State of the Industry Report, a <a href="http://www.gsma.com/mobilefordevelopment/industry-update-33-markets-now-have-3-or-more-mobile-money-services-for-unbanked-customers">new post</a> on the GSMA MMU blog gives a run-down of new service deployments, market competition, and the impact of mobile money on financial inclusion. Eighty-eight markets now have at least one live mobile money service targeting unbanked communities. Since February, services have deployed in new country markets including Romania, Sudan, and Panama. Up from 27 markets last December, there are now 33 markets globally that have three or more live mobile money services.

Image credit: <a href="http://commons.wikimedia.org/wiki/User:Iainf" target="_blank">Ianf</a>

17th Microcredit Summit, Ebola Crisis, Mobile Money Update – Top Picks of the Microfinance Blogosphere

Panama

Romania

Sudan

Agent Banking

&gt; Posted by Alice Allan, Head of Advocacy, CARE International UK

<a href="http://cfi-blog.org/category/financial-inclusion-2020/" target="_blank" rel="attachment noopener wp-att-8901"><img class="alignright size-medium wp-image-8901" style="border: 0" src="http://centerforfinancialinclusionblog.files.wordpress.com/2012/12/blogseries.jpg?w=300" alt="" width="300" height="66" /></a>

The <a href="http://www.centerforfinancialinclusion.org/programs-a-projects/financial-inclusion-2020" target="_blank" rel="noopener">Financial Inclusion 2020</a> campaign at the Center for Financial Inclusion at Accion is building a movement toward full financial inclusion by 2020. Accordingly, this blog series will spotlight financial inclusion efforts around the globe, share insights coming out of the creation of a roadmap to full financial inclusion, and highlight findings from research on the “invisible market.”

Today marks the start of an important meeting in Monrovia, Liberia, where the UN <a href="http://www.beyond2015.org/hlp-meeting-monrovia-applications-are-now-open" target="_blank" rel="noopener">High Level Panel</a> will look at what might replace the current Millennium Development Goals (MDGs) when they expire in 2015. With a focus on economic transformation, the panel hopes that any future framework to reduce poverty includes increasing "jobs and growth," and "tackling inequality."

Those of us focused on financial inclusion believe increased access to finance can help achieve these admirable aims. But would the UN High Level Panel agree?

Last week the Banking on Change partnership between Barclays, CARE International, and Plan UK produced <a href="http://www.careinternational.org.uk/research-centre/microfinance/251-banking-on-change-breaking-barriers-to-financial-inclusion" target="_blank" rel="noopener">Banking on Change: Breaking the Barriers to Financial Inclusion</a>, a report which, amongst other things, makes the case compellingly enough that we believe the UN High Level Panel should take note.

<a href="http://www.careinternational.org.uk/news-and-press/latest-news-features/2260-banking-on-change-developing-economies-could-receive-an-annual-boost-of-157bn-through-savings-led-microfinance-says-new-report" target="_blank" rel="noopener">The Banking on Change partnership</a> is committed to achieving financial inclusion by helping poor people access tailored services and products that match their level of economic development. Banking on Change is the world’s first savings-led program that combines the deep understanding of poor communities among two leading NGOs with the financial expertise of a global bank in order to encourage extremely poor people to begin their path to financial inclusion through savings-led microfinance.

Banking on Change has reached 513,000 people in 11 countries* in just three years. On average, each member has saved $58 per year through savings groups. Multiplying this figure by 2.7 billion unbanked people worldwide would represent $157 billion in potential savings annually. Where savings groups are then linked to the formal financial system, people are increasing their regular savings as they have the guarantee of its security. The expectation is that this will provide an influx in banking deposits, which could in turn be used to finance businesses and households.

After establishing a savings culture, the most entrepreneurial and active of savings group members go on to receive business skills and financial training and establish micro-enterprises before additional access to credit or more formal banking is considered. The partnership is paving the way for future NGO/private sector partnerships that can improve the lives of poor people, and also have a business benefit by opening up a new customer base at the bottom of the pyramid. The program has also had impressive social impacts. In Uganda for example, women increased their ability to influence their husband’s decisionmaking by 33 percent. And in Ghana savings groups, people regularly put money aside each month into a "social fund" which enabled them to buy National Health Insurance cover, even when they did not have access to a regular income throughout the year.

<a href="http://www.careinternational.org.uk/news-and-press/latest-news-features/2260-banking-on-change-developing-economies-could-receive-an-annual-boost-of-157bn-through-savings-led-microfinance-says-new-report" target="_blank" rel="attachment noopener wp-att-9594"><img class="alignright size-medium wp-image-9594" style="border: 0;margin: 5px" src="http://centerforfinancialinclusionblog.files.wordpress.com/2013/01/img-300-banking-on-change-report-3_page_01.jpg?w=212" alt="" width="212" height="300" /></a>The report sets out the immense potential that this pool of savers represents, both economically and socially.

It therefore seemed obvious to us to question why financial inclusion had not and is not being talked about as part of the discussions surrounding the MDGs. We felt that the MDG process offers an opportunity to call for a new global partnership that commits governments, donors, and the private sector to take financial inclusion to scale. The MDGs would also provide a focus on including the very poorest, thereby complementing other emerging international efforts including the Maya Declaration on financial inclusion.

The report doesn’t argue that a new goal be created, but suggests that perhaps financial inclusion be used as a potential indicator of inclusive economic growth, with equity tracker measures that capture how far women and young people are financially included.

At the launch of the report, the Department for International Development’s (DFID) Chief Economist Stefan Dercon questioned the need for another MDG goal on this issue and felt that by putting too much emphasis on reaching targets, poor people might end up being forced to accept inappropriate products and services.

What is clear is that it is a missed opportunity that 2.7 billion people globally do not have access to formal financial services. This is a development challenge and an opportunity that the High Level Panel could embrace as they strive to achieve more inclusive economic growth. As the Governor of the Central Bank of Kenya has said, “Financial inclusion is no longer something that is ‘nice to do’ but is an essential part of the global economic development agenda.”

We welcome your views as to whether the MDGs should consider financial inclusion. You can also add your voice to the debate <a href="http://www.worldwewant2015.org/" target="_blank" rel="noopener">here</a>.

For more information on Financial Inclusion 2020, <a href="http://bit.ly/FI2020signup" target="_blank" rel="noopener">sign up for campaign updates</a>.

*Egypt, Ghana, Kenya, Mozambique, Tanzania, Uganda, Zambia, India, Indonesia, Vietnam, and Peru

Image credit: <a href="http://www.careinternational.org.uk/news-and-press/latest-news-features/2260-banking-on-change-developing-economies-could-receive-an-annual-boost-of-157bn-through-savings-led-microfinance-says-new-report" target="_blank" rel="noopener">Banking on Change</a>

Have you read?

<a href="http://cfi-blog.org/2012/11/13/accumulating-financial-assets-microfinance-ambivalence-about-savings-and-the-poor/" target="_blank" rel="noopener">Accumulating Financial Assets: Microfinance Ambivalence about Savings and the Poor</a>

<a href="http://cfi-blog.org/2012/09/20/support-the-global-appeal-for-responsible-microfinance/" target="_blank" rel="noopener">Support the Global Appeal for Responsible Microfinance!</a>

<a href="http://cfi-blog.org/2012/07/25/can-we-make-savings-a-little-bit-more-interesting-for-people-please/" target="_blank" rel="noopener">"Can we make savings a little more interesting for people, please?"</a>