Tag Archives: Haiti

Game on: Mobile + Money = Better Health

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This morning I spoke at USAID’s MiniU on Global Health at George Washington University with Charley Johnson of the USAID Mobile Solutions Office, Dustin Gibson of Johns Hopkins, and Pamela Riley of Abt Associates.  The pearl?

1.7 billion people with access to a mobile phone have no bank account.  1 billion phone owners lack access to health care.  Game on: mobile + money = better health. 

The goal of the talk was to describe why I believe that mobile money will have a powerful impact on public health, from the perspective of my work at MEDA, where I support the organization in leveraging mobile across our 6 areas of focus – Savings, Youth, Rural Finance, Woman, Agriculture, and Health –  to make each area more efficient & effective in creating Business Solutions to Poverty.

Narrowing in on how mobile money can improve post-disaster resilience, I focused on Haiti, where a recent evaluation of non-conditional cash transfers after the earthquake found that mothers who received cash spent it on food, refrigeration, cooking, and health services, and therefore (we assume) were able to better stabilize the health and nutrition of their families.  However, this cash aid was rare and slow – after the earthquake, there simple was no way to move cash around the country due the lack of banking and transportation infrastructure, and Haitians were largely unable to receive either cash aid or remittances from family members abroad.

Understanding that the inability to transport cash around the country was one of the key hindrances to humanitarian relief efforts after the earthquake, the Gates Foundation and USAID turned to mobile money to ensure that these problems can be avoided in the future.  The resulting incentive grant, the Haiti Mobile Money Initiative (HMMI)  resulted in two mobile money products, T-Cash and TchoTcho Mobile.  The question now is, has it worked?

The good news is, yes, at least, it’s starting to.  The clearest example is the from only last month, when Hurricane Isaac made landfall near Port-au-Prince, where over 400,000 people still live in tents.  Digicel was able to send cash aid to 5000 mothers within 2 days of the hurricane, an unprecedented response time for distribution of cash aid, since the mobile money transfer via TchoTcho Mobile reduced the time and infrastructure needed to distribute cash.   We can assume that these mothers, like those after the earthquake, used this cash to maintain the nutrition and health of their families while rebuilding their homes yet again.  There are several other organizations using TchoTcho Mobile to a variety of humanitarian and development projects.

Moving from mobile transfers in post-disaster relief, I covered a different end of the mobile money spectrum:                       supply-chain management. MEDA has been working with the government of Tanzania since 2004 to prevent malaria infection through the distribution of Long Lasting Insecticidal-treated Nets (LLINs) through the Tanzania Net Voucher System, or TNVS.

The program uses vouchers to provide a sustainable and convenient way to partially subsidize the cost of the voucher to women, while still encouraging the habit of paying for bed nets, which increases the likelihood that bed nets will actually be used. Last year, TNVS switched from a paper voucher system to an e-voucher system, so that now beneficiaries receive the voucher to their mobile phone, and all transactions are monitored electronically.   In less than a year of implementation, the program has seen 3 key impacts:

  1. An estimated 30% savings in operation costs
  2. It is now possible to manage liability by having vouchers automatically expire after 60 days
  3. It is now possible to have real-time insight to the gaps in the supply chain, i.e. lack of demand for nets in certain areas or lack of supply in other areas, issues which keep vouchers from being redeemed. With the paper system, if a voucher wasn’t redeemed, there was no way to tell if the reason was on the supply or the demand side.

These are  only two of many examples of how mobile money can improve public health.  Other points that I appreciated from other panelists and audience members:

  1. The health sector is also a crucial way to promote the uptake of mobile money due to the size ot the sector in most countries.
  2. If health practitioners choose to design a program and need support from the mobile money operator, they need to sell the program based on the operator’s bottom line.
  3. In Kenya, the pilot run by John Hopkins and panelist Dustin Gibson to test using mobile money to incentivize vaccine uptake found that moms like mobile money more than airtime (in Kenya, where MPesa is ubiquitous) and that is important to involve husbands in order to increase uptake.

Where do you think the greatest potential is for mobile money to improve public health?

Looking Forward: Mobile Money in Haiti

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From July 2010 to July 2011, I worked at a cell phone company in Haiti, Digicel, where I designed, tested, and implemented the first mobile money product in Haiti, TchoTcho Mobile.   Digicel had explored the idea of launching mobile money before the earthquake occured in January 2010; however, the impetus to launch when they did was in large part due to the Haiti Mobile Money Initiative, a $10 million incentive fund launched in partnership between USAID and Gates Foundation.



The scaling phase of this award is still in process, and it was recently announced that the two existing mobile money products, TchoTcho Mobile and T-Cash, have reached 1 million transactions combined (press release here.)  Despite this impressive achievement, for those carefully watching the progression of mobile money in Haiti, it has clearly not reached a tipping point where a significant percentage of Haitians are using the product.  As Dalberg put it in their recent report, ‘there is more to be done in establishing these services,’ and operators are still grappling with the challenge of ‘build[ing] a critical mass of active users around a well-designed and well-supported service delivery model.’  The same report outlines many of the challenges that the operators have faced in terms of consumer education, regulatory, and partnership issues.  Digicel’s specific operational challenges were very openly and honestly discussed by the former CEO Maarten Boute at the GSMA Mobile Money for the Unbanked Working Group in Barcelona in February of this year, and the video of that interview can be found here.

So what can be done?  With the incentive prize coming to an end, there is a question of how the development sector can continue to engage with mobile money in Haiti and to support the adoption of the product throughout the country.  I am often asked this question: What can we do? because of my experience, and one of my first answers is: Everything in Haiti takes longer than expected, and a little patience goes a long way.  However, with deeper thought, I have come up with a few ideas that I believe can be practically implemented, and which aren’t the commonly cited solutions – which include more customer education and lower the legal transaction limit of 10,000HTG (250 USD), both of which are critical parts of the equation.

  1. Build products that address the need for security – I truly believe that mobile money in Haiti will be a success because I saw in my time at Digicel that there is real demand for the product.  This demand first and foremost came from the need for secure ways to store and send money, which do not yet exist in a country which has a high amount of theft.  I saw that many of our customers were using TchoTcho Mobile to save small amounts of money on a weekly basis.  In another situation, we interviewed market retailers who were using the service to immediately deposit cash after making a large sale, so that they were not targeted by thieves due to the visibility of the sale.  This real demand is there and can be accessed with proper communication of the value proposition, and with well-trained and accessible agents.
  2. Encourage the platform providers to open up their systems –  Allowing 3rd parties to build apps on top of the existing platforms is the quickest way to expand products and services  – think Twitter, Facebook, and the iPhone – 3 of the most successful products in recent years, all of which have driven usage through 3rd parties (think Farmville!)  Currently, it is extremely hard to integrate the TchoTcho Mobile back end (provided by Yellow Pepper) with any other system, even a bill payment system for say, a water company.  This change would take time and a bit of resources, but could make a substantial difference.
  3. Conduct research on how to make retail payments (or bill payments, etc.) work – I recently met with FinMark Trust who are doing a similar study in Zambia in order to try to jump start the mobile retail payments industry there. Research is a good use of donor money in this situation because the operators are short-staffed (per Maarten’s comments in the above video) and therefore having an outside party provide research on how to enter new markets with value-added services (VAS) can help to kick-start new projects.
  4. Recognize the potential for a non-MNO actor to enter the market – This is absolute blasphemy coming from someone who spent a year working at the MNO and fully believing in the strength of the MNO to drive mobile money.  I still believe that Digicel can drive TchoTcho Mobile and that the product will be successful.  At the same time, I am now working with innovative start-up companies such as Mobile Transactions in Zambia, and I see that they can create different, creative products for new market segments (more on this on the CGAP Technology blog.)  MNOs are great at delivering mass-market products, such as airtime or peer-to-peer transfers, which are accessible and useful to almost everyone.  There is less evidence that they are able to successfully develop and provide services to smaller population segments, such as smallholder farmers or savings groups.  Development actors can help MNOs do so, as is the case with Grameen app lab in Uganda, while at the same time companies such as Mobile Transactions are proving that a 3rd party can find a viable business model in serving these different markets.

So despite the challenges, mobile money is and will continue to move forward in Haiti.  There are already many exciting new initiaves which are using mobile money to rebuild houses (with UNDP), to provide funds to purchase food (Food for Peace), and to help parents in Cite Soleil send their kids to school ( Ti Manman Cheri ).  These current initiatives show the potential of the service to grow through partnerships, which can help to address each of my points above by encouraging innovation from a wide variety of actors.  I personally will continue to support growth of mobile money in Haiti through on-going support for Fonkoze through my current position at MEDA, and as an active observer, consultant, and a passionate believer that Haiti can and must be supported with sustainable, lasting solutions.

TC105: Thoughts on Mobile Money for Development

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A few weeks ago, I had the pleasure of supporting the TechChange Mobiles for Development (TC105) course as a moderator.  I was interviewed for the course by co-founder Nick Martin, which stimulated a interesting conversation with many of the highly experienced and knowledgeable course participants.  Excerpts from that interviews are below.

The course itself was an amazing opporunity to interact with experts across the ICT for development field, and to dive into specific areas of interest including mobile financial services, mobile health, and mobile education.  I highly recommend checking out their upcoming course on the same topics – early registration is now open on their website.

1. Just so everyone is on the same page can you walk us through the difference between mobile money transfer, branchless banking, and the other various terms used in the industry?

  • Branchless banking is simply banking outside of bank branches (retail outlets) – it doesn’t need have to use a mobile phone.  As @yoe [course participant] mentioned in the Zambian case study,  “retailers on any small town could be potential small bank branch.”
  • Money money is an umbrella term for anytime you are using mobiles to conduct financial transactions.
  • Money transfer is the movement of electronic value from one phone to another.  This is the basis the of peer-to-peer (P2P) transactions, which are driving the growth in Kenya, and can be the base for other, more complex products such as microfinance loan repayments or microinsurance.

2.  You just got back from Haiti.  Can you talk about some of the projects and work that MEDA is hoping to do in the country?  How have you seen use of mobiles evolving over time in Haiti since earthquake?

  • MEDA is working with Fonkoze to help them develop a comprehensive strategy for leveraging mobile with minimum risk to the MFI and to their social goals.
  • In terms of mobile money in Haiti, the conversation for a while after the earthquake was all about cash-for-work payments, which is a post-disaster mentality because  cash-for-work is a short-term response mechanism, not sustainable job creation.  Now, there seems to be a lot more momentum in thinking about how to use mobiles for long-term empowerment & job creation. For example, the local tech company Solutions is looking into how to use mobiles with NFC to map agribusiness throughout Haiti, and there has been great progress in starting the Ayiti Living Lab, which will incubate local innovation to make tech more relevant to local communities.

3. You worked on the launch of mobile money in Haiti at Digicel, and now are supporting the growth of the field more broadly. You mentioned in the chat that there are 121 deployments of mobiles for financial services around the world but only 11 have over 250k active users.  Where do you see the field heading?

  • I see a broader recognition in the development field that the excitement around mobile money is really about branchless banking and that the mobile phone is only one delivery method – there has to be flexibility to consider ATM cards, paper vouchers, and over-the-counter transactions depending on the context.  The goal is to provide safter and more convenient alterntives to cash and to the traditional bank branch.  When we start from this premise, it is much easier to build products based on user preferences and to drive active use.


5. We’ve talked about the village phone ladies in this course, many are also familiar with one laptop per child. How do NGO work in the space of mobiles and innovation while taking on the risk of unplanned obselesnce is raised and working against evaluation frameworks, donor cycles, etc.?

  • This will be the new paradigm of aid, which will be more “opensource” and harder to measure.  Impact will be less about meeting pre-set goals and more about stimulating innovating thinking and social change in less quantifiable ways.


5. Question from Janita (one of the course participants): “Hello Chrissy. I am very interested in knowing more about the SMS technology to help deliver vouchers electronically to health clinics. How do you keep it fraud free? Do you work with all telecoms or have you chosen one telecom to work with? Do you have one short code?”

  • Fraud starts with proper identification of participants.  If you can get each person registered with one phone number, you’re probably good.  If your participants share phones or don’t have phones to begin with, this might be more of a challenge.
  • If you are sending vouchers, you need to work with at least mobile money provider (telecom or other)  They should send a voucher with a one-time code redeemable at specific location.  In this type of a program, you would’t need a short code.
  • If you need a  short codes from all of the main telecoms, this would be great, but can be a challenge and the time for negotiations needs to be built into your program plan.


6. What advice would you have for folks wanting to do work in mbanking sector?

  • Pick something to specialize in where there is a currently a lack of expertise (in other words, don’t do what everyone is doing)
  • Develop a technical expertise – content knowledge is rarely enough
  • On-the-ground implementation experience is important in any field; in mobile financial services, private sector experience can provide an extra edge since this field is really an intersection of multiple sectors (private, public, and non-profit)

Mixing in patience & and a little sweat…Thoughts on Community Development part 2

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In my last post, I wrote about creating community ownership of projects, and focused on the need to ground truth innovation in the design phase.   Now, moving onto my second observation from Cite Soleil, I will discuss sweat equity in the implementation process.

What is sweat equity?  I chose this term to depict the fact that ownership does not necessary mean that communities have to pay for it.  It does, almost always, mean that the project will take more time than planned.  One example provided to me by my friend Sabina:  An NGO decided to build a school in the community.  They purchased the materials, but made it clear that the school must be built by the community themselves, and by members of multiple blocs to overcome trust issues (see previous post.)   The building of the school started, and stopped, started again, and stopped again.  Each time, the NGO did not step in to continue the building, and their consistency made it clear that the community alone was responsible for the completion of the school.  When it was finished, the community did not only use the school, but it became a full community center, voluntarily used for community events and social gatherings.  On the contrary, a child nutrition center right next door cannot seem to get anyone to come to the center.  Why?  They built the center without any community buy-in, and failed to recognize that it would have been much more sustainable to provide income-generating activities within the area (which offers very little formal employment) so that parents could afford to feed their children on their own.

Another example is this Eiffel Tower.  The picture was started by a young and humble graffiti artist, Snake, who will paint upon request for little to no commission, as long as the procurer provides the spray paint.  However, spray paint is relatively expensive, and this Eiffel Tower, unfortunately, is not yet finished because the community members who asked for it have run out of money for paint, for the time being.  And yet, they still find pride in the picture, which is for the community and by the community, and they are confident that it will be finished someday.  Sabina, who still has some American sensibilities despite being integrated with into the Haitain community, has been tempted to simply buy the paint and get it finished.  Hwoever, she knows very well that if she did, the picture would be ruined, and would no longer have any meaning for the community.  So she’ll just have to wait, too.

Working in the Red Zone…Thoughts on Community Development, part 1

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Community development takes time.  I think we all know this, to some degree, and yet the message often gets lost in the world of development aid with our funding cycles, program goals, and an understandable desire to scale quickly.  I recently had a chance to reflect on the necessity, and difficulty, of creating community ownership of development projects during a trip to Haiti. I had the privilege to spend time with a good friend, an American woman living in Cite Soleil.  Cite Soleil is an area made famous by the documentary film the Ghosts of Cite Soleil, which depicted a violent gang warzone.  The area, made of up possibly 400,000 residents and including both rural and urban areas, is still considered one monolithic neighborhood and a “red zone” by many organizations, (meaning that they consider it not safe for international staff.)  And yet, development organizations continue to work in the area, many realizing that these negative depictions do not reflect the reality of a community that may have systemic problems but that also has families, children, entrepreneurs, schools, and incredible amount of potential.

Helping Cite Soleil, however, is not easy.   It is not one community but an area made of up many blocs.  There is a lack of trust between blocs, and a general lack of trust of outsiders – paint an NGO logo on a school and you can almost guarantee that no one will enter.  This lack of trust stems, in part, from the history of politicians favoring certain groups at certain times, providing gifts and money to some in order to cause conflict with others (a text-book example of the classic divide and rule tactic often used by rent-seeking states seeking to control a population.)

I’m reminded of a blog post I wrote a while ago on the message of the movie Where the Wild Things Are, which is a story about the “risks of making promises you can’t keep and of trying to solve the problems of people you don’t understand.”  Outside projects, no matter how well-planned or funded, will easily fail when faced with the reality of community dynamics, since “relationships and human emotions are complex and messy,” in any society.

So how can well-intentioned outsiders help in such an environment of mistrust?  Although I won’t claim to have all of the answers, I will share two lessons that I observed clearly during my recent visits.  The first, ground truthing innovation in the design phase, is discussed here, and the second, sweat equity in the implementation process, will be discussed in the following post.

Ground truthing innovation in the design phase:   Brilliant people in the developed world can conceptualize and develop a seemingly infinite number of interesting products to help poor areas such as Cite Soleil, and our tendency is often to build, make sure it works, and then scale.  However, testing products within the community (much like the concept of rapid prototyping in product design) can avoid costly deployments of technologies that simply won’t be accepted by the community.  A good example of this idea being implemented is the work of Haiti Communitere, an organization that provides a space for international organizations to test new ideas with the community before they are deployed.   One idea, to improve shipping containers that have been used as UN offices since the earthquake, was rejected by the community members who tested it and simply stated, This is not a house.

On the other hand, a house being built out of recycled materials from around the area is being embraced by those Haitians who are participating in the building of the house.  This house is built out of the 1000s of styrofoam containers left in canals and roads all over Port-au-Prince, and yet through clever design and involvement of the community, it is becoming a real home.  Therefore, it is not only well-designed to be sustainable and earthquake-resistant, but it will also be an comfortable place for a family to choose to live in with dignity.

This process of ground truthing innovation serves multiple purposes: it involves the community in the design process which helps to create community buy-in & ownership; it helps to avoid costly deployments of technologies that will be rejected by the community that we are intending to help; and it stimulates further innovation by providing (in the case of Haiti Communtere) open-source ideas that can be modified and adapted to work in other communities.  This creates a low-cost scaling mechanism which can create a larger amount of impact, over time, by creating a ripple effect of innovation in communities across Haiti.  Of course, this may also prove to be difficult for organizations to accept since it will be harder to take credit for and to evaluate the impact of open-source development projects, especially if the real impact will come from other people implementing your idea without you even knowing about it.  Yet, if our goal is to create sustainable change with limited resources, then we may have to challenge some of ideas of how to evaluate impact.   I would love examples or thoughts on how your organization is handling these challenges.

Life in Haiti

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One thing that I have learned by traveling is that security is far more subjective than I previously imagined.  The question “is it safe here?” seems at first to be an easy one to answer, by simply looking at crime statistics and asking people that live in the area.   Yet, I realize now that this question can be asked 100 times to people in the same neighborhood, and you can receive 100 different answers. Especially in a place that is as historically and culturally complex as Haiti, security becomes a deeply personal issue, with an answer that is constantly changing and evolving.

Haiti is the first place that I have lived that is considered by most to be highly insecure.  In Tanzania, I walked around alone during the day, took public transportation, and even went jogging with my iPod.  In Haiti, I am not supposed to go anywhere without a both a driver and a bodyguard, which are provided 24 hours by my employer.  The other day, I walked across the street from my office to buy a Coke from a local stand.  The walk took 30 seconds and at all times I was in sight of the men who guard my building with large rifles.  And yet, when I walked back into the parking lot, an American construction worker looked at me and said “Don’t do that again!”

Don’t do what again?  Act like an independent adult who speaks enough of the local language to support a street vendor by buying a 50 cent soda?  His strong belief that my action was insecure is starkly contrasted by an American friend that lives here.  She speaks Haitian Creole fluently, walks 20 minutes to work every day, and pays a moto-taxi to take her to Cite Soleil to watch the World Cup with her local friends.  Cite-de-Soleil is the notorious slum of Haiti, considered by Haitians and internationals alike to be controlled by gangs, drugs, and violence of all kinds.  And here is a small, twenty-something girl from New Jersey who does not think twice about spending her Sundays watching soccer in a neighborhood and working and farming with the local community.

I am not one to take risks, and my overriding goal is to ensure my own security, for the sake of my family and friends that had to live through knowing that I was in an earthquake in a foreign, underdeveloped country.  And yet, you can see how the varying attitudes here can make it hard to assess how to ensure my security in a way that makes me feel comfortable in my current home.  I do not want to live in Haiti and never see the country, spend time with the people here, or spend money at local businesses.  When I am on the street, most people don’t look twice at me.  In fact, the boys that play soccer in front of my hotel stop their game to let me pass when I go to visit my friends next door.

I also don’t want to be naïve.  Haiti has a violent, unstable history, and the people here are possibly at the end of their rope, so to speak, with 1.5 million of them still living in tents 6 months after an earthquake that killed so many because of the failure of their government to provide basic infrastructure.  Haitian friends tell me that they expect the country to experience violence if there is a hurricane, or if the election in November does not go well, or for any number of other reasons.  These are people speaking about their own country, neighbors and friends.

What does this mean for my day to day actions?  I will continue to take my driver and bodyguard when I want to go to dinner at night.  But I will also continue to speak to people on the street and to walk down the block alone in the mornings to buy vegetables.  I did not come back to Haiti to live in fear.  I came here because the people have never been anything but wonderful to me as their guest, because they seem to always be singing and playing soccer, and because they have an entrepreneurial spirit to keep innovating and moving forward despite civil wars, hurricanes, and earthquakes that never seem to let them be.   The reality of my decision to be here, at the same time, means that I have to think every day how to weigh the varying opinions and my own judgment in order to assess my personal, constantly evolving sense of security.