Request for Application #2019-020

Digital Financial Services on Health Outcomes and Health Systems

Banking on Health: A Global and Local Assessment of DFS and Health Solutions for Low-Resource Settings

Executive summary: 

Grameen Foundation USA (Grameen), in partnership with IntraHealth International (IntraHealth), proposes to conduct a global landscape assessment to understand the role of digital financial services (DFS) to both advance financial protection of households when seeking health care services and improve health system performance. Drawing on respective expertise in DFS, development of consumer health financing instruments, health systems strengthening and development of digital health innovations, Grameen and IntraHealth will draw on country-level staff and partners to conduct a desk review and in-depth structured interviews that will be designed to capture local lessons, articulate three to four informative case studies, and synthesize lessons and recommendations for both health and financial services actors.

Consortium Team: 

Grameen: As the prime for the proposed landscape assessment approach, Grameen has over 15 years of experience designing, testing, and scaling health financing and DFS. Grameen brings programmatic experience working at the intersection of health and microfinance, using human-centered design to develop products and services, and participating in consumer protection and social performance management initiatives. Grameen also has experience developing and integrating digital technologies for the health and financial sectors, such as the MOTECH suite of services designed to address community health worker (CHW) training and support and the Mifos open-sourced platform for cloud-based core banking systems. While unpublished, Grameen conducted a desk review for Marie Stopes International (MSI) to inform MSI’s strategy for assisting franchisees in gaining access to credit to support startup, operating, and/or expansion capital. Grameen also contributed to the development of two literature reviews (in 2011 and 2017) of microfinance and health protection initiatives, of which health financing was one innovation assessed, and explored the role of financial service providers (FSPs) in health financing.

In 2019, Grameen completed research to outline the lessons learned developing health financing products with FSPs. Some of these products were digital in nature, but the majority representing traditional finance approaches, such as health savings, health loans, linkages to health insurance products and the necessary complementary services needed to ensure effective take-up and use of these financial products as well as the associated health services. The development of these health financing tools was the result of local collaborations with public and private health facilities, FSPs, and insurance providers to ensure the products responded to both household needs and the needs and processes of health facilities in accepting payments for health services. The lessons-learned documentation outlined key lessons such as understanding decision-making power within households (particularly since many health interventions are targeted to women), limiting red-tape for qualifying health events, and the importance of developing an (digital) ecosystem where financial service and health providers can collaborate and remove barriers for households seeking health treatment, among others.  

In 2018, with the support of USAID/mStar, Grameen conducted a similar comprehensive global landscape assessment (inclusive of case studies) as well as a webinar, blogs and presentations, of the state of practice related to the use of digital farmer profiles, intended to support the efforts of the USAID Digital Development for Feed the Future (D2FTF) to mainstream digital agriculture tools across Feed the Future programming. USAID D2FTF also completed a case study of Grameen’s collaboration with Musoni Kenya on a DFS agricultural loan product for smallholder farmers.

Bobbi Gray, Research Director and Christian Loupeda, Senior Director of Financial Inclusion, who both co-authored Grameen’s research on health financing, will lead efforts for the health financing landscape assessment on behalf of Grameen.

IntraHealth: Supporting Grameen, IntraHealth builds on 40 years of experience in assisting countries to strengthen their capacity to plan, develop, manage, and support health workers. IntraHealth’s key approaches in human resources for health and health systems strengthening include developing and supporting digital health solutions to help health sector leaders communicate more effectively with health workers, make better, more informed decisions about health workforce policy, planning, training, regulation, and management, and lead successful change management processes to move from paper-based to digital management systems. IntraHealth developed global digital health goods to support continuous improvement of health system management and performance, such as iHRIS, the leading human resources information system for health workforces, mHero, a communication solution for governments to connect with health workers, and the Global Open Facility Registry, for identifying, reconciling, and synthesizing duplicate or incomplete facility records across multiple data sets. All three global goods are supported by members of the Digital Health team.

Wayan Vota, Digital Health Technical Lead, and Pamela McQuide, Health Systems Strengthening Technical Lead will lead efforts for the health financing landscaping assessment on behalf of IntraHealth.

Final Technical Application: 
Application Status: 
Not Approved


Great concept note! This approach closely complements our own thinking, as do your recent assessments of health financing instruments and digital services in agriculture, respectively. Would you be interested in exploring potential opportunities for collaboration on the preliminary application "co-creation" phase?

I just wanted to note that Tomorrow Global remains interested in the possibility of joining forces given our similar perspectives and complementary skill sets (especially insofar as your related work with Freedom from Hunger some years back also inspired some of my more academic research). Moreover, I believe we would be well-situated to address some of Celia's comments by bringing economic theory to bear on the case study selection criteria and key variables to ascertain from interviews or administrative data (and can also contribute quantitative analysis of the latter, which might be helpful to incorporate into the proposal).

The focus on DFS for both health and health systems performance is appropriate, and clearly reflected in the range of potential participants.

There are plans for 4 case studies. We recommend clarifying whether the approach you plan to use to develop those case studies is to-be-determined, or if not, clarifying what it will contain. It was hard to be sure from this initial application, which at first states, “Grameen and IntraHealth will co-create a research methodology…” which indicates that the methods are not yet developed, but then describes an approach on pg. 4 consisting of mostly interviews as well as document review, and on pg. 5 the activities appear to be mostly interview-centered.

Celia, thanks for the feedback. We will revise the concept note to clarify the question above. 

Celia, when I uploaded our budget and budget narrative tonight, it shows up as a public document, so I deleted it until I get confirmation from you that this is intended. In the documentation, it shows that the budget and budget narrative would be private documents. Can you confirm? When I logged out, it still showed up. 

Hi Celia, once I logged out of my browser completely, the budget items don't show up. I think we're good to go. -Bobbi