Request for Application #2019-020

Digital Financial Services on Health Outcomes and Health Systems

MSH - PharmAccess - Assessing the Role and and Implementation of DFS for Financial Protection and Improving Health Systems

Executive summary: 

Digital financial services (DFS) have the potential to significantly support the advancement of individual financial protection and improved health system performance. Management Sciences for Health (MSH) proposes to lead the development of a landscape report examining the role of DFS in two country case studies in support of these goals and documenting the critical implementation success factors for practical use by governments, donors, and others interested in advancing this space.

MSH will collaborate with private sector stakeholders including PharmAccess, government stakeholders, USAID, and experts from across health systems, finance and insurance, and digital financial services sectors. The report will examine the successes key DFS programs in the health sector have had in contributing to financial protection and health systems outcomes, and analyze implementation considerations and critical program components which can enable or hinder success. It will focus on DFS implementations which have achieved scale and longevity, to inform future programing. Implementation will include review of existing literature, consultation with key stakeholders, and development of a systematic approach of how to review DFS for health successes and implementation experience adopting a process evaluation approach – which is also expected to be a contribution to the DFS for health field. The mixed-methods review approach will be implemented with selected DFS programs, gathering insight and triangulating results across stakeholder perspectives including DFS implementers, government, beneficiaries, and providers.

Collaborating partner PharmAccess will facilitate examination of innovative M-TIBA-enabled programs as one of the key programs reviewed, providing key insights to ongoing DFS-enabled health insurance for UHC in Kenya. The DFS payment-enabled community-based health insurance (CBHI) program in Rwanda is proposed as a case study of a government-led program reaching national scale.

Consortium Team: 

Management Sciences for Health

MSH is a recognized leader in health systems strengthening, with 47 years’ experience in 150 countries. It brings deep experience across the focus areas of the activity, including in health financing, resource mobilization, and insurance; as well as in the design and implementation of a range of digital solutions in partnership with private sector and ministries of health. MSH will lead the technical implementation, data gathering, and report writing.

MSH is a holder of the Integrated Health Systems (IHS) IDIQ with the Global Health Bureau and brings strong experience in universal health coverage; including serving as the Network Manager of the Joint Learning Network for Universal Health Coverage (JLN) Steering Group. MSH supported the design of a digital membership management system for community based health insurance (CBHI) in Rwanda which integrates with several mobile money operators to facilitate household premium payment; a program proposed as a country case study in the approach described below.  

MSH also has significant experience conducting landscape assessments in the digital space. MSH developed the six-volume mHealth Compendia with 167 profiles of digital health interventions including DFS interventions and a Reaching Scale edition under the USAID African Strategies for Health. These have served as foundational resources in the digital health space, having been referenced for a significant number of reports as well as in the development of the Digital Health Atlas. MSH has tailored landscaping reviews for specific needs including country reviews to inform national mHealth strategies, supporting cross-sectoral learning and collaboration in the development of the roadmap for the Digital REACH Initiative, and leading country review and creation of a Digital Health for Tuberculosis Care and Treatment Roadmap in Bangladesh. In addition, MSH has led the development of community learning opportunities including a workshop on Digital Financial Services for Health.

PharmAccess Group

PharmAccess will be a collaborating partner in the activity. PharmAccess is experienced in designing and scaling DFS products for health. They aim to be an innovator and catalyst for practical changes that can be brought to scale, and believe that better functioning healthcare markets are key to the realization of UHC. Their work includes the cost-efficient design of scalable health programs through public-private partnerships by making financial risks transparent and predictable, creating investment opportunities for governments, donors and other parties. To meet the challenge of low health insurance coverage and high individual financial risk from health shocks, PharmAccess has partnered with Safaricom and IT company CarePay to develop a health wallet on a mobile phone, launched as M-TIBA in 2016. PharmAccess and affiliate, CarePay, are engaged in the design, roll-out, and scale of DFS for health M-TIBA programs in Kenya, Nigeria, and Tanzania and will serve as a key study example as described in the approach below.

MSH sees USAID as a key member of the team and will plan to engage closely with USAID as well as other key stakeholders, including the organization implementing the global landscaping activity over the course of the program.


Application Status: 
Approved - fully funded


Focusing the primary purpose on developing country case study opportunities makes sense, and both HSS and DFS are addressed. Methodological approach is well defined; adaptation of the process evaluation model is an interesting idea to capture mediators/mechanisms of impact. We note you have highlighted the potential need for more time to implement research, this can be considered if concept is selected.

We recommend considering how to include a mix of public and private sector DFS providers in the analysis for purposes of informing learning related to the sustainability of DFS for health service provision.

How wil you ensure your findings are relevant for the Asian context? Can you speak more about how your are specifically planning to take advantage of Sherri's digital expertise, as well as the digital expertise of others?