Pesinet: Mobile Tech and Micro-Insurance for Child Health in Mali

Posted by AnneryanHeatwole on Jul 10, 2010

Healthcare agents in Bamako Coura, Mali, are providing better care to children with the help of mobile phones. Healthcare agents with Pesinet, a non-profit organization based in Mali, perform weekly checkups on children and then send the results to a doctor for evaluation through a Java application.

Anne Roos-Weil, founder of Pesinet, says: 

In Sub-Sahara Africa you have a very, very high child mortality rate. […] In Mali, where our project is based, one child out of five dies before the age of five. What we realized is that they’re mostly dying because they don’t go to the doctor or the healthcare center early enough.

Pesinet, which was founded in September 2007 and began its pilot run in October 2009, works on what the NGO identified as the three main barriers to medical treatment for children in Bamako. The first is a geographic barrier: in many rural areas people don’t have easy access to health care centers. The second barrier is family finances; paying for medication and visits to the doctor can be a huge financial burden on struggling families. The third barrier is what Roos-Weil calls “an attitude barrier” -- many people wait until illnesses are severely advanced before visiting a doctor, which makes treatment more difficult than if the disease had been caught in its early stages. 

Pesinet devised a system that creatively addresses each barrier: First, healthcare agents directly visit the homes of children enrolled in the program so that families don’t have to go to a healthcare center. Secondly, families pay roughly one euro a month to enroll in the service, which acts as micro-insurance. The fee covers the healthcare agents’ visits, a visit to the doctor if the agents notice any signs of illness, or if the doctor remotely identifies problems, and covers half the price of medication if a child needs it, so that families aren't hit by a huge medical bill all at once if their child gets sick. Finally, agents make home visits each week so potential illnesses can be detected early. Explains Roos-Weil,

The core idea of Pesinet is try a system that manages to both detect early and prevent most of the diseases, and create a change in the attitude of the population toward healthcare and early treatment.

Why Mobiles:

The two healthcare agents, Assetou Niambélé and Fatoumata Doumbia, carry mobile phones during their weekly home visits to the 400 children currently enrolled in the program. According to Roos-Weil, using mobiles has allowed the program to reach many more children than would have otherwise been possible. The healthcare agents look for five key symptoms (fever, vomiting, diarrhea, cough, and weight loss), record the data onto a Java mobile application, then send the data to a doctor at the local health care center. Explains Roos-Weil, “We designed an application that is really easy to use, very basic. It’s a case of either entering digits or letters, if they want to enter the name of the subscriber, or a case of ticking boxes.” Below is an image from the Pesinet website of the application in action:

image

Says Roos-Weil,

What we found useful in mobile technology is mostly a case of efficiency in the way health workers do their work. Because basically, while using mobile technology you can ensure that the agent is having proximity to families, so she can do the home-based check-up while seeing a lot of children in a short time, which allows the doctor to follow up on a great number of children. Mobile technology, in our case, […] allows a model whereby we can touch a great volume of children while using just one doctor.

Creating Sustainability:

Pesinet has faced challenges during its pilot phase, primarily in creating trust among potential subscribers in a no-prevention culture and creating a self-sustaining business plan. 

The service has been running since October 2009, but Pesinet began actively recruiting new subscribers in May 2010. While Roos-Weil is happy with the number of subscribers that have joined the system so far, she estimates that the current rapid expansion will eventually plateau. She says that the door-to-door approach is the best way for Pesinet to promote its services, as it takes a lot of time to build trust with the families and convince them that micro-insurance is a worthwhile investment. She says:

When one mother is already subscribing, what happens is that the neighbors and the mothers living close by see the agent coming. They get interested by the project, they learn what it’s about, and then they subscribe. So it takes quite a while to get to a big number of children because you need to build trust in a project from families.

Roos-Weil says that the organization’s expansion has been slow to build a self-sustaining program, mainly because the break-even point can only be reached with a great volume of children to keep the price affordable for families. However, while in the start-up phase Pesinet has received grants from corporate foundations in order to cover the initial costs. She estimates that the group will be able to self-support once it reaches 1500 children (with six healthcare agents) or 2000 children (with ten healthcare agents). She says, “What we want to do is implement a service that would be able to self-sustain without any external funding as soon as we get the break-even point. So the idea is to not put into place too many partnerships that we won’t be able to sustain in the long run.”

The program also only covers the top three illnesses that result in child mortality in Mali (respiratory illnesses, diarrheal diseases, and malaria account for 60% of under-5 deaths in Mali); treatment for chronic diseases is not included in the half-priced medication coverage. However, the program is off to a good start – according to a study performed by the Malian Ministry of Health, 96% of the mothers enrolled in the program reported being satisfied with the service, and 99% of the mothers said they would recommend Pesinet to their friends or family.

Below is a video that shows how the mobile reporting system works:

Flash animation from Anne Roos-Weil on Vimeo.

 

 

 

 

Basic Information
Organization involved in the project?: 
Project goals: 

The goals of Pesinet are:

  • To prevent child mortality from benign diseases through regular home screenings
  • To create an insurance plan so that health problems do not bankrupt families

 

Brief description of the project: 

Pesinet is a mobile healthcare service currently deployed in Bamako Coura, Mali. Parents sign up for a healthcare worker to visit their children weekly for a regular checkup. The agents collect data via mobile phone, and send it to a doctor at a healthcare center, who reviews the information for changes. The parents pay the equivalent of one Euro a month, which covers visits to the doctor in case of emergency, and provides half-price medication in case the child needs medical care. 

Target audience: 

The target audience is parents of children under five in Bamako, Mali (for the current pilot; later it will expand to all parents of children under five who live in areas with high under-5 mortality rates in Mali). 

 

Detailed Information
Length of Project (in months) : 
10
Status: 
Ongoing
What worked well? : 

In a survey conducted by the Malian Ministry of Health, 96% of the mothers enrolled in the program reported satisfaction with Pesinet, 99% wished to recommend the service to family and friends, and 97% of the families found the service to be "very affordable."

What did not work? What were the challenges?: 

The program's challenges are:

  • Breaking through the trust barrier - Pesinet found it difficult to promote the service rapidly in areas where there is little awareness of the value of prevention, as this involves a significant cultural shift. 
  • The organization's desire to be financially self-sustaining has meant slow growth (compared to subsidized programs); the paying approach inevitably led to slower adoption than if the service were free of charge. 

 

Pesinet: Mobile Tech and Micro-Insurance for Child Health in Mali Locations

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Healthcare agents in Bamako Coura, Mali, are providing better care to children with the help of mobile phones. Healthcare agents with Pesinet, a non-profit organization based in Mali, perform weekly checkups on children and then send the results to a doctor for evaluation through a Java application.

Anne Roos-Weil, founder of Pesinet, says: 

In Sub-Sahara Africa you have a very, very high child mortality rate. […] In Mali, where our project is based, one child out of five dies before the age of five. What we realized is that they’re mostly dying because they don’t go to the doctor or the healthcare center early enough.

Pesinet, which was founded in September 2007 and began its pilot run in October 2009, works on what the NGO identified as the three main barriers to medical treatment for children in Bamako. The first is a geographic barrier: in many rural areas people don’t have easy access to health care centers. The second barrier is family finances; paying for medication and visits to the doctor can be a huge financial burden on struggling families. The third barrier is what Roos-Weil calls “an attitude barrier” -- many people wait until illnesses are severely advanced before visiting a doctor, which makes treatment more difficult than if the disease had been caught in its early stages. 

Pesinet devised a system that creatively addresses each barrier: First, healthcare agents directly visit the homes of children enrolled in the program so that families don’t have to go to a healthcare center. Secondly, families pay roughly one euro a month to enroll in the service, which acts as micro-insurance. The fee covers the healthcare agents’ visits, a visit to the doctor if the agents notice any signs of illness, or if the doctor remotely identifies problems, and covers half the price of medication if a child needs it, so that families aren't hit by a huge medical bill all at once if their child gets sick. Finally, agents make home visits each week so potential illnesses can be detected early. Explains Roos-Weil,

The core idea of Pesinet is try a system that manages to both detect early and prevent most of the diseases, and create a change in the attitude of the population toward healthcare and early treatment.

Why Mobiles:

The two healthcare agents, Assetou Niambélé and Fatoumata Doumbia, carry mobile phones during their weekly home visits to the 400 children currently enrolled in the program. According to Roos-Weil, using mobiles has allowed the program to reach many more children than would have otherwise been possible. The healthcare agents look for five key symptoms (fever, vomiting, diarrhea, cough, and weight loss), record the data onto a Java mobile application, then send the data to a doctor at the local health care center. Explains Roos-Weil, “We designed an application that is really easy to use, very basic. It’s a case of either entering digits or letters, if they want to enter the name of the subscriber, or a case of ticking boxes.” Below is an image from the Pesinet website of the application in action:

image

Says Roos-Weil,

What we found useful in mobile technology is mostly a case of efficiency in the way health workers do their work. Because basically, while using mobile technology you can ensure that the agent is having proximity to families, so she can do the home-based check-up while seeing a lot of children in a short time, which allows the doctor to follow up on a great number of children. Mobile technology, in our case, […] allows a model whereby we can touch a great volume of children while using just one doctor.

Creating Sustainability:

Pesinet has faced challenges during its pilot phase, primarily in creating trust among potential subscribers in a no-prevention culture and creating a self-sustaining business plan. 

The service has been running since October 2009, but Pesinet began actively recruiting new subscribers in May 2010. While Roos-Weil is happy with the number of subscribers that have joined the system so far, she estimates that the current rapid expansion will eventually plateau. She says that the door-to-door approach is the best way for Pesinet to promote its services, as it takes a lot of time to build trust with the families and convince them that micro-insurance is a worthwhile investment. She says:

When one mother is already subscribing, what happens is that the neighbors and the mothers living close by see the agent coming. They get interested by the project, they learn what it’s about, and then they subscribe. So it takes quite a while to get to a big number of children because you need to build trust in a project from families.

Roos-Weil says that the organization’s expansion has been slow to build a self-sustaining program, mainly because the break-even point can only be reached with a great volume of children to keep the price affordable for families. However, while in the start-up phase Pesinet has received grants from corporate foundations in order to cover the initial costs. She estimates that the group will be able to self-support once it reaches 1500 children (with six healthcare agents) or 2000 children (with ten healthcare agents). She says, “What we want to do is implement a service that would be able to self-sustain without any external funding as soon as we get the break-even point. So the idea is to not put into place too many partnerships that we won’t be able to sustain in the long run.”

The program also only covers the top three illnesses that result in child mortality in Mali (respiratory illnesses, diarrheal diseases, and malaria account for 60% of under-5 deaths in Mali); treatment for chronic diseases is not included in the half-priced medication coverage. However, the program is off to a good start – according to a study performed by the Malian Ministry of Health, 96% of the mothers enrolled in the program reported being satisfied with the service, and 99% of the mothers said they would recommend Pesinet to their friends or family.

Below is a video that shows how the mobile reporting system works:

Flash animation from Anne Roos-Weil on Vimeo.

 

 

 

 

Basic Information
Organization involved in the project?: 
Project goals: 

The goals of Pesinet are:

  • To prevent child mortality from benign diseases through regular home screenings
  • To create an insurance plan so that health problems do not bankrupt families

 

Brief description of the project: 

Pesinet is a mobile healthcare service currently deployed in Bamako Coura, Mali. Parents sign up for a healthcare worker to visit their children weekly for a regular checkup. The agents collect data via mobile phone, and send it to a doctor at a healthcare center, who reviews the information for changes. The parents pay the equivalent of one Euro a month, which covers visits to the doctor in case of emergency, and provides half-price medication in case the child needs medical care. 

Target audience: 

The target audience is parents of children under five in Bamako, Mali (for the current pilot; later it will expand to all parents of children under five who live in areas with high under-5 mortality rates in Mali). 

 

Detailed Information
Length of Project (in months) : 
10
Status: 
Ongoing
What worked well? : 

In a survey conducted by the Malian Ministry of Health, 96% of the mothers enrolled in the program reported satisfaction with Pesinet, 99% wished to recommend the service to family and friends, and 97% of the families found the service to be "very affordable."

What did not work? What were the challenges?: 

The program's challenges are:

  • Breaking through the trust barrier - Pesinet found it difficult to promote the service rapidly in areas where there is little awareness of the value of prevention, as this involves a significant cultural shift. 
  • The organization's desire to be financially self-sustaining has meant slow growth (compared to subsidized programs); the paying approach inevitably led to slower adoption than if the service were free of charge. 

 

Pesinet: Mobile Tech and Micro-Insurance for Child Health in Mali Locations

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