I’ve been in Uganda for almost a week now, doing a needs assessment with the East Africa Blum Fellows smartphone team – on whether and how smartphones can be used in the context of healthcare in Uganda. We’ve had meetings all over Kampala, with Satellife/Healthnet Uganda, the Ministry of Health, and various people at Makarere University. See my flickr account for a photo diary.
My most productive meeting so far has been with Francis and Gerry at Microcare, Uganda’s largest insurance company. Ben Bellows has been working with Microcare and Marie Stopes International on Output Based Aid (OBA), a voucher-based scheme for the delivery of STI treatment in the Mbarara district 6 hours drive west of Kampala (by the way, I just arrived in Mbarara yesterday). Ben and I (along with Mahad and Sonesh) have been talking about how to integrate smartphones into the voucher claims process and recently won a CITRIS award to fund the implementation of a pilot deployment. So when I arrived in Kampala, I made plans to meet Microcare and MSI to talk about our plans.
What strikes me most about Gerry and Francis is how fast they think. Having learned all about their insurance system, I asked why they didn’t use smart cards for the OBA program as well. In a flurry of conversation we realized that the smart cards are durable enough to be reused – and would be a useful platform for a new rural program promoting antenatal care. Rather than using vouchers, which could be resold or appropriated, they will issue smart cards for the 9-month duration of the pregnancy, recording visits. The "admission" into the program would be the cost of the smart card (about $1), and upon completion the patients would return the card in exchange for a small gift (we were thinking of baby socks). Within five minutes of my question, we not only had a whole scheme worked out, we also had a name: Smart Delivery. Using smartphones enabled with smart card readers we can set up a rural terminal such that transactions can be delivered efficently via SMS at extremely low cost. Within one hour, we had defined a protocol, and Francis had assigned the project to one of his software engineers (Microcare insources their work to a wholly owned software company in Chennai) and made plans to complete the work by June 15th. I’ll keep you posted on what happens! In the meantime, I’ve loaned them my two GPRS modems, so they will be testing the system using two PCs. I’ll see what I can do to implement the smartphone version…although it’s been entertaining trying to figure out the APIs without access to the web for documentation!
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I don’t get it – the only thing that seems to prevent you from “reselling” the prepaid services represented by the smartcard is the color photo on the front. (As compared to a paper voucher, I mean. And it seems like you could print photos on paper vouchers as well, in which case a cameraphone with QRcode software would be adequate to document voucher use as opposed to a smartphone with a smartcard reader.) And this doesn’t seem to solve the kind of collusion-based fraud problems that were brought up in the discussions after Lakshmi’s trip, though maybe those are not serious problems in this country?
Actually – it is not just the photo on the front, it is also the photo in their database, which appears when the card is scanned. In addition, each service provider has a list of “revoked” identities, which they can use to determine if the card is till valid.
With respect to the maternity ante-natal care program, we expect there to be less fraud because service is offered for a course of 9 months, and shared use of the cards is easily trackable – patient/mother history is included in the database, fraud would require that the card be “shared” by a mother with the same development stage – and then the mother wouldn’t be able to access care for the next visit, and risks losing care for the entire duration of the pregnancy.
QRCode is a good potential modification to the voucher system (for OBA, not the antenatal program). I think the main difference between the two ideas is that the antenatal program requires a long-running id, and the voucher program is essentially point-of-care single visit management rather than ID-based.
And to clarify – the health insurance program that uses the smartcards currently (the one with the photo ids) is another program entirely separate from the two described above.