Paying for childbirth by mobile phone

People who need to go to hospital in southern Madagascar tend to think twice, even in emergencies. Leaving a clinic after treatment isn't allowed until all fees and expenses have been paid. Many locals are poor, have no health insurance, and no financial cushion. “This has always been a problem,” reports Elsa Rajemison, co-founder and managing director of online platform mTomady. “Even if relatives step in, it often takes days for the money to arrive. That's because hardly anyone has their own bank account to transfer money.” 

Together with two doctors from the NGO “Doctors for Madagascar”, Rajemison cast around for a solution. “What we saw in abundance, even in remote areas, were cell phone towers,” she says. So they came up with the idea of ​​an electronic health savings account and founded mTomady in 2019 – ”tomady” means “strong and healthy” in Malagasy, and “m” stands for ”mobile.” Once registered, users can add savings to be used for medical purposes. Those savings will then be matched by donations.

“More than half of all births take place without any medical assistance”

Not everyone has a mobile phone of course; often there is only one in the family. That's why the team decided that mTomady would work on a SIM card alone. This can be read at health stations and used to pay for medication or operations. 

Women and families stand to benefit most from mTomady. Maternal mortality is very high in Madagascar where more than half of all births taking place without any medical assistance. mTomady offers free mobile ultrasound examinations to pregnant women which allows women to be better prepared for a difficult birth and to start saving for a possible caesarean section. 

However, Rajemison emphasizes that technology is only a small part of the project. “It's important to gain people's trust through a lot of education.” Although she now manages the project from Berlin, the Madagascan often travels to her homeland to keep up to date with ​​potential problems. When it became clear that tiny SIM cards were easily lost, the organization distributed a keyring that incorporated storage.

The project has gone from strength to strength: Now mTomady now even has offshoots in Congo and Uganda.