[Music]
in the last few years a new technology
has developed in Africa and you’ve
probably never had access to it but that
technology might just change the way we
think about health care I’d like to tell
you about flow home flour salt soap for
a living he was 16 when a truck crashed
into his shopping store by the road his
brothers rushed him to the nearest
hospital
in a blanket tied to a stick floor had
lost consciousness when they arrived in
the emergency room the blanket was
soaked in blood and his right arm and
leg were twisted in an unnatural way he
needed immediate surgery to survive I
was at this hospital in Cameroon that
night the surgeon and I we scrubbed
rushed to the operating room and waited
for the patient to be brought in but
Flor didn’t come after a while we went
back to the emergency room the IV line
was still dangling from the drip stand
but flora was gone and so was his family
what had happened we asked the nurses as
was their usual routine they had asked
his family to go to the pharmacy to buy
drugs IV fluids sutures even the gloves
for the operation the family did the
math they were willing to pay but they
just didn’t have the cash with them or
any other means to pay right there and
then and this is why they were asked to
leave
upon hearing this the surgeon I was
working with just lost it
he made the nurses go out into the night
and search for flaw he even offered to
pay for the drugs himself but flan did
not return and the next day I learned
that he had died that night just steps
away from the hospital gate the surgeon
I got to know that night was dr. Elson a
visiting surgeon from madagascar there
was something special about Elson he had
worked in rural Africa for years and in
a context where there’s almost no health
insurance and no comprehensive
state-funded health care patients being
turned away by a hospital sadly is a
common reality and in fact stories like
florence happen so many times every day
in Africa but Elson was a man who would
not accept a single patient going
without the care they needed well since
vision was to return to Madagascar and
open a hospital for the poor where no
one would be turned away now you might
think of Madagascar as you know
animation movies or amazing wildlife but
there is another side to Madagascar and
that is that 93% of the population lives
below the poverty line in the remote
south of the island Elson and his wife
converted an old rice mill into a
hospital children would fetch water from
outside the village and sell it to the
hospital and electricity would come from
a small generator that would regularly
break this was the only surgical
hospital within 150 kilometers
area for roughly 1 million people
referrals were out of the question
because of the distances and during the
rainy season the hospital would be cut
off for weeks at a time when roads would
turn into streams and mud holes would
become insurmountable obstacles but
patients came soon the hospital was
working at its capacity and patients
would be sleeping everywhere outside on
the hospital grounds every hour of every
day
Elson was uncalled for emergencies his
wife standing next to him holding a
torch for him to see when I started to
work as a doctor I spend all my holidays
at this hospital I was absolutely amazed
to see it grow at first I asked friends
and family for help and I did later we
registered as an NGO soon we had enough
money together to build a proper
hospital
it opened in 2015 it has 40 beds a staff
of 22 fully equipped operating rooms but
most importantly from the first day this
was entirely managed by a Madagascan
partners and it’s been running
successfully since and one of the
poorest regions on earth to keep itself
sustainable and self-reliant the
hospital does charge for care but one
thing was clear the story of flora must
not repeat itself so in an emergency the
hospital treats first and sorts payment
later but this part problems of its own
sometimes the hospital had to keep
patients for weeks of extra time until
the bills were paid for example ina a
young mother who had given birth to
twins she had to spend an extra three
weeks on the hospital compound for her
bill to be paid
have family during that time sold some
of the kettle her brother took the money
in cash to the hospital he paid the bill
ina could go home but to achieve this
the hospital had to waste energy and
time to keep her as a medical hostage
and again this is so common in Africa
most hospitals in a similar setting they
have a dedicated room or a dedicated
building where they keep patients until
the bills are paid another more tragic
story is that of Malala a young woman
with a life-threatening bleeding after
delivery our ambulance had arrived in
her village and wanted to take her to
the hospital but her father stepped in a
way refusing to let her go why well the
last time someone from his family had
been to hospital he was shocked by the
bill all sorts of unexpected fees and
side payments he didn’t understand he
felt cheated by the hospital and that
brought his family close to ruin so
maybe this time they could have averted
the treatment but they weren’t willing
to take the risk
so when hospitals have the power to set
prices or deny treatment then patients
are the weakest link in the chain we
never knew what happened to Malala but
whether it rattling with seed source of
problems a huge change was creeping up
on us all right and I need your
participation now I would love to know
who of you in this room does not have a
bank account can you raise your arm
please so not have a bank account
no one Wow so to put this in perspective
99%
of Germans have a bank account all of
you seem to have one so I would like you
to think for a minute how life would be
like without one
how would you receive your salary how
would you pay your electricity bill
how would you save well not having a
bank account is normal for most Africans
fewer than 5% of Madagascar’s have a
bank account and that’s because the
small savings of the poor are just not
worth the bank’s effort to offer them
accounts all for health insurance to
offer them policies so when we started
working seven years ago this is what a
bank transferred looked like in
Madagascar the hospital had to hire an
armed guard who would take a bag full of
cash
go into the car and drive for 200
kilometres to paid into the bank account
but since then something absolutely
dramatic has happened every town and
every village in Madagascar and that’s
placed is so remote you can have a hard
time finding even a single plastic bag
there now connected to the outside world
with a mobile phone tower more than half
of Madagascar’s have a phone and there’s
a million new users each year and in the
footsteps of this revolution has
followed mobile money now mobile money
allows you to send money from one phone
to the other without the need for a bank
account you can deposit money the same
way that you charge up with phone credit
so with a simple scratch card it’s safe
it’s easy transferring money it takes
just some seconds and millions of
ordinary Africans use it every day
to receive the salary to send money to
loved ones I actually have it in my
pocket how it goes on okay
it’s not a text it’s not a text it’s not
it’s something different it’s something
different it’s it’s the real thing this
is the real thing
so the Mobile Money thing is so easy you
don’t need internet to do that it’s like
sending an SMS and it’s so useful that
it spread extraordinarily fast and this
is the real thing because when I asked
Elson if his hospital had received any
funds with mobile money his answer was
yes they got half their revenue in 2017
over this phone so while we were
thinking about how we could finance
healthcare by supporting hospitals this
technology was developing that gave
people unprecedented control of their
finances and that shifted our thinking
could we instead support patients to pay
for their care could we help patients
like flora ina and Malala now in a cash
economy saving money is risky if you
have money under your bed I can get
stolen if you have a large investment
like farmland that can only be sold in
one piece so let’s imagine a health
savings account on your phone a health
wallet this works exactly like mobile
money but with the crucial exception
that money can only be spent at
registered clinics and there is no way
for you to take it out spend it on other
things
take it out in cash you know send it to
your loved ones go to the pub so you
know it’s there for when you need it
most
let’s take it a step further a
government an NGO or people like you or
me or a patient’s family they can all
send money to the health wallet and be
sure it can only be used for healthcare
money can also be restricted to specific
procedures like checkups during
pregnancy or HIV treatment and if there
are several registered clinics in an
area it’s the patients that can choose
the one that gives the best care because
ultimately it’s them carrying the money
funds can also be used to top-up savings
if a certain amount has been deposited
so to encourage people to save for
healthcare but crucially the health
wallet helps to make payments more
transparent and to reduce the risk for
corruption how does that work the health
wallet provider agrees on fixed prices
with the clinics so the patient’s know
in advance how much they need to pay and
in order to get their money the
hospitals need to register the treatment
and the bill and that very much reduces
the opportunity for corrupt hospital
staff to extract extra charges so many
of these ideas are really being
pioneered in other African countries but
how would that have helped our patients
now Florence family they would have had
an emergency savings account that’s
excessively accessible immediately for
ina she could have send the money in a
matter of minutes
saving her a three-week-long stay at the
hospital
and malala’s father he wouldn’t have had
to be afraid of these unpredictable or
illegitimate fees earlier this year we
we took this idea to the Madagascan
government Friday night we were sitting
down with the Deputy Minister of Health
at his office he was very tired leaning
back in his chair but when he heard
about the health wallet he did like this
and then and he said I smell it I smell
it he jumped up he opened the doors to
the to his colleagues who were still
there in a Friday at 8:00 everyone came
in and right there and then they started
a commission a working group that is now
working with us to pilot the health
wallet in Madagascar later this year and
if that’s going to work the health
wallet will become an integral part for
the Madagascan health care system and
it’s a country of twenty four million
people
so our dream is that one day everyone in
Madagascar will get care when they need
it and that’s regardless of their income
but that might not happen in a way we
expect Africa is not just catching up
with the West Africa is using new
technologies to find completely
different solutions to the problems
modern societies face if we can listen
to the way Africa is changing and we’re
prepared to change our thinking then we
have a unique opportunity right now to
transform healthcare in Africa and to
make sure that cases like phones do not
happen again thank you
[Applause]
[Music]
in the last few years a new technology
has developed in Africa and you’ve
probably never had access to it but that
technology might just change the way we
think about health care I’d like to tell
you about flow home flour salt soap for
a living he was 16 when a truck crashed
into his shopping store by the road his
brothers rushed him to the nearest
hospital
in a blanket tied to a stick floor had
lost consciousness when they arrived in
the emergency room the blanket was
soaked in blood and his right arm and
leg were twisted in an unnatural way he
needed immediate surgery to survive I
was at this hospital in Cameroon that
night the surgeon and I we scrubbed
rushed to the operating room and waited
for the patient to be brought in but
Flor didn’t come after a while we went
back to the emergency room the IV line
was still dangling from the drip stand
but flora was gone and so was his family
what had happened we asked the nurses as
was their usual routine they had asked
his family to go to the pharmacy to buy
drugs IV fluids sutures even the gloves
for the operation the family did the
math they were willing to pay but they
just didn’t have the cash with them or
any other means to pay right there and
then and this is why they were asked to
leave
upon hearing this the surgeon I was
working with just lost it
he made the nurses go out into the night
and search for flaw he even offered to
pay for the drugs himself but flan did
not return and the next day I learned
that he had died that night just steps
away from the hospital gate the surgeon
I got to know that night was dr. Elson a
visiting surgeon from madagascar there
was something special about Elson he had
worked in rural Africa for years and in
a context where there’s almost no health
insurance and no comprehensive
state-funded health care patients being
turned away by a hospital sadly is a
common reality and in fact stories like
florence happen so many times every day
in Africa but Elson was a man who would
not accept a single patient going
without the care they needed well since
vision was to return to Madagascar and
open a hospital for the poor where no
one would be turned away now you might
think of Madagascar as you know
animation movies or amazing wildlife but
there is another side to Madagascar and
that is that 93% of the population lives
below the poverty line in the remote
south of the island Elson and his wife
converted an old rice mill into a
hospital children would fetch water from
outside the village and sell it to the
hospital and electricity would come from
a small generator that would regularly
break this was the only surgical
hospital within 150 kilometers
area for roughly 1 million people
referrals were out of the question
because of the distances and during the
rainy season the hospital would be cut
off for weeks at a time when roads would
turn into streams and mud holes would
become insurmountable obstacles but
patients came soon the hospital was
working at its capacity and patients
would be sleeping everywhere outside on
the hospital grounds every hour of every
day
Elson was uncalled for emergencies his
wife standing next to him holding a
torch for him to see when I started to
work as a doctor I spend all my holidays
at this hospital I was absolutely amazed
to see it grow at first I asked friends
and family for help and I did later we
registered as an NGO soon we had enough
money together to build a proper
hospital
it opened in 2015 it has 40 beds a staff
of 22 fully equipped operating rooms but
most importantly from the first day this
was entirely managed by a Madagascan
partners and it’s been running
successfully since and one of the
poorest regions on earth to keep itself
sustainable and self-reliant the
hospital does charge for care but one
thing was clear the story of flora must
not repeat itself so in an emergency the
hospital treats first and sorts payment
later but this part problems of its own
sometimes the hospital had to keep
patients for weeks of extra time until
the bills were paid for example ina a
young mother who had given birth to
twins she had to spend an extra three
weeks on the hospital compound for her
bill to be paid
have family during that time sold some
of the kettle her brother took the money
in cash to the hospital he paid the bill
ina could go home but to achieve this
the hospital had to waste energy and
time to keep her as a medical hostage
and again this is so common in Africa
most hospitals in a similar setting they
have a dedicated room or a dedicated
building where they keep patients until
the bills are paid another more tragic
story is that of Malala a young woman
with a life-threatening bleeding after
delivery our ambulance had arrived in
her village and wanted to take her to
the hospital but her father stepped in a
way refusing to let her go why well the
last time someone from his family had
been to hospital he was shocked by the
bill all sorts of unexpected fees and
side payments he didn’t understand he
felt cheated by the hospital and that
brought his family close to ruin so
maybe this time they could have averted
the treatment but they weren’t willing
to take the risk
so when hospitals have the power to set
prices or deny treatment then patients
are the weakest link in the chain we
never knew what happened to Malala but
whether it rattling with seed source of
problems a huge change was creeping up
on us all right and I need your
participation now I would love to know
who of you in this room does not have a
bank account can you raise your arm
please so not have a bank account
no one Wow so to put this in perspective
99%
of Germans have a bank account all of
you seem to have one so I would like you
to think for a minute how life would be
like without one
how would you receive your salary how
would you pay your electricity bill
how would you save well not having a
bank account is normal for most Africans
fewer than 5% of Madagascar’s have a
bank account and that’s because the
small savings of the poor are just not
worth the bank’s effort to offer them
accounts all for health insurance to
offer them policies so when we started
working seven years ago this is what a
bank transferred looked like in
Madagascar the hospital had to hire an
armed guard who would take a bag full of
cash
go into the car and drive for 200
kilometres to paid into the bank account
but since then something absolutely
dramatic has happened every town and
every village in Madagascar and that’s
placed is so remote you can have a hard
time finding even a single plastic bag
there now connected to the outside world
with a mobile phone tower more than half
of Madagascar’s have a phone and there’s
a million new users each year and in the
footsteps of this revolution has
followed mobile money now mobile money
allows you to send money from one phone
to the other without the need for a bank
account you can deposit money the same
way that you charge up with phone credit
so with a simple scratch card it’s safe
it’s easy transferring money it takes
just some seconds and millions of
ordinary Africans use it every day
to receive the salary to send money to
loved ones I actually have it in my
pocket how it goes on okay
it’s not a text it’s not a text it’s not
it’s something different it’s something
different it’s it’s the real thing this
is the real thing
so the Mobile Money thing is so easy you
don’t need internet to do that it’s like
sending an SMS and it’s so useful that
it spread extraordinarily fast and this
is the real thing because when I asked
Elson if his hospital had received any
funds with mobile money his answer was
yes they got half their revenue in 2017
over this phone so while we were
thinking about how we could finance
healthcare by supporting hospitals this
technology was developing that gave
people unprecedented control of their
finances and that shifted our thinking
could we instead support patients to pay
for their care could we help patients
like flora ina and Malala now in a cash
economy saving money is risky if you
have money under your bed I can get
stolen if you have a large investment
like farmland that can only be sold in
one piece so let’s imagine a health
savings account on your phone a health
wallet this works exactly like mobile
money but with the crucial exception
that money can only be spent at
registered clinics and there is no way
for you to take it out spend it on other
things
take it out in cash you know send it to
your loved ones go to the pub so you
know it’s there for when you need it
most
let’s take it a step further a
government an NGO or people like you or
me or a patient’s family they can all
send money to the health wallet and be
sure it can only be used for healthcare
money can also be restricted to specific
procedures like checkups during
pregnancy or HIV treatment and if there
are several registered clinics in an
area it’s the patients that can choose
the one that gives the best care because
ultimately it’s them carrying the money
funds can also be used to top-up savings
if a certain amount has been deposited
so to encourage people to save for
healthcare but crucially the health
wallet helps to make payments more
transparent and to reduce the risk for
corruption how does that work the health
wallet provider agrees on fixed prices
with the clinics so the patient’s know
in advance how much they need to pay and
in order to get their money the
hospitals need to register the treatment
and the bill and that very much reduces
the opportunity for corrupt hospital
staff to extract extra charges so many
of these ideas are really being
pioneered in other African countries but
how would that have helped our patients
now Florence family they would have had
an emergency savings account that’s
excessively accessible immediately for
ina she could have send the money in a
matter of minutes
saving her a three-week-long stay at the
hospital
and malala’s father he wouldn’t have had
to be afraid of these unpredictable or
illegitimate fees earlier this year we
we took this idea to the Madagascan
government Friday night we were sitting
down with the Deputy Minister of Health
at his office he was very tired leaning
back in his chair but when he heard
about the health wallet he did like this
and then and he said I smell it I smell
it he jumped up he opened the doors to
the to his colleagues who were still
there in a Friday at 8:00 everyone came
in and right there and then they started
a commission a working group that is now
working with us to pilot the health
wallet in Madagascar later this year and
if that’s going to work the health
wallet will become an integral part for
the Madagascan health care system and
it’s a country of twenty four million
people
so our dream is that one day everyone in
Madagascar will get care when they need
it and that’s regardless of their income
but that might not happen in a way we
expect Africa is not just catching up
with the West Africa is using new
technologies to find completely
different solutions to the problems
modern societies face if we can listen
to the way Africa is changing and we’re
prepared to change our thinking then we
have a unique opportunity right now to
transform healthcare in Africa and to
make sure that cases like phones do not
happen again thank you
[Applause]
[Music]
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