Case Study 9: D-tree Tanzania

The program currently has 208 trained traditional birth attendants (TBAs) and community health workers (CHWs) who serve a network of 4,500 women who have enrolled in the program. TBAs in Zanzibar are typically paid to assist deliveries, creating a financial disincentive for them to refer patients to health facilities. To address this issue, D-tree launched a program in November 2011 that offers mobile-enabled clinical guides to TBAs to help them treat women and identify those who should be referred to health facilities. The program also incorporates an SMS-mobile money payment system, which incentivizes timely and appropriate referrals. TBAs conduct home visits, screen pregnant women for risk factors and danger signs, identify the need for referrals, and accompany the woman to the health facility. D-tree uses mobile money to ensure that TBAs can make prompt payment for transport to the health facility or in case of complications. As of October 2013, more than 1,720 financial transactions had been sent to TBAs to pay incentives. The program performed 781 transfers from D-tree to TBAs for emergency transport, while TBAs made more than 3,000 payments to drivers for transport to health facilities. The use of mobile money enables rapid referrals and contributes to increased rates of institutional deliveries among program beneficiaries. The program has also reduced administrative costs and improved accountability and oversight for program administration. D-tree invested in building relationships with local actors, including the Ministry of Health, district health officials, and local health institutions, to ensure buy-in and local ownership of the program. The organization provides comprehensive training to TBAs on the decision support application and the use of mobile money. D-tree also offers a cash payment option for community health workers, as some TBAs initially took time to become accustomed to using mobile money. The program has seen a strong adoption of mobile money, with drivers and TBAs becoming comfortable using the system. The program has faced challenges, including integrating mobile payments with existing information technology systems. D-tree established a web-based platform that synthesizes payment information in one place, providing a running balance for each TBA through an automated system. The program has also faced challenges in measuring the impact of mobile money, as it is difficult to quantify and isolate from other program effects. However, the benefits of mobile money are significant, including reduced costs for staff time, vehicle rental, and fuel, as well as a security risk associated with cash payments that is eliminated with the use of mobile money.