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