28 April 2021

A digital health wallet for people without insurance


More than 1 billion people in low- and middle-income countries lack access to primary health care, mainly due to inadequate safety nets. Doctors from the Department of Neurology at Charité – Universitätsmedizin Berlin have created a digital solution to this problem and have now launched the company mTOMADY with the help of the Digital Health Accelerator program of the Berlin Institute of Health (BIH) at Charité. Users of the service can securely and efficiently send, save, and spend funds for medical treatments via a mobile phone-based system. The mTOMADY health platform was initially rolled out in Madagascar, with other African countries to follow.

For many years now, two junior physicians in the Department of Neurology at Charité – Universitätsmedizin Berlin, Dr. Julius Emmrich and Dr. Samuel Knauß, have been volunteering in developing countries such as Madagascar. Some 93 percent of the population of this island nation lives below the poverty line and less than five percent of Malagasy citizens have a bank account. As a result of these conditions, the doctors have witnessed their fair share of distressing moments during their volunteer work. “For example, a patient who had been seriously injured in a car accident died because his family could not afford to pay for the treatment in advance,” Knauß recounts. And Julius Emmrich recalls: “We often saw seriously ill or injured patients refuse to go to the hospital for fear of the high cost of care.”

Mobile money for healthcare

In recent years, Madagascar has made significant progress in terms of digitalization and large parts of the country have been fitted with mobile phone masts, which means that even the most remote areas now have mobile coverage. More than half of Madagascar’s population has a mobile phone, and more than one million new users are added every year. This increasing digitalization has spurred an enormous boom in mobile money, which involves transferring funds securely via mobile networks from one user to another in much the same way as a text message. 

The challenging conditions in the healthcare system that Emmrich and Knauß encountered in their work, along with the digital strides made by Madagascar, gave them the idea to create a health platform called mTOMADY, which means “strong and healthy” in Malagasy. mTOMADY works like a digital health wallet. To use the service, all you need is a SIM card that connects you to a local mobile phone network. Cash can be converted into mobile money at mobile cash points, which can be found on almost every street corner in Madagascar. Users can efficiently and securely transfer funds via the mobile money system to an account reserved for medical expenses.  

A special feature of mTOMADY is that the money loaded onto the health account can be used exclusively to pay for healthcare services. This ensures that users build up a financial cushion for emergencies or unforeseen expenses due to illness or accidents, which can save lives in critical situations. In addition, users can enroll in health insurance through the platform. Donations can also be made to a digital donation platform from which all mTOMADY members benefit.

BIH Digital Health Accelerator gives support

Julius Emmrich and Samuel Knauss are both participants in the Digital Clinician Scientist Program of Charité and the BIH, which has allowed them to develop mTOMADY during their residency training as neurologists. The BIH’s Digital Health Accelerator provided around €1 million in funding to the project from July 2018 to December 2020. It supported the team with mentoring from experienced experts in areas such as mobile technology, software development, product development and health insurance, and helped plan and prepare for the spin-off, which was completed in December 2020 with the founding of mTOMADY gGmbH.

“We are thrilled that through our support for mTOMADY a digital health solution is now available for developing countries to deploy, and that we are thus able to contribute to social value creation in local communities,” says Thomas Gazlig, head of BIH Innovations, the joint technology transfer office of Charité and the BIH. In January 2020, mTOMADY was an award winner in the Global Health Hub Germany’s “New Ideas for Global Health” innovation contest. The Malagasy Ministry of Health is currently working with mTOMADY to make the mTOMADY health wallet an integral part of the country’s healthcare delivery system.

Initial focus was on helping pregnant women

mTOMADY began by supporting pregnant women in Madagascar’s central highlands. “Madagascar has high rates of maternal and infant mortality, and few births are attended by a healthcare professional,” says Julius Emmrich in explaining the choice. Samuel Knauß adds: “Helping pregnant women first lays an important foundation for the country’s future.” mTOMADY has since opened up the service to other groups of patients. Emmrich and Knauß are also in the process of integrating several local insurance companies into the health platform, which will boost the efficiency of the service and give patients an even broader range of support. The mTOMADY team today includes staff from nine different countries, and plans are in the works to expand the service to Ghana and Uganda.