Liberian Health Care Workers Transition to Mobile Money
Meet Kou, a health worker in rural Nimba County, Liberia. During the Ebola crisis, Kou took action to combat the disease, going door-to-door in her community to stop its spread. The relentless determination of Kou and her peers to rise each morning and fight back against the illness helped bring the epidemic to a halt.
Despite facing life-threatening risks performing her daily work duties, Kou wasn’t able to access her pay. To pick up her salary she had to travel a far distance from her rural community to the bank, but travel was restricted due to quarantines and was risky because of the prevalence of Ebola and difficult road conditions. While many of her peers protested the lack of pay through boycotts, Kou continued working towards saving her country.
To increase efficiency of payments, FHI 360’s Mobile Solutions Technical Assistance and Research (mSTAR) Project, funded by USAID, is working with Liberia’s Ministry of Health (MOH) to offer mobile money salary payments. This gives health workers the option to receive their salaries from mobile money agents who are often closer and more convenient than banks.
Kou spends a shocking amount of her salary on collecting her salary. Her monthly net income is LD 14,300 (USD $146) of which she spends LD 800 on transportation to the bank to retrieve her salary. At the bank, she is frequently told that the bank “system is down” and is forced to wait until the money is accessible, sometimes for several days. During this time not only is Kou missing work, but she’s also racking up costs. She spends LD 100 round trip to her relative’s house where she can sleep, LD 150 on food, and LD 100 on a phone card to inform her family of the delay. At the bank, Kou waits in line for four hours and then pays LD 300 in bribes to finally pick up her salary. When she receives the cash it is LD 13,200 (USD $135) instead of the LD 14,300 that she expected. The bank can only offer the explanation that this is what was deposited and Kou has no access to a paystub explaining the additional deductions. After spending another LD 800 to return home, Kou is left with LD 10,950, only 77% of her salary.
mSTAR first worked with Liberia’s Ministry of Education to roll out mobile money salary payments for teachers. The mSTAR team faced questions and challenges during the rollout, such as cash availability (liquidity) and participant targeting. When mSTAR began to plan for rolling out MOH salary payments, the team did not assume that the challenges for health workers would mirror those in education. To gain a clear understanding of health payment systems, use of mobile technology, and health worker attitudes and trust in the government, mSTAR and the MOH completed two related analyses: Liberian Health Workers and Mobile Money: An Ethnography and A Contextual Analysis of Payment Disbursements for Liberian Health Workers. The ethnography describes the experiences and attitudes of health workers in Liberia with regards to mobile phone usage and salary disbursement, while the Contextual Analysis explores the cultural, social, and environmental context of payment disbursements. The research was done by the mSTAR team and 10 researchers across five counties who conducted direct observation, focus group discussions, and key informant interviews.
Some of the findings confirmed what was already known—that health workers spend a relatively large portion of their salaries and a significant amount of time away from their jobs and families to collect monthly pay. The reports confirmed widely held assumptions, like the lack of trust health workers felt towards their employer because of inconsistent deductions and unreliable frequency of payments.
The reports also unearthed new, surprising findings that will impact the project’s rollout. For example, a majority of health workers that participated in the study already use mobile money. They are sending remittances to family for child care, school fees and as unexpected expenses arise. In some cases, mobile money is even used to pay bills or pay the school for fees directly.
Kou doesn’t like the current system through which she receives her salary, but she is still skeptical of the new and unfamiliar mobile money system. mSTAR’s comprehensive look at Kou’s and her peers’ patterns allows mSTAR’s team to frame mobile money in a context Kou understands and build trust in the system by relating it to health workers’ current needs.
With this targeted method, Kou will better understand the system and will be more likely to enroll in mobile money payments, which will enable her to collect her salary while avoiding unnecessary travel away from home and expenses. Most importantly, the mobile money approach helps keep Kou safe, and in the occurrence where traveling is dangerous in Liberia, Kou will be able to receive her salary and continue caring for her community.