Mobile cash helps patients, providers fight TB

TB CARE II in Bangladesh

Through the USAID TB Care II project, URC works in partnership with the government of Bangladesh's National Tuberculosis Programme and local nongovernmental organizations to reduce the incidence of TB and multi-drug-resistant TB (MDR-TB) and to reduce morbidity and mortality due to TB in Bangladesh. The project provides technical support to strengthen the National Tuberculosis Programme capacity for diagnosis and management of TB and MDR-TB. The project also supports a grants program through local NGOs to increase the detection and management of TB as well as to improve community awareness about the prevention, transmission, and early diagnosis and management of TB. Increasing access to diagnosis and management of MDR-TB through a community-based model is a priority focus of this project.

The project supports good nutrition for MDR-TB patients in treatment—which can take 24 months—in their communities through a small allowance, which patients use to supplement their diets. In addition, the project supports direct-observation treatment (DOT) providers, who visit their patients daily and track adherence to treatment protocols, with a small stipend for transportation and communication costs. Each TB patient receives 1,500 Bangladesh Taka (BDT), approximately USD $19, per month and each DOT provider receives BDT 1,800 (approximately USD $23) per month.[1]  At first, the project distributed these payments in person, in cash, but as the project grew and more patients and DOT providers were brought into the system of care, this process took up to a month to complete. A more efficient method of payment was needed.

Mobile banking

Electronic transactions offer a quick, convenient, secure way to get money into the hands of people who need it—if they have a mobile money account and a mobile phone. TB CARE II began to explore ways to implement a mobile solution that could handle their growing base.

The concept of mobile banking is relatively new in Bangladesh: the country introduced mobile financial services in 2011. While 74% of Bangladeshis subscribed to a mobile cellular service in 2013,[2] formal financial accounts were less common. In November, 2013, TB CARE II launched its mobile banking solution through Dutch Bangla Bank (DBBL), one of Bangladesh's largest mobile financial service providers. With the help of DBBL staff, mobile money accounts were opened for all MDR-TB patients and DOT providers with mobile phones. Individuals who did not have a SIM card were asked to purchase one in order to receive payments; participants did so without hesitation, although this may not always be the case in all circumstances.

Initial resistance to the mobile cash transfer system came from some doubtful field-level staff, who were unfamiliar with the system's reliability and effectiveness. Internal trainings were conducted by DBBL and the project's finance team at start up. Some isolated problems, such as irregular fund-transfer notifications from DBBL, created confusion for the project and beneficiaries. The project's finance team is working with DBBL to regularize the disbursement of e-statements and to ensure that the confirmation SMS is being sent with the fund transfer.

Quick, reliable, and verifiable

What once took a month to complete has been reduced to three days, at most. Project beneficiaries and providers can count on a regular allowance and project staff can now devote time once spent distributing cash to other aspects of the project. What's more, the switch to a cashless system significantly reduced complaints of funds not being received, funds being misused, and the existence of "ghost" patients—fake patients created to syphon funds. "Now we can track which patient is receiving the money and the exact time and if we have any confusion, we can easily cross-verify," explained TB CARE II's finance and administrative manager.

TB CARE II provided support to 426 patients and 312 DOT providers in Bangladesh through the mobile banking system in 2014; the system's speed and reliability ensured that they have one less thing to worry about along their journey to stop TB.





[1] Currency conversion calculated based on daily rate, February 20, 2015

[2] World Bank Data, accessed online February 20, 2015

MDR-TB patient Mohammed Helal withdraws his stipend, paid to him monthly using mobile banking services, from an ATM close to his house
MDR-TB patient Mohammed Helal withdraws his stipend, paid to him monthly using mobile banking services, from an ATM close to his house
March 03, 2015
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