Salama Mateza
What the project is about
Access to health care as a human right is still not guaranteed for many farmers. To achieve the goal of Universal Health Coverage (UHC) by 2030, health systems need to become more resilient and sustainable. In Madagascar, many people do not have access to health care because it is very expensive. Smallholder farmers in particular are excluded from comprehensive health insurance.
Through the digital platform mTOMADY, which connects beneficiaries to different health financing mechanisms, project partners have been able to contribute financially to the health care of cocoa farmers - even in remote areas.
What was done
Max Felchlin AG and its customers worked with Elucid and its partner mTOMADY and the Sambirano cooperative to provide health insurance to farming families who produce cocoa for Felchlin's Madagascar couverture.
This worked as follows: Beneficiaries registered by mobile phone number or membership card, which gave them access to a digital money box and a certificate of insurance. Health providers identified beneficiaries with smartphones/tablets, submitted claims to the health insurance company and received reimbursements through the mTOMADY platform. This both improved the transparency of payments and made it easier to track utilisation and thus identify the need for health services. Data protection remained guaranteed: The health data was only passed on in aggregated form and could not be traced back to the individual.
With this project, all farming families producing the cocoa for Felchlin’s Madagascar couverture receive access to healthcare.
880 cocoa farmers and their family members are enrolled into a local health insurance that covers up to 80 % of the healthcare costs.
The goal is to reduce benefiaries' out-of-pocket expenditures for health and thereby to combat poverty and child labour.
What the project achieved
In the Diana region of Madagascar, 880 cocoa farmers and their families were enrolled in a local health insurance scheme that covers up to 80% of health costs in participating facilities. In total, more than 8569 treatments were carried out, most of them to combat malaria, influenza or diarrhoeal diseases. In total, more than 57 families were protected from extreme poverty through the Salama Mateza project.
What lessons could be learned from the project?
At the start of Salama Mateza's implementation in May 2021, we initially relied on the local mobile network to register farming families. However, since January 2022, Elucid, together with partner mTOMADY, has significantly improved offline accessibility to meet the needs of farming families and health providers with limited access to mobile phone infrastructure. Since then, all processes run offline, including the registration of farm families and submission of disease cases. Data is stored securely until a mobile phone connection is available for uploading.
Instead of SIM cards to access health services, an alternative solution was introduced. In a collaboration between Elucid and mTOMADY, we provided all farming families with a membership card. This has streamlined access to care and eliminated the need for a phone, overcoming connectivity and trust barriers in these communities.
“The program encouraged me to visit the hospital when I was sick and not stay home. Without this, my child would not have been born.”
Interview with Mirko Schneckenburger, Head of Marketing & Communications at Max Felchlin AG
Mirko Schneckenburger, to what extent were the approaches of the project new and innovative?
The Salama Mateza project provided financial access to health care for the first time in remote communities in northern Madagascar thanks to the existing mobile infrastructure. Thanks to the network of local staff and health workers, barriers to financing and infrastructure were reduced. A real-time impact dashboard tracked health service utilisation, disease prevalence and expenditure for beneficiaries. At the same time, an up-to-date database on farms was made available. This improved data quality. In addition, the incentive of health care strengthened the farmers' ties to local enterprises.
What has Max Felchlin AG learned from the project?
We in Europe usually take functioning health care for granted. This is quite different in Madagascar, where the cost of treatment often threatens the very existence of the people. This new form of support quickly met with broad acceptance and the project can be described as extremely successful. We have learned that investing in health insurance generally improves the living situation of the local population because this huge cost item can be reduced considerably.
What do you recommend to other actors who implement similar projects?
One challenge is certainly the geographical distance and the fact that our understanding of health care and the associated processes are very different from those in the country of origin. It is worthwhile to make sufficient time and resources available and to see for yourself on-site. This is particularly helpful for our own understanding of the situation and for any communication.
How was it ensured that the successes would have a long-term effect?
Max Felchlin AG's goal was to make the project financially independent within six years. Due to the positive progress, we achieved it after only two years. Since our partner organisation Sambirano SA has launched another project, "Salama Jiaby" (Health for All), to enable more people, especially the elderly, to have access to health insurance, it was decided to continue both projects under one roof in mid-2023.
The project partners and SWISSCO welcome this step, as it is important that such projects are lived and supported locally. The flow of information and transparency remain guaranteed, and Max Felchlin AG and Sambirano SA will continue to work closely together to initiate further successful projects. The experience gained will also serve to implement similar commitments in the cocoa-growing regions of Ghana.
Organisations involved
