Science & Tech

Enhancing health-related remittances to Zimbabwe through digital technology

By Johannes Machinya

Ndabatisa malayitsha mapiritsi amai eBP” (I gave malayitsha the BP tablets for mother). “I will send [the groceries] with malayitsha at the end of the month.” “Is your malayitsha reliable, I want to send my things home?” “How much does [the] malayitsha charge [to carry] one thousand rands?” “Did malayitsha deliver all the things I sent?”

These are common refrains one hears from many Zimbabwean migrants in South Africa. The statements, often made over the phone, carry promises of remittances to expectant relatives in Zimbabwe; inquiries as migrants search for reliable and cheaper informal cross-border transporters (or malayitshas) to transport goods and money to their families; and anxieties that haunt migrants after sending their goods (or money) with the malayitshas.

For a long time, informal cross-border transporters have been important actors in the South Africa-Zimbabwe remittance corridor, couriering all sorts of goods, and money, and people as well, across the borders, providing the convenience of door-to-door delivery even in remote villages, and enabling ‘unbanked’ migrants to also support their families in Zimbabwe. However, this way of remittance transfer has remained highly unreliable, costly, with long delays and high risks of loss.

Remittances are a lifeline for households whereby a significant share is used to cover health-related costs. Migrants also send health-related remittances through the malayitshas. But the risks and costs associated with this informal remittance transfer jeopardise the transformative potential of health-related remittances.

The story of Precious (not her real name), an undocumented Zimbabwean working as a domestic worker, illustrates this. Precious received a WhatsApp message from her younger sister who is staying with her mother in rural Zimbabwe, “[Our] Mother is not feeling well, we need money to take her to the doctor.” Precious texted back, “I will send the money at the end of the month with malayitsha.”

Month-end, Precious buys groceries and a teddy bear. She stuffs the money for her mother’s medical care inside the teddy bear, a trick, of course not unbeknown to the malayitshas, used by many Zimbabweans to avoid paying malayitshas for transporting money because carrying money is charged separately from the luggage. Malayitshas usually charge an exorbitant flat rate of 20% for the delivery of money to Zimbabwe. Precious then perfectly packs her groceries and the teddy bear in a large bag which she then takes to the collection point to give to the malayitsha.

Before loading the bags into the trailer, the malayitsha unpacks all the bags in the presence of the sender and together they count the items being send to Zimbabwe to determine the charge. While doing this, the malayitsha keeps asking his clients if there is no money hidden in the groceries as he will not be liable for the loss of any undeclared things.

Deceitfully, Precious denies that she hid any money in her bag. After counting and putting all her items back in the bag, the malayitsha wraps the bag with a plastic wrapper and marks it with a permanent marker “PRECIOUS TIRIVANHU.”

Usually, it takes 48 hours for the malayitsha to cross into Zimbabwe. All this time, Precious is asking for an update from the malayitsha, “Where are you now?” “How is the border?” “When do you expect to deliver my bag?”

To her sister who will receive the bag in Zimbabwe, Precious gives the list of contents in the bag.

On the third day, she receives a WhatsApp message from her sister that the bag had been delivered but the teddy bear is missing. Distraught, because she knows she would never recover the money, Precious asks the malayitsha about the missing teddy bear. The malayitsha profusely apologises and tells her that the bags were opened at the border by the Zimbabwe Revenue Authority (Zimra) officials, and he suspects that is when he might have misplaced the teddy bear. He then offers to replace the teddy bear. But Precious had lost more than just a teddy bear; she lost the money meant to pay for her mother’s medical checkup and her mother fails to receive the treatment she desperately required.

Remittances and healthcare

Zimbabwe’s public healthcare system has collapsed following years of corruption and underfunding dating back to the late 1990s. There have been acute shortages of medical supplies in public healthcare facilities.

Reduced fiscal support in Zimbabwe’s public healthcare sector forces citizens to out-of-pocket heath expenditure. Even for those citizens with health insurance, rising inflation also forces them to make additional payments out of their pockets.

On the other end, private healthcare facilities demand foreign currency payments for provision of healthcare services.

These challenges have made it difficult for citizens to access and utilise healthcare services.

In such a context of collapsed public healthcare and unaffordable private healthcare, the diaspora community becomes a significant source of economic support through remittances. People in situations of need, like Precious’ mother, then look up to their relatives in the diaspora for health-related remittances.

With millions of Zimbabweans estimated to be living outside their country, remittance flows into Zimbabwe are a vital artery pumping life into the country’s ailing economy. Previous research showed that more than 50 per cent of urban households in Zimbabwe depend on migrant remittances for everyday consumables, including health.

Remittances, particularly direct person-to-person cash transfers, can be problematic, though. While direct cash transfers have been applauded for their potential to spur socioeconomic transformation, Ana Escalante, writing on NextBillion, contends that they are prone to misuse. One version of misuse is that family members back home can use the money for other things as the story of James shows.

James lives in the United States. He receives a WhatsApp call from his elder sister informing him that his brother-in-law (his sister’s husband) had an inguinal hernia and the doctor had advised that he urgently undergoes hernia surgery. They had a medical insurance with Premier Service Medical Aid Society (PSMAS). The medical aid only covers for the doctor’s consultations and excludes surgery which costs about US$300. James is touched after hearing how his brother-in-law is wreathing in pain and the following day, he sends his sister the money through MoneyGram.

Every day, James calls his sister to hear how the surgery went, but every day his sister gives an excuse, “The doctor was not there today”, “There was no electricity”, “We were told to come next week”, until he gets tired of asking. He later discovers that his brother-in-law did not go for the surgery; together with his sister, they just used the money for something else. Feeling betrayed, he vows to never assist them with money again.

With cash-to-cash transfers prone to misuse, ‘purposed’ remittances, those that are earmarked for a particular purpose, as Bal Joshi notes, deliver greater socioeconomic impact because they are directly turned into the value for which they are intended.

EasyHealth and ‘purposed’ remittances

EasyHealth is a digital remittance platform that facilitates the flow of ‘purposed’ health-related remittances to Zimbabwe.

EasyHealth targets Zimbabweans scattered across the world, who, according to the country’s Minister of Finance, Mthuli Ncube, sent over US$1 billion in 2020, the highest ever contribution made to the local economy, surpassing foreign aid to Zimbabwe. Part of these remittances are invested in the health of family members.

The EasyHealth platform connects Zimbabweans outside of the country with various private healthcare service providers in Zimbabwe like doctors, nurses, pharmacists, etc.

The service providers register on the platform’s mobile or web-based application. But before registering, they must provide required information for examination of the authenticity of their certification. Once this has been ascertained, the service providers then provide a catalogue of the services and products they offer, the prices they charge, their location in Zimbabwe, as well as operating times.

This makes the EasyHealth platform a transnational medical space or digital marketplace – a value transfer space – for medical products and services.

People living outside of Zimbabwe also register on the platform as sponsors. They can navigate the platform searching for the medical practitioners or medical products matching their needs and can remotely purchase the medical goods and services for delivery in Zimbabwe.

For prescribed medication, the sponsors must upload electronic prescriptions to the system and will see the cost of the medication from the different medical facilities or service providers on the platform.

When completing transactions on the EasyHealth platform, the sponsors provide the details of the recipients, or dependents: name, address, phone number. They can also select whether they prefer the products to be delivered at home to the recipient or for the recipient to pick in person at the facility or service provider. They also do the same when paying for a medical checkup; they select whether the dependent should be picked from home, or they can go on their own to the medical facility. Of course, this can only be done within a certain prescribed radius.

The sponsor then proceeds to make payment for the services their dependent in Zimbabwe requires. Once payment is confirmed, all the parties are notified: the sponsor, the service provider, and the dependent.

If the services paid for by the sponsor involve any medical examination or procedure, the medical practitioner is required to provide a summary of what has been done on the dependent as well as some recommendations. The details of the clinical report can be availed to the sponsor only with the consent of the dependent. No consent, no sharing!

The platform keeps a traceable medical history of the patient.

A major concern for many remittance senders is whether receivers will use the remittances for their intended purpose. EasyHealth gives the remittance sender more control over the use of the remittance, thus lowering opportunities for waste and misuse. It dramatically lowers the cost for senders and receivers. For example, instead of sending US$100 through money transfer operators such as Western Union, MoneyGram, or, which charge around 10 per cent of the sent amount, or through malayitshas in the case of people in South Africa, who charge 20 per cent of the sent amount, EasyHealth allows the sponsor to pay directly to the medical provider. This increases the buying power of the remittance. It also removes the cumbersome hurdles often encountered by recipients of cash-based remittances when they travel to pick up the money or queue to pay healthcare costs.

So far, about 1176 Zimbabweans living outside of the country use the EasyHealth platform to pay for the medical services of their loved ones in Zimbabwe and 247 medical practitioners have registered.

Research from other remittance-based economies, particularly in East Asia, has shown that the misuse of cash remittances breeds mistrust and strains the relations between remittance senders and recipients, which in the long run may adversely affect the volume of remittance flows.

EasyHealth typically swings the control dynamics of the remittance process in favor of the sponsors. The implicit show of mistrust that is implied in the bypassing of recipients may disturb the sociocultural values in the sponsor-dependent relations, causing tension which may affect the flow of remittances. Nonetheless, in this piece, I present a techno-optimist perspective of how digital technology is transforming the flow of health-related remittances in a way that not only reduces the cost of remitting, or increases the speed at which remittances flow, but, most importantly, gives remitters more control over how remittances are used, which consequently increases the value and socioeconomic transformation potential of the remittances.

In the final analysis, with the merits that EasyHealth avails in the remittance market, and given that approximately 60 percent of cash remittances are spent on consumption goods (e.g., food, basic household items) it seems like a noble idea to expand digital remittance platforms and the purposed remittance model to other investment goods in order to make optimal use of the remittances. ■

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