While the COVID-19 pandemic has shrouded much of the world’s memory of recent public health crises, the PHB engagement in Sierra Leone to help battle the Ebola outbreak of 2013 comes vividly in our mind once again.

Ebola appeared in Guinea’s remote forest and spread rapidly to neighbouring Liberia and Sierra Leone in late 2013. The West African Ebola epidemic claimed 11,000 lives and managed to leave a deep social stigma scar before science contained it in 2016.

Amid the ongoing health crisis, we were called upon to help make a difference with what we do best – digital innovations. We know that our work creates an impact – but seldom has it had the urgency of being in the thick of the Ebola crisis in Sierra Leone. As the world deals with current humanitarian and health challenges, our Ebola response experience is another reminder of how co-operation, dedication and innovation can solve complex problems, even in the most challenging circumstances.

Our Founding Partner, Philippe Breul, recalls, “It was incredibly satisfying and humbling to have been a part of the team that delivered the impactful solution of designing a digital payment solution to protect Ebola health workers at that time.” In the face of this public health crisis, the Sierra Leone government and international agencies scrambled to ramp up Ebola response workers across the country in the hope of containing the spread and providing respite to the infected population.

As the health crisis worsened, so did the plight of the healthcare workers. The very people who cared for the sick and infected also had to struggle for their own livelihoods. Despite their risk, the salary did not reach the healthcare workers on time due to the persistent logistical challenge of moving cash – thereby leaving them and their dependants increasingly vulnerable.

The cash-based system, prone to indiscriminate corruption, became the biggest impediment to paying healthcare workers on time. Late and incorrect payments fueled the frustrations among these vital response workers. Ultimately they resorted to staging strikes and walk-outs to demand full and timely payment. To contain the Ebola health crisis, the government had to win the frontline workers’ hearts and minds, which necessitated a better payment mechanism.

PHB, as part of the response team, had to precisely identify ways to digitize cash-based payments to serve people providing critical healthcare on the frontlines of the Ebola battle. Coordinating with the government, NGOs, and donor community was needed to overcome the first monumental task – the creation of a registry of Ebola response workers. Lorisa Canillas, working with PHB and UNDP in partnership with the Dutch consultancy Ayani, supported creating such a master payment database.

Beginning with the paper-based registry, verifying the worker’s authenticity onsite and digitizing the record with a photo and a fingerprint for biometric verification required significant efforts, especially when it had to be carried out at many locations across the country. The team working with iDT labs, a local fintech startup, worked tirelessly for several months developing a digital payment system which delivered 30,000 response workers payment directly to their mobile phones, or to bank accounts for those who had them.

The transition to a digital payments process is estimated to have avoided the loss of over 800 working days during the Ebola response, by stopping response workers’ pay strikes, and cutting out corrupt go-betweens and long queues for workers to collect cash payments. Payments that used to take more than a month were delivered in just one week.

The Better Than Cash Alliance (BTCA) evaluated the impact of the project and established that it saved the lives of many front line workers and USD 10 million by eliminating fraud and duplicate payments while reducing logistical costs of travel associated with cash.

Covid-19 reminds us of the vital role of healthcare professionals and frontline workers in keeping us all safe. In developing countries, healthcare workers are often underpaid or not paid on time. Working together with our partners to streamline and digitize payments, we have seen the potential to realize these benefits for healthcare workers. Knowing that they are well cared for, assures that we can all be cared for well.

Photos: Courtesy of Annie Spratt