Florent, 16, used to sell soap for a living. When a car crashed into his stall, severely injuring him, his family brought him to the hospital, but without enough ready cash to pay for the treatment, they were sent away. This is a common story in contexts where there is no comprehensive state-funded healthcare or insurance – but Dr. Elson, a Madagascan surgeon was determined to change this. Together with his wife he dreamed of opening a hospital for the poor in Madagascar, a country where 92% of the population lives below the poverty line.
A chance encounter with Dr. Elson changed Julius’ life forever. Inspired by Elson’s vision, Julius got together with friends and colleagues to set up an NGO, organise medical aid missions to Madagascar and built a hospital in the remote south of the island. The hospital is running successfully and largely independently, charging patients for their care. Treating first before asking for money means nobody is turned away, but some patients are held in the hospital for weeks until the bills are paid. This is so common among hospitals in Africa, that some have dedicated sections for keeping people as a kind of ‘medical hostages’. Also, hospital pricing can be highly intransparent to patients, with many opportunities for real and perceived corruption. But when hospitals have the power to set prices, the patients are the weakest link in the chain.
But here is where the story changes: In the past decade, a technological revolution has swept through Sub-Saharan Africa. Fewer than 5% of Madagascans have a bank account. But more than half now have a mobile phone. This has opened the way for the new technology of mobile money, allowing anyone to send and receive electronic payments through text message without the need for a bank account, internet access or a smartphone. Julius and his team are proposing a new way of using mobile money: to allow people to save for healthcare. Money saved in such a ‘mobile health wallet’ can only be spent at partnering clinics. The government, NGOs and relatives can send money to that account and be assured it will only be used for health purposes. Payments are transparent and traceable, reducing potential for corruption. Earlier this year, they took this idea to the Madagascan government who are excited about the idea and are supporting a pilot study in the capital. If this proves to be successful, they could scale up the ‘health wallet’ to become an integral part of the healthcare system serving 24 million Madagascans.
Julius Emmrich is working on ways to make healthcare accessible to people living in extreme poverty. He is the co-founder and chairman of Doctors for Madagascar, a charity supporting healthcare development.

In his day job he works as a neurologist and neuroscientist at the Charité – Universitätsmedizin Berlin. He is affiliated with the German Federal Institute for Risk Assessment and holds a Junior Clinician Scientist position at the Berlin Institute of Health. 

Born in Freiburg, Julius grew up next to a farm in Bavaria. He got pretty good at packing during his student years: studying medicine at the Universities of Freiburg and Leipzig, gathering data for his doctoral thesis at Mount Sinai Hospital in New York City and finally for an MPhil degree at the University of Cambridge. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx


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