MOBILE MONEY USAGE TOWARDS RURAL HOUSEHOLDS’ ABILITY TO ACCESS MEDICAL SERVICES. A CASE OF MAZOWE RURAL HOUSEHOLDS, MASHONALAND CENTRAL, ZIMBABWE

Abstract

ABSTRACT Research Title: Mobile money usage towards rural households’ ability to access medical services. A case of Mazowe rural households, Mashonaland central, Zimbabwe. Name of Researcher: Gorejena Adrian Name of Supervisor: Dr. Timely Chitate Date Completed: November 2019 Statement of Problem Zimbabwe has been facing cash shortages at a time when a lot of people especially in the rural areas are unbanked. Shortage of cash has become a hindrance to most rural households to access some of the basic needs such as health services and education (Diza, Munyanyi, & Gumbo, 2017). According to United Nations (2014), the economic downturn in Zimbabwe caused profound disintegration in the national health system, with the state failing to maintain the extensive medical structure, and health costs shifted to the users of services, leaving a large proportion of the general population with less or no access to health services. The introduction of mobile money by financial institutions has come in as another channel to support convenience in accessing various critical services / basic needs (GSMA , 2015). Other studies have seen an increase in mobile money user empowerment and bringing positive effects on households’ welfare, to name a few. However, there is limited empirical evidence from previous researches on the extent of mobile money usage and the rural households’ ability to access critical services. Therefore, this study is designed to determine the extent mobile money usage has helped rural household’s ability to access medical services in Mazowe Rural District, Zimbabwe. Research Methodology This research sought to study the extent of mobile money usage towards rural households’ ability to access medical services in Zimbabwe. A quantitative research where a sample of 250 households out of a population of 4,580 households in Mazowe Rural District was used. The researcher used stratified random sampling to identify respondents. A questionnaire with a 5-point Lirket scale was used for the research. The questionnaire was tested for reliability and validity prior to distribution and a Cronbach Alpha of 0.823 was obtained. Two hundred and fifty questionnaires were distributed and collected for analysis. A Statistical Package (SPSS) version 23 was used to analyse the responses. Findings of the Study The following were the key findings of the study; 1. The research findings revealed that households in Mazowe Rural District at the time of this research were able to access medical services using mobile money, but to an average extent. This was evidenced by a mean score of 3.2392 (SD=.80134) with a standard deviation showing homogeneity in responses. This result implies mobile money usage has not been a popular conduit for medical service access in Rural Mazowe District. 2. Network coverage scored an average mean score of 3.4312 (SD=0.61948) meaning network coverage cause households in Mazowe Rural District to access medical services using mobile money to an average extent. The average mean score implies that network provision or service is a challenge on medical service access using mobile money and there was homogeneity in responses. 3. The extent to which tech-serve promotion influence households to access medical services using mobile money in Mazowe Rural District is of average extent as shown by an average mean score of 3.1799 (SD=0.70579). The standard deviation of 0.70579 revealed that there is homogeneity in responses. The finding suggests that in Zimbabwe mobile money usage has not been promoted at national level. 4. Transaction cost hinder access to medical services using mobile money to an average extent as evidenced by the mean score of 3.1472 (SD=0.57506) and there was homogineity in responses. This result implies transaction cost of using Ecocsh, OneMoney or Telecash is still a barrier to hoseholds in Mazowe Rural District to use mobile money to access medical services. 5. The results of social influence towards medical service access by the Mazowe Rural District Households scored an average mean score of 3.0640 (SD=0.67160), it is clear that social influence affects medical access by Mazowe households to an average extent, this too, with homogeneity in response as evidenced by the standard deviation of 0.67160. 6. The study established that individual characteristic has an average mean score of 3.3220 (SD=0.66111). This means the individual characteristic influence on households to access medical services using mobile money in Mazowe Rural District is of average extent. Homogeneity in their response is noticed. The average score implies platforms for electronic money transfer such as ecocash, onemoney and telecash offered by mobile network operators were useful and convenient but they did not totally replace the need for physical cash attitude. 7. After preliminary analysis to ensure no violation of normality, linearity and homoscedasticity, findings show 4 out of 5 independent variables (Tech-serve promotion, Transaction Cost, Social Influence and Individual Characteristic) have significant positive relationships with medical services access as evidenced by [r=.321, n=250, p<.01], [r=.132, n=250, p<.05], [r=.209, n=250, p<.01] and [r=.315, n=250, p<.01], respectively. This means mobile money usage has a positive significant correlation with medical service access at 95% confidence level. Network coverage [r=.021, n=250, p>.05] is found to have no significant relationship with medical services access. 8. The research findings established tech-serve promotion as strongest predictor of medical service access as evidenced by a 1 point increase in awareness of mobile money usage is associated with a 0.340 point increase in overall medical service access. This didn’t come as a surprise to the researcher given that the Zimbabwean market is characterized by information asymmetry. However, a weak beta value implies there are other factors which are more important to the respondents but beyond the scope of this study and they require further interrogation. 9. The null hypothesis stating that mobile money usage has no impact on medical service access by households in Mazowe Rural District was only accepted by 1 out of the 5 independent variables. Network coverage was the only independent variable with lower than the normal medical service access score of 3.5, as evidenced by mean score of (3.4312 ± 0.61948) a statistically insignificant difference of 0.06880 (95% CI, 0.0084 to 0.1460), t(249) = -1.756, p=.080. Therefore the hypothesis is rejected and the alternate hypothesis which states that mobile money usage has a significant influence on medical services access by households in Mazowe Rural District is accepted. Conclusions In conclusion, the study sought to assess the extent of mobile money usage towards medical services access by households in Mazowe Rural District. The study revealed that the degree of medical services access using mobile money by households in Mazowe Rural District is average. This was evidenced by a mean score of 3.2392 (SD=.80134) with a standard deviation showing homogeneity in responses. This result implies mobile money usage has not been a popular conduit for medical service access in Rural Mazowe District. The extent to which network coverage, tech-serve promotion, transaction cost, social influence and individual characteristic influence households to access medical services using mobile money in Mazowe Rural District is of average extent as shown by their average mean score of 3.4312 (SD=0.61948), 3.1799 (SD=0.70579), 3.1472 (SD=0.57506), 3.0640 (SD=0.67160 and3.3220 (SD=0.66111), respectively. Their standard deviation revealed that there is homogeneity in responses. The finding suggests that in Zimbabwe mobile money usage has not been promoted at national level. On the relationship between mobile money usage and medical services access, the researcher concluded that there is a positive significant relationship between the two variables. That is an increase in mobile money usage, medical services access using mobile money also increases. However, the weak link suggest need for a study to fully establish the reasons why there is low uptake of medical services access using mobile money given that mobile money is coming in as an additional payment service to already existing ones, this was outside the scope of this study. The study established tech-serve promotion as the best predictor of medical service access where by a 1 point increase in awareness of mobile money usage is associated with a 0.340 point increase in overall medical service access. However, a weak beta value implies they are other factors which are more important to the respondents which require further interrogation. The variables (network coverage and transaction cost) were excluded in the model as they were identified to be insignificant and it implies technical issues have not fully establish a relationship that is strong at 95% confidence level. The null hypothesis stating that mobile money usage has no significant influence on medical service access by households in Mazowe Rural District was only accepted by 1 out of the 5 mobile money usage factors. Therefore the alternate hypothesis which states that mobile money usage has a significant influence on medical services access by households in Mazowe Rural District is accepted. Recommendations Based on the research findings, the study recommends the following action plans for various stakeholders for the betterment of medical service access in rural areas of Zimbabwe. The recommendations are deduced from the interpretation and analysis of evidence from this research and are directed to the mobile network operator (MNO), Banks, government and regulators. Network coverage registered average access to medical service, a rather disturbing scenario. If Zimbabwe, rural communities specifically, is to benefit from the emerging digital innovations, the researcher recommends an urgent need to have the appropriate infrastructure in place by MNO, and investment in low‐cost rural networks in order to provide a potential solution. Government as regulator must promote more usage of mobile money through offering tax rebates on investments that helps sustainable developments especially in marginalized areas. Tech-serve promotion (awareness) is an important factor of mobile money usage in rural areas. There is need for financial education programmes by MNO and banks aimed at enhancing people’s understanding of mobile money is critical in promoting increased usage to access medical services among the financially excluded segments of the population. For instance EcoCash can introduce training and sensitization on awareness of services offered in the m-money service resulting in sustainable utilisation of the service package. Transaction cost hinder access to medical services using mobile money to an average extent. The affordability of mobile money by most rural people that are often excluded from the formal financial sector makes mobile money ideal to meet their needs. Therefore the researcher recommends further reduction in transaction costs by MNO and banks. Government can also enforce regulations on the pricing of mobile money transactions to ensure usability of services. Individual characteristic influence to medical access using mobile money registered average influence. Given that mobile money is now being used by less educated people, it therefore calls for re-designing mobile money applications by MNO and Banks in a manner that can be used even by the less educated. As mobile money ecosystems continue to develop, more opportunities of integrating mobile money into health applications. This makes a good case to call Zimbabwean government to come up with policies that promote usage of mobile money services at national level. Therefore, the researcher recommend Government through Ministry of Health and private hospitals to come up with a research fund such that these kind of studies can be expanded to other provinces then make a comparison. Recommendation for Further Studies The study has mainly described the impact of mobile money usage and rural households’ ability to access medical services in Mazowe Rural District. However, by the design and aim of the study, there is need to further; 1. There is need of further research to find out government rules and regulation in place to assist the rural dwellers access health especially using mobile money – for example mandate giants like Econet to ensure network coverage in rural areas and government can help by giving the mandated providers loans to ensure it happens. 2. There is need for a study to fully establish the reasons why there is low uptake of medical services using mobile money given that mobile money is coming in as an additional payment service to already existing ones. 3. This was a cross-sectional survey, where responses to the variable studied were collected at the same point in time. Therefore, individuals’ perceptions over challenges encountered in using mobile money may change overtime due to increased usage experience and improvements in the application itself. As a result, there is need for further research that conduct a longitudinal (panel data) research design to investigate the mobile money challenges encountered at multiple points of time during the usage process. 4. There is need for further research on how communities can develop alliance with institutions such as banks, local clinics and insurance houses so that they can be more utilisation of the mobile money in health sector. 5. A further interrogation of other factors such as cultural issues, mobile penetration rate, and ICT literacy just to mention a few is need.