A Blueprint for Smarter Aid

Discussions around new funding models in the development sector have dominated discussions at UNGA this year. So Lisa Felton, Managing Director of Vodafone Foundation has been considering what a blueprint for future funding could look like, based on the Foundation’s experience, especially the m-mama programme which has demonstrated a different approach, by delivering national, government-funded maternal emergency transport at a fraction of traditional costs, and now scaling across Africa. Read on to understand how smarter philanthropy can deliver lasting results.

The global development landscape is undergoing a seismic shift. With foreign aid budgets shrinking across major donor countries and multilateral institutions, the need for smarter, more efficient, and impactful interventions has never been more urgent. Traditional aid models are increasingly scrutinised for their high overheads, complexity, inefficiency, and lack of measurable outcomes.

In this context, the Stanford Social Innovation Review’s article Big Aid Is Over presents a compelling case for radical simplification in aid delivery. It advocates for focused, scalable, cost-effective solutions that deliver tangible results. One such solution is m-mama, a maternal emergency transport system developed by the Vodafone Foundation in partnership with the Governments of Tanzania and Lesotho and implementation partners including Pathfinder International, Touch Health, and Riders for health. .

m-mama exemplifies the principles of smarter aid. It is simple in design, focused in purpose, and powerful in impact. By leveraging mobile technology and community resources, m-mama addresses one of the most critical challenges in maternal health: delays in reaching emergency care. This article explores m-mama as a blueprint for the future of aid, drawing on insights from peer-reviewed research, field evaluations, and real-world implementation.

Maternal mortality remains a pressing global health issue, particularly in sub-Saharan Africa. According to the World Health Organization, approximately 260,000 women died during and following pregnancy and childbirth in 2023 712 deaths every single day. This marks a 40 percent reduction since 2000, but progress has slowed, and disparities remain stark. Sub-Saharan Africa alone accounted for 70 percent of these deaths. These deaths are largely preventable with timely access to quality care.

The Three Delays model is widely used to understand the barriers to maternal health care: the delay in deciding to seek care, the delay in reaching care, and the delay in receiving adequate care. Among these, the second and third delays - reaching adequate care - are often the most critical in emergency situations. Lack of affordable and reliable emergency transport, poor infrastructure, and long distances to health facilities contribute to this delay, resulting in many preventable deaths. Addressing these delays requires innovative solutions that are both accessible and scalable and, above all, affordable to governments. Common facility-based ambulance systems are expensive, with high upfront and running costs, and often inadequate and poorly managed especially in rural areas. This is where m-mama steps in, offering a community-based, technology enabled emergency transport system that ensures timely access to appropriate emergency care.

m-mama is a digital enabled emergency referral and transport system designed to address the second and third delays in maternal health care. Developed and led by the Vodafone Foundation and partners, the system uses a mobile dispatch platform and mobile money payments to triage the emergency transport needs of pregnant women and newborns, coordinating the response of ambulances augmented by volunteer community drivers.

The process begins with a toll-free call to a 24/7 dispatch centre. Trained dispatchers, health workers employed by government, use a triage system to assess the urgency of the situation. If an ambulance is unavailable, the system automatically identifies and contacts a nearby community driver who is paid via mobile money when they transport the patient to the nearest appropriate health facility. The success of the m-mama system is based on the careful assessment of health and transport resources and the development of multiple routes – 30 million routes were mapped and planned in Tanzania – combined with real time management of the transport. As a result mothers and babies are transported to facilities who know to expect them and where the appropriate care and treatment is known to be ready and available. Over 60% of women transported in Tanzania receive life-saving emergency c-sections.

This model is simple yet effective. It leverages existing infrastructure such as mobile phones, local drivers, existing ambulances and health facility resources to create a responsive and reliable emergency transport service. It is designed to be affordable to government, scalable, adaptable, and sustainable, with strong integration into national health systems and community ownership.

m-mama’s co-creation with government has been critical to its success. Donor funds are only used to fund one-time set up costs and related staff. From the outset government provides all the ongoing costs such as those for community drivers, the staff for the dispatch centres and regional coordinators to manage driver recruitment and retention. In other words, all elements that typically act as a barrier to government ownership and sustainability were determined in advance through a process of genuine partnership and co-creation. Naturally this approach requires greater time at the outset with government required to commit and secure financial and human resource. However, the outcome is a programme that in Tanzania targeted $18m of donor funds to create a fully national emergency transport system that costs the government only $1m per year to sustain is transporting circa 70,000 mothers and babies in emergencies annually. The importance of the leadership of H.E. President Samia Hassan’s Government, in recognising the opportunity and committing upfront resource cannot be overstated.

The effectiveness of m-mama has been rigorously evaluated through implementation research and field studies and published in peer reviewed journals. A study published in PLOS Global Public Health found that m-mama is a cost-effective intervention for emergency referrals in Tanzania’s Shinyanga region. The cost per completed emergency referral by m-mama was found to be $170, compared to an ambulance only model which costs $472 per referral. This is a significant difference , demonstrating the scalability and sustainability of the service.

The National Institute for Medical Research in Tanzania carried out qualitative research in regions across the country to access the impact of m-mama. The study found strong Government commitment and alignment, improved emergency referrals for health workers, engagement of key ministries (finance, ICT, transport and health), and significant benefits for communities, who no longer struggle to find transport or money during emergencies.

m-mama’s success in Tanzania has paved the way for regional expansion. The program has also been scaled nationally in Lesotho and the Government of Malawi has committed to m-mama - roll-out preparation has already commenced. m-mama’s deliberately simple digital infrastructure, with source code shared with government without license, making it extremely adaptable and minimal ongoing cost, allows for rapid replication and adaptation across diverse geographies within countries or across the region. Key to this scalability is the program’s design.

By using community drivers and mobile technology, m-mama minimizes the need for new infrastructure, greatly increasing the efficiency of existing resources. In Tanzania ambulances trips are now more than 30% less expensive than before m-mama while emergency transport availability has increased by 100% nationally. m-mama reduces costs while expanding reach of emergency transport. The real-time data provided by the system is used by government officials to manage the performance and bottlenecks at facilities improving system efficiency and delivery. It integrates seamlessly with existing systems in health and is operated by national and local governments, ensuring sustainability and alignment with national health strategies.

The program also drives systemic change. It strengthens health systems by improving emergency response coordination, training health workers, and fostering public-private partnerships. It builds community trust and empowers local stakeholders, creating a foundation for sustainable development.

Lessons from the scale-up process highlight the importance of government ownership from the beginning, broad stakeholder engagement, and continuous monitoring and evaluation. m-mama’s expansion demonstrates that simple, effective interventions can be scaled to reach millions of people across multiple countries.

This approach is increasingly urgent. A joint report released by WHO, UNFPA, and UNICEF in April 2025 warned that global aid cuts are threatening fragile progress in maternal health. While maternal deaths declined significantly between 2000 and 2023, the pace of improvement has slowed. The report calls for renewed investment in proven, scalable interventions-precisely the kind of solution m-mama represents. In parallel, a June 2025 editorial in Frontiers in Digital Health emphasized the growing role of mobile health solutions in reducing maternal health disparities. It called for greater investment in digital platforms that integrate with national systems - exactly the model m-mama has pioneered.

These calls for smarter investment come at a time when the broader aid landscape is under immense pressure. According to the Centre for Global Development, the United States is expected to cut its aid by more than half compared to 2023 levels, while the UK has reduced its aid-to-GNI ratio to just 0.3 percent. A Brookings analysis warns that the dismantling of global health programs, particularly in HIV, TB, and malaria, could have long-term consequences for health systems in low-income countries. These trends underscore the need for donors, but also governments, to prioritize interventions that are not only effective but also resilient, scalable, and locally owned.

While m-mama has demonstrated significant success, it is important to address potential challenges. One concern is contextual adaptability, ensuring the model works effectively in different settings. m-mama addresses this by customizing its implementation based on local needs and resources – identified collaboratively with government. Infrastructure limitations, such as poor road conditions and limited mobile coverage, can pose challenges. However, the program’s reliance on community drivers and mobile technology makes it resilient and adaptable – community drivers and local facilities are well used to adapting solutions on rural roads during the rainy season, or, for example when boats or horses are needed in certain locations. Continuous investment in infrastructure and technology is essential for sustained success but the creation of systems like m-mama will ensure that those investments are managed, coordinated and efficient. Ensuring equity and access is another challenge. m-mama continues to prioritize reaching the most vulnerable populations, including those in remote and underserved areas.

m-mama stands as a powerful example of what smarter aid can achieve. It is simple, scalable, and cost-effective. It saves lives, strengthens health systems, and empowers communities. It embodies the principles of radical simplification, economies of scale, and systemic change. As the development sector navigates an era of constrained resources, m-mama offers a blueprint for the future. It shows that focused interventions, backed by evidence and driven by technology, can deliver transformative impact. But the success of such models depends not only on what is possible, but on what is prioritized.

There is a danger here that the wrong lessons are learned. m-mama works because it is a genuine partnership requiring a collaborative approach to tackling a defined challenge. This process is not without difficulty. Just as Henry Ford remarked that if he had given people what they asked for he’d have simply developed ‘a faster horse’, so too Ministries of Health will always ask for more ambulances. The m-mama team’s insistence that their donor funds be used to create affordable and sustainable systems that prioritise the poor living in rural areas, ensured that all parties were incentivised to think beyond the ‘buy more ambulances’ mantra. It remains to be seen whether funds handed by macro development funders to government will result in sustainable impactful solutions like m-mama, or whether it will simply result in more poorly managed ambulances. Partnership and collaboration itself bring new perspectives and technical expertise which creates additional value. The way in which donors deploy funds, beyond the funds themselves, is critical to success.

m-mama has demonstrated that it works. It has shown that it can scale. But whether it will reach its full potential depends on the choices made by governments and institutions. The most effective solutions are not always the most visible or politically convenient. They require a willingness to simplify, to focus, and to invest in what delivers.

In the end, smarter aid is not just about better design. It is about better decisions. By learning from m-mama and embracing its principles, we can build a more effective, accountable, and human-centred aid system that delivers real results for the world’s most vulnerable populations.

This article was written by Lisa Felton, Managing Director, Vodafone Foundation.