Improving medication availability through mobile wallets and pooled community funds: results from the MoPuleesa hypertension intervention in rural Uganda

In Uganda, frequent shortages of antihypertensive medications hinder continuity of care, undermining blood pressure management. Building on preliminary ethnographic research, this study evaluates a community-led, mobile-wallet-based pooling intervention-MoPuleesa-designed to improve medication access at a rural clinic in Nakaseke District, Uganda. Over a 7-month period, 183 patients enrolled and were linked to a digital savings platform that required monthly contributions of 5000 UGX (∼USD 1.39) into a communal fund to bulk-purchase medications at a discounted cost. Using survey data, transaction logs, and clinic records, we assessed contribution behavior, risk of adverse selection, equity, changes in medication availability, and patient blood pressure levels. On average, 48% participants contributed each month. Contribution rates showed no significant differences across education levels or medication costs, suggesting minimal equity concerns or adverse selection. Government pharmacies fulfilled only 8% of total prescriptions; however, for contributors, MoPuleesa closed 84% of the remaining medication gap. However, despite improvements in medication supply, we did not observe statistically significant improvements in blood pressure. Our findings demonstrate the feasibility and effectiveness of mobile money pooling in addressing chronic medication shortages. MoPuleesa achieved broad participation and equitable outcomes in a resource-constrained setting and significantly improved medication availability. We conclude that mobile-based fund pooling for medication can significantly improve medication supply and, with improvements in eligibility assessments, could serve as a complementary or intermediate solution to structural barriers in under-resourced health systems.