Improving health care access for the urban poor through mobile-based flexible prepayment

Over half of Nairobi’s population lives in informal settlements, characterized by high levels of poverty and inadequate provision of essential public services. Health services in these informal settlements are delivered through a maze of public, private and faith-based providers. Public health facilities with the capacity to provide maternity services and emergency obstetric care are few and under-resourced. In this situation, the private-for-profit sector fills the gap and are the predominant source of health services. However, the majority of these residents are low-income earners whose ability to save and pay for services is limited. In this context, the role of health insurance and medical savings is critical to protect patients and their families from catastrophic health expenditure. Yet health insurance coverage is low among the urban poor and generally across Kenya.

To address the challenge, Malteser is implementing a flexible payment system to enable patients in informal settlements to make prepayments for maternity services, using their mobile phones. The system is based on lessons learned from other sectors, where flexible pre-payment has been shown to increase access to financial products such as loans, and mobile phones have been used to promote savings for anticipated expenses. The mobile application: M-Afya, allows the mother, her family and friends to set aside small amounts of money during pregnancy to cover the costs of delivery, using MPesa. The money is saved in a protected account that can only be used for health services at designated facilities, promoting access to quality care. M-Afya also disseminates health information through SMS messages, reminding clients of their clinic appointments and informing them when payments are due, as well as tracking individual payments.

From October 2015 to December 2017, Malteser piloted this innovative financing model in Embakasi sub-county of Nairobi, which showed an increase in access to and utilization of MNH services. Specifically, mothers who completed at least four ANC visits during their pregnancy increased from 65% to 79%; the skilled birth attendance rate also increased from 93% to 98%; and the mother-baby pairs that received postnatal check-ups within 48 hours of birth increased from 58% to 79%. 

In addition, data comparing the project intervention sites with neighboring Kamukunji sub-county showed significant differences, with mothers who were exposed to the M-Afya model being more than twice as likely to take up maternal and neonatal care services. 

While the results from the pilot are positive and demonstrate the value of pre-payment financing models, it is the potential of such innovations to serve as an entry point to health insurance that is exciting. The project found that mothers who successfully manage to save for their maternity care through M-Afya were willing and able to continue saving even after birth. This provides a great opportunity for women to transition into health insurance products that allow payment of premiums in installments. Malteser is engaging with NHIF to explore the possibility of linking M-Afya clients to suitable insurance products such as NHIF Supa Cover, where mothers are required to pay only KES 500 per month (approx. USD 5) to receive inpatient and outpatient cover for themselves and their families.