Malteser International

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Portfolio Title: M-Afya

Grant Type: Innovation

Counties: Nairobi

Timeline: Oct 2015 – June 2018

Funding Round: 1

The Problem

The role of health insurance and medical savings is critical to protect patients from catastrophic health expenditure. In the informal settlements of Nairobi, most low-income earners make small amounts of money on a daily or weekly basis, leaving families to prioritize their day-to-day needs whilst health insurance is only thought of once emergency strikes. Though the National Hospital Insurance Fund has revised its provisions to include people working in informal sectors, low-income earners cannot afford to pay monthly premiums upfront, including women who worry about pregnancy and delivery costs.

M-Afya: Enhancing Financial Access Through Mobile Pre-Payment

Malteser International introduced a flexible payment system to enable patients in informal settlements to make pre-payments for maternity services, using their mobile phones. The innovation was based on lessons learned from other sectors, where flexible pre-payment has been shown to increase access to financial products such as personal and business loans, and mobile phones have been used to promote savings for anticipated expenses. The M-Afya is a mobile application that allows a mother and her family and friends to set aside small amounts of money during pregnancy to cover the costs of delivery, using M-Pesa: a mobile money application in Kenya. The money is saved in a protected account that can only be used for health services at designated facilities, promoting access to quality care. In addition to the financial savings function, the M-Afya system is also used to send text messages to the mother and her partner about maternal and newborn health, thereby acting as platform for client education. It also sends reminder messages for clinic appointment dates and payments.

The innovative solution was tested in Embakasi Sub-County targeting 10 private health facilities serving informal settlements (intervention sites). A similar number of health facilities in Kamukunji Sub-County were enlisted as non-intervention sites (comparison sites). 

Results

  • By the end of the project, a total of 364 pregnant women had been enrolled on M-Afya platform through which they had saved money for their delivery at the 10 participating health facilities.
  • Analysis of outcome indicators revealed significant differences between the intervention and comparison sites, including:
    • More women in the intervention sites (79%) had attended at least 4 antenatal care visits compared to those in the comparison sites (74%);
    • Women who had heard of M-Afya services were 2.4 times more likely to have received at least four ANC services compared to those who never heard of M-Afya model;
    • The proportion of pregnant women who received skilled delivery services in the M-Afya sites was higher (98%) than that in the comparison sites (94%);
    • Women in intervention sites were 2.6 times more likely to have used skilled delivery services compared to those in the comparison sites;
    • A slightly higher percentage (79%) of women and their babies in the intervention sites had received a post-partum health check from health care providers within 48 hours as compared with 76% in the comparison sites.

Lessons Learnt

Flexible pre-payment models have the potential to reduce financial barriers that limit access and utilization of maternal and newborn health services for poor households. Mothers who successfully managed to save for their maternity care through the M-Afya platform were willing and able to continue saving even after birth. This provides a great opportunity for hitherto uninsured poor women to transition into health insurance products that allow payment of premiums in instalments. The unparalleled growth of mobile money technology in Kenya multiplies the prospects of actualising this possibility.

For more information about this project, contact:

Caroline Nyongesa

Malteser International

caroline.nyongesa@malteser-international.org

Kimani Karuga

Options Consultancy Services Ltd.

k.karuga@manikenya.com