Medical smart card extended to maternal care

When women visit Pumwani, the cost of their medical care is deducted from their savings on the pre-paid card.

Approximately five per cent of Kenyans have medical insurance according to Samuel Agutu, the managing director of Changamka Microhealth Limited, the company behind the smart card.

Kenyans employed in the formal sector pay for mandatory health coverage, but 11 million adults working in the informal sector and their dependants – representing the most vulnerable segment of the population—have no such insurance.

“Without medical cover, meeting maternity costs becomes a challenge for most people in Kenya and despite government hospitals charging very modest fees, families cannot pay the charges. Thus, women continue to deliver at home with the help of inexperienced people and most die when emergency situations present,” Mr Agutu says.

A normal delivery costs about Sh3,400 at Pumwani Maternity Hospital; a caesarean costs Sh6,000.

Hospital management say it is forced to waive fees to nearly Sh1.5 million every month.

Kenyan government statistics show that 56 per cent of women give birth at home, putting mother and child at risk.

Sixty three per cent of deliveries in rural areas and informal settlements take place at home.

Avoiding a costly visit to the hospital is a contributing factor.

“My sister recently delivered her third child at Pumwani Maternity Hospital,” says Judith Ayuma, a domestic worker in Nairobi’s Pipeline Estate.

“She had hoped to deliver at Makadara health centre where the cost is Sh30, but since her labour pains came at night (when the health centre was closed) she had to be rushed to Pumwani where the cost of delivery is higher. She checked into the hospital, but had no idea how she would pay the bill.”

When it was time to be discharged, Ayuma’s sister was detained at the hospital until relatives raised the Sh3,400 fee.

Mr Agutu says the idea behind the smart card is to encourage families to develop a culture of saving for childbirth as well as for their other health needs.

“We are simply telling families that health care is as essential as food and other basic necessities. Just as they save up for other needs, they need to save for medical care,” Mr Agutu says.

“While we acknowledge that there is a cadre of women who cannot spare even Sh30 a day, we also know that women are innovative and belong to various savings groups popularly known as ‘chamas’. We are telling women to take part of this money they receive from the ‘merry go round’ and upload some of it into the smart card to cater for their families’ medical needs,” he says.

Changamka launched a smart card in September 2009, offering discounted rates at participating medical centres to see a doctor, have tests done or purchase medication.

“We have negotiated with particular health care providers who have agreed to charge a modest fee of Sh450 when card holders visit their clinics. In return we promise health facilities an increase in the number of patients who are smart card holders,” Mr Agutu said.

Building on its success, the company is now extending coverage to maternal care.

The smart card scheme offered by Changamka – a Swahili word meaning ‘get excited’ or ‘awaken’ – could be an important complement to the subsidy offered by the voucher scheme.

Mr Agutu says that since early July, 500 maternity smart cards have been purchased.

His company is negotiating to expand the number of medical providers who accept the card.