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KENYA: Medical Smart Card Extended to Maternal Care

NAIROBI, Aug 15 2010 (IPS) - Kenyans can now save towards the cost of childbirth at the country’s largest maternal hospital thanks to a medical smart card system.

Funding maternal care

Various means to overcome financial obstacles for women in need of maternal care are ongoing in Kenya.

One very successful scheme, known at the Output Based Approach(OBA), sells vouchers to women for $2.50.

The voucher covers delivery as well as pre and post-natal check-ups.

With donor funding, Kenya was able to run this pilot project in four districts - Kisumu, Kitui, Kiambu and Nairobi in the Korogocho and Viwandani slums.

"From the pilot we realised that the project was a success because the number of women delivering in hospitals increased dramatically beyond our expectations reaching 61,000 while we had planned for 52,000," Francis Kundu, a programme officer with the National Coordinating Agency for Population and Development told IPS.

The only problem is funding. Kundu says the sale of the vouchers is still confined to the regions from the pilot project due to limited resources.

The government has set aside $1.25 million to support this programme, and Kenya is seeking funding to increase the districts covered by the OBA project.

Similar subsidies for maternal care and family planning have been attempted in Cambodia, Bangladesh, Uganda and Tanzania with success.

In Uganda, a pilot project initially catered only for treatment of sexually-transmitted infections but has expanded in scope to include maternal healthcare.

The prepaid card offered by Nairobi’s Pumwani Maternity Hospital enables holders to upload small amounts of money through the M-PESA cellphone money transfer facility. When women visit Pumwani, the cost of their medical care is deducted from their savings on the pre-paid card.

Approximately five percent 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,” Agutu says.

A normal delivery costs the equivalent of $42 at Pumwani Maternity Hospital; a caesarean costs $75. Hospital management say it is forced to waive fees to the tune of nearly $19,000 every month.

Kenyan government statistics show that 56 percent of women give birth at home, putting mother and child at risk. When the data is broken down geographically, it emerges that 63 percent 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 30 Kenyan shillings (a bit less than 40 U.S. cents), 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 $42 fee.

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,” Agutu says.

“While we acknowledge that there is a cadre of women who cannot spare even 30 shillings 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 450 shillings ($5.50) when card holders visit their clinics. In return we promise health facilities an increase in the number of patients who are smart card holders,” Agutu explains.

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.

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.

He is confident that uptake will be strong, suggesting that an intelligent combination of a convenient means to save and discounted services available at a wide range of health points could offer a large number of uninsured Kenyans access to essential medical services.

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