Changamka was founded on the belief that Mobile Technologies can be leveraged to improve the demand side financing initiatives to improve access to healthcare for the lower economy, under served populations in the developing world. This coincide with the establishment of MPESA in Kenya.
Maternal and Newborn Child
The leading causes of maternal mortality in Kenya, as in many developing countries, are Postpartum Hemorrhage and preeclampsia. Only 42% of Kenyan women have delivery at a medical facility while the figure is only 27% in Western Kenya Province for which reason these women are heavily exposed to the leading causes of maternal mortality. This exposure can, arguably, not be addressed outside a medical facility and it is therefore critical to provide access to facilities and appropriate interventions within the facility. Life-threatening complications during labour and delivery are often unpredictable and unpreventable. All pregnant women must have access to skilled care at birth and a guarantee that basic or emergency obstetric care services are accessible when needed.
Over the years insurance companies in Kenya have matured and currently offer various payment mechanisms to the provider, including fee-for-service (either directly to the provider or reimbursement to the patient), diagnostic related groups (DRG) fixed payments and capitation.
The employed population of Kenya is the members of private covers of different types. It is estimated that out of Kenya’s total 2 million formal sector workers at least 800,000 have a medical cover with the private insurance firms. This contribution is over and above the legal mandated fees payable to NHIF. The health insurance coverage is however estimated at only 8% of the overall formal population and another 40% will have some form of self funded scheme to cover their health related costs.
Distribution of these products is mainly done by brokers and registered agents. Commercial Banks have also recently started offering the products via bank assurance as well as providing facilities for premium installments for clients at a fee.
The healthcare industry in Kenya is financed by the government, patients, and donors. Out-of-pocket expenditure as a percentage of total health spending is very high, at 42.7% in 2010. When considering only private expenditures on health, that rises to 76.6%. This cost, typically due at the time of service, puts healthcare out of reach for many. The high out-of-pocket costs are compounded by the lack of health insurance coverage in Kenya. As noted above, only about 10% of Kenyans are covered by insurance and even fewer have outpatient coverage. The
Providing Value to the Patient, Community, and Health System
Both of Changamka’s founders have a long background in insurance in Kenya and were familiar with data from the Association of Kenya Insurers (AKI) indicating that only 3% of Kenyans were covered by private health insurers with another 7% to 9% covered by the National Hospital Insurance Fund (NHIF). This left up to 90% of Kenyans without formal healthcare financing. Changamka was created to help fill this gap and targets the working poor, with incomes between USD $1.50 and $10 per day. At 15 million people, this group makes up 35% of Kenya’s population. The working poor are excluded from the conventional government and private insurance schemes and have essentially no access to affordable healthcare. Furthermore, payment inefficiencies due to bureaucracy and paperwork drive up healthcare costs, putting essential care further out of reach. Pregnant women among the working poor in Kenya often go without antenatal care and typically deliver at home, without a midwife or other health worker.
Changamka’s program provides a mobile technology solution for payment that benefits both the healthcare provider and the patient. Providers benefit from efficiency gains by cutting out administrative costs of billing and payment, translating into lower healthcare prices and, ultimately, increase in access and utilization of healthcare services. Patients benefit from the opportunity to save
“Part of the reason we developed the micro- insurance product was because of catastrophic medical expenses. Savings is not sufficient.”
Zacharia Oloo, Co-Founder and Executive Director
money over time to cover future healthcare expenses, as well as access to an affordable micro-insurance product for those that want comprehensive coverage.
Changamka has also worked with development agencies to deliver maternal care to the poorer households using existing voucher schemes. Changamka’s e- voucher system provides a transparent and accountable method to transfer donor subsidies to care providers for each registered patient at the time of care delivery.