Of the three billion people who live on less than the equivalent of $2 per day, one billion have no access to the healthcare system. In some cases, this is because healthcare facilities are too far away; in others, because services are prohibitively costly. Mobile finance has emerged as an important tool to address both of these challenges – enhancing healthcare accessibility and affordability among base-of-the-pyramid consumers.
Kenya, the “home of M-Pesa,” has been a hub for innovation at the intersection of health and mobile financial services (MFS). With M-Pesa providing the infrastructural “rails” upon which value-added services can be built, a variety of health-related mobile finance offerings have emerged in Kenya and Tanzania. From pre-paid savings to health insurance, mobile platforms are striving to ensure affordable healthcare is not solely a luxury; but rather, a universal right.
Mobile Health Insurance For The Base-Of-The-Pyramid
Frustrated by the lack of health insurance options for low-income Kenyans, Zack Oloo and Samuel Agutu devised an innovative solution: creating a medical smart card that could be used to save money for future medical expenses. Developed by their company Changamka Microhealth Ltd., the card can be purchased from local shops without registration (a barrier to acquiring traditional insurance), and loaded periodically with money via M-Pesa. These funds can eventually be put towards any healthcare expenses, from doctor’s visits to medicine.
“With the advent of M-Pesa, we saw an opportunity to spread the access and availability of healthcare, either as insurance, or as a non-insurance health plan,” said Oloo, Chairman and Co-Founder of Changamka, in a recent interview. Targeting those with the greatest need for health insurance – individuals earning $2 per day or less – Changamka was able to sell 13,000 cards during the first year and a half of operations following its launch in 2009.
Despite the need for health savings, however, getting people to sign up was not always easy. According to Oloo, saving for healthcare was not something that people had done in the past, so acquiring customers required significant behavioral change communication. In an IPS News article, Samuel Agutu, Changamka CEO and Co-Founder said: “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.”
In addition to their Smart Card, Changamka has recently launched the Linda Jamii platform, in partnership with Safaricom and Britam insurance company, which offers mobile micro-insurance to lower-income individuals. Through the platform, customers can save money on their phone, and purchase health insurance once a certain savings threshold is met. Another innovative Changamka platform, implemented with funding from the Saving Lives At Birth consortium managed by Grand Challenges Canada, provides a subsidy m-voucher that women can use to access peri-natal care and facility delivery, one of a growing number of health-related MFS platforms catering to women.
Mobile Money For Women’s Health
As we creep closer to 2015, the deadline for reaching benchmarks set out in the UN Millennium Development Goals (MDGs), a variety of MFS platforms have emerged to improve maternal health, one of three health-focused MDGs. Other mobile money offerings similarly address specific healthcare challenges afflicting low-income, rural women by leveraging the M-Pesa infrastructure. From maternity to basic outpatient care, MFS has become a key way to ensure that women have affordable access to essential health services.
One example is maternal healthcare platform Mamakiba, winner of the USAID “Apps 4 Africa” contest, which uses M-Pesa as the “rails” upon which to offer value-added community services, including a patient-facing SMS savings calculator and prepayment tracking tool. Upon meeting with a Mamakiba healthcare worker, low-income, pregnant women in peri-urban areas of Nairobi can establish a savings target that will cover the costs of their pregnancy, from ante-natal care to delivery. They can further set up a savings plan that will allow them to meet that goal, and begin payments via their M-Pesa accounts.
In a number of emerging market countries, the cost of transport to health facilities is a key barrier to healthcare for rural women. For women living with fistula, a debilitating childbirth injury commonly caused by obstructed labor, accessing timely medical care is particularly essential. Leveraging mobile banking, organizations in Tanzania and Kenya have removed barriers to care for low-income fistula patients.
The Freedom from Fistula Foundation in Kenya, for instance, provides free fistula screenings, and arranges logistics to a Nairobi hospital for repair, sending funds for transportation via M-Pesa as necessary. Comprehensive Community-Based Rehabilitation in Tanzania (CCBRT) incentivizes field “ambassadors” to send more fistula patients for care using M-Pesa. The ambassadors are tasked with identifying potential patients, calling CCBRT, and distributing funds for transportation. They are then sent a financial incentive from CCBRT “as a gesture of appreciation and an incentive to send more fistula patients for care.”
The potential for mobile money to transform healthcare accessibility among base of the pyramid populations is immense, tapping into extensive mobile infrastructure to reach the 1.7 billion people who have mobile phones, but no bank account.[7, page 2] The key is developing more robust mobile financial services catering to the unbanked or underbanked, which can then be leveraged for healthcare accessibility, as these examples from East Africa illustrate.