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Nairobi – Affordable healthcare system for urban poor

May 18, 2011 – Affordable healthcare systems boost safe motherhood for poor

When Zacharia Rombo and Samuel Agutu came together in 2008, the mission was simple — to develop a system that embraces technology to provide affordable healthcare.

This was informed by past experiences in their careers as chartered insurer and accountant respectively.

The result of this union was the birth of Changamka Micro Health Limited, a private company in the business of health insurance that targets the poor.

“It was after realising that not more than 10 per cent of Kenyans are insured under health schemes that we decided to go this way. The purpose was to get the uninsured poor who are the majority in the population, to a position to plan and afford medical care,” says Mr Rombo.

At the beginning, the initial focus was on general healthcare.

However, this has since changed to include safe maternal healthcare targeting 60 per cent of Kenyan women who deliver outside medical facilities.

Today, Changamka Micro Health is known for its popular smart card — the Changamka card — which allows members to save in advance for medical expenses to cover inpatient and outpatient services.

Unlike the common insurance schemes that restrict members to certain amounts of premiums for specified values of medical cover, the smart card allows for flexible contributions.

Ideally, one spends the amount that one has contributed.

An initial payment of Sh300 is made to acquire the card after which a card holder can contribute from as low as Sh50 to maximum limits that depend on their financial ability.

For a person living in poverty with no constant income, this mode of payment is ideal.

The card is popular in Nairobi, especially among the residents of slums where poverty and unemployment is rife.

For example, of 1,800 Changamka smart card holders who have applied for payment of maternal expenses, more than half live in the city.

“It is because we started in Nairobi but we are now taking the message to other low income areas. Other places where the maternal smart card has been catching up include Mombasa, Kikuyu and Naivasha,” says Mr Rombo.

According to Ann Kihara, a consultant obstetrician and gynaecologist, maternal healthcare should address all aspects of safe motherhood that includes proper access to medical attention during and after pregnancy, focus on family planning and ward off maternal and child mortality.

However, health experts have always sought to achieve 100 per cent deliveries in medical facilities and ensure that mothers and their babies are well cared for after birth.

Research has shown that not all mothers give birth in health facilities, because of poverty and cultural barriers, but cheaper financial solutions would go a long way to ensure safe motherhood in Kenya.

Amref country director Festus Ilako believes that contrary to the past situations where the poor have always been left out in planning affordable medical packages, projects are coming up that target the poor to ensure that they receive necessary medical attention including maternal care.

“Such options like the voucher system help mothers from low income areas to access maternity services at subsidised rates,” he says.

The most popular voucher system locally is ran with support from the German government.

Under the system, mothers buy vouchers for as low as Sh200 that guarantee them services like pre-natal, delivery and post-natal care at selected medical facilities.

Karuga Kimani, a health adviser at Save the Children UK, says that while the voucher system is affordable to the poor, its use has been hindered by cultural beliefs that have often seen beneficiaries shy away from health facilities.

“In some communities, especially in the arid lands, women will never be comfortable to walk to a hospital where the person aiding delivery is a male health worker. It also calls for a solution on how to handle these cultural barriers even as financial solutions are being sought. Also, some have vouchers but have difficulties accessing a medical facility because of poor road networks,” said Mr Karuga.


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