The smart way to give birth

2010-09-04 13:21

Nairobi, Kenya - Kenyans can now save towards the cost of childbirth at the country’s largest maternal hospital thanks to a medical smart card ­system.

The prepaid card offered by Nairobi’s Pumwani Maternity Hospital enables holders to upload small amounts of money through a cellphone money transfer facility.

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

Only 5% 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.

Agutu says: “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.”

A normal delivery costs the equivalent of $42 (about R300) at Pumwani Maternity ­Hospital. A caesarean costs $75. Hospital management says it is forced to waive fees to the tune of nearly $19?000 every month.

Kenyan government statistics show that 56% of women give birth at home, putting mother and child at risk. When the data is broken down geographically, it emerges that 63% 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 40 US 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 healthcare is as essential as food and other basic necessities. Just as they save up for other needs, they need to save for medical care,” he says.

“While we acknowledge that there is a cadre of women who cannot spare even 30 shillings (about R2.70) 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 their smart cards to cater for their families’ medical needs.”

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

“We have negotiated with particular healthcare providers who have agreed to charge a modest fee of 450 shillings (about $5.50) when card holders visit their clinics. In return we promise health facilities an increase in the number of patients who are 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.


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