SHOPS is funded by the U.S. Agency for International Development.Abt Associates leads the project in collaboration withBanyan GlobalJhpiegoMarie Stopes InternationalMonitor GroupO’Hanlon Health Consulting
Study of Changamka’s Maternity Savings Card: Preliminary Evaluation Results
Second Global Symposium on Health Systems ResearchNovember 1, 2012
Overview
• Financial barriers limit use of maternity health services in developing countries.
• Changamka card, which provides convenience as well as savings mechanism, is promising.
• Test of card at Pumwani Hospital in 2010-2011.
• Convenience feature of card proved to be more important to the Pumwani clientele.
• Savings feature is potentially more important to other women in community.
2
Financial Barriers Limit Use of Maternal Health Services
• 90% of Kenyans not covered by health insurance, most health services bought with cash
• 43% of births in Kenya occur in health facilities, a significant barrier to reducing MMR
• Few Kenyans have bank accounts, but many use M-Pesa mobile phone system for savings
• M-Pesa cannot be used at health facilities, has no commitment savings mechanism
3
The Promise of a Maternal Services Card
• Simple stored-value smart card (or e-card)
• For users: Convenient, safe and cost-free, allows for dedicated savings
• For health facilities: Low cost, attractive to customers, reduces nonpayment risk
• Maternity services have predictable timeline and cost, are well suited to a savings mechanism.
4
Changamka Convenience/Savings Card
• Changamka MicroHealth Limited, established in 2008 in Nairobi
• Offers healthcare savings cards, including the maternity care savings card
5
• Facilitates cashless transactions
• Provides a micro-savings mechanism
Trial of Card at Pumwani Hospital
• Card offered at kiosk in Pumwani Hospital from July 2010 to September 2011.
• Deposits at kiosk and through mobile phones (M-Pesa).
• Card use fees borne by the hospital.
• Card can currently be used at 9 private hospitals in Nairobi and in hospitals in Mombasa and Naivasha.
6
Trial of Card at Pumwani Hospital
• Pumwani Maternity Hospital owned by Nairobi City Council.
• Largest maternity hospital in Sub-Saharan Africa, with about 27,000 deliveries per year.
• Provides CEOC.
• Pumwani Hospital clientele is large, distinctive.
7
Trial of Card at Pumwani Hospital
1st-time mother services (VDLR, HB count, blood
profile, urinalysis) $6.00
Normal delivery:
$36.00 + $4.85/night (1)
or
C-Section:
$72.00+
$4.85/night (3)
Follow-up ANCs: $0.60
Registration & 1st ANC: $3.00
PNCs: $0.60
8
Assessment of the Card Trial
• ‘Natural experiment’ at Pumwani Hospital, not a rigorous, controlled evaluation
• Changamka data on user transactions
• Survey data• Changamka card users• Pumwani Hospital clients from same neighborhoods
who did not get Changamka cards• Community sample: Women from same neighborhoods
who gave birth in period covered by the study
• In-depth interviews with subsample of survey respondents
9
Card Safety and Convenience Findings
• Card users versus comparison group (women who went to Pumwani Hospital for services before or after 15 months when card was offered):
• Average card user made 4.3 ANC visits, 14% more than comparison group (difference statistically significant across education and income subgroups).
• Card users were more likely to have at least 4 ANC visits (the WHO recommendation).
• Convenience and security appear to drive this result more than savings feature.
10
Card Safety and Convenience Findings
• Card user sample:• 78% found card convenient to use,
• 60% said card helped pay for services, leave hospital more easily.
• 80% said the card safer than carrying cash, 87% thought it was more convenient than M-Pesa.
• Community sample:• 71% do not feel safe carrying money to a hospital.
11
Card Saving Findings
• 6% of card users engaged in genuine savings and two-thirds of savers used cards for deliveries.
• Card users versus comparison group:• No difference in deliveries at facilities (96% for both
groups).• No difference in use of skilled birth attendants.
• Predictable finding, because most Pumwani Hospital clients committed to facility delivery, many covered by insurance.
12
Card Saving Findings
• Card user sample:• 75% said card helped them save money by not letting
them spend it on other things.• 15% said card helped by preventing their families from
spending the money on other things.
• Community sample:• 60% were interested in using a maternity card for
saving if it could be used at multiple facilities.• Interest grew to 87% if delivery cost held to KSh 3,000.
13
Card Users Have More Education and Income than Community Sample
Primary Education;
36.30%
Secondary Education;
45.90%
Post-Sec-
ondary Educa-
tion; 17.80%
Community Sample
Primary Edu-cation; 17.70%
Secondary Education;
51.80%
Post-Sec-ondary Ed-
ucation; 30.50%
Card Users
14
SHOPS is funded by the U.S. Agency for International Development.Abt Associates leads the project in collaboration withBanyan GlobalJhpiegoMarie Stopes InternationalMonitor GroupO’Hanlon Health Consulting
[email protected][email protected]
www.shopsproject.org
Thank You