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Study of Changamka’s Maternity Savings Card: Preliminary Evaluation Results

Study of Changamka’s Maternity Savings Card: Preliminary Evaluation Results. Second Global Symposium on Health Systems Research November 1, 2012. Overview. Financial barriers limit use of maternity health services in developing countries.

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Study of Changamka’s Maternity Savings Card: Preliminary Evaluation Results

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  1. Study of Changamka’s Maternity Savings Card: Preliminary Evaluation Results Second Global Symposium on Health Systems Research November 1, 2012

  2. 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.

  3. 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

  4. 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.

  5. Changamka Convenience/Savings Card • Changamka MicroHealth Limited, established in 2008 in Nairobi • Offers healthcare savings cards, including the maternity care savings card • Facilitates cashless transactions • Provides a micro-savings mechanism

  6. 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.

  7. 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.

  8. Normal delivery: $36.00 + $4.85/night (1) or C-Section: • $72.00+ • $4.85/night (3) Registration & 1st ANC: $3.00 Follow-up ANCs: $0.60 1st-time mother services (VDLR, HB count, blood profile, urinalysis) $6.00 Trial of Card at Pumwani Hospital PNCs: $0.60

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. Card Users Have More Education and Income than Community Sample

  15. Thank You David_Long@abtassoc.com Thierry_van_Bastelaer@abtassoc.com Benjamin_Woodman@abtassoc.com www.shopsproject.org

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