presentation (Henderson)

USING MOBILE MONEY
TO PREPAY FOR HEALTHCARE
IN KENYA
Mexico City, November 2014
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PHARMACCESS GROUP
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Opportunities
ProblemChallenges
Connecting people to quality healthcare
Kenya’s health system – challenges, opportunities & strategies
Stuck in a vicious circle
 Low demand and low-quality supply - no quality
standards
 Mortality <5yr 108k, Maternal 5.5k at birth
 Health Expenditure $17, OOP $21, Donors $19 / capita
 43% of 42 mio live below poverty line
 Institutional environment is weak, little enforcement
 Lack of trust & low level of investments due to high risks
 Lack of reliable data and information
Kenya is developing rapidly
 Economic growth 5-7% and growing middle class,
increasing demand for quality healthcare
 Mobile penetration 93%, M-PESA penetration 85%, 60%
of GDP flows through M-PESA
 Government dedicated to work towards universal health
coverage and acknowledges role of the private sector
 New constitution states right to quality health services
Movie: Mobile Health Research Lab – started in July 2013
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mHealth: THE SOLUTION
A matrix for development of products & services
mHealth opportunity
mHealth landscape
- examples  Enrollment
 Advocacy
 Health status reporting
 Premium collection
 Access to public and
donor benefits
 Claims payment
Producer
 Quality assurance
 Inventory & logistics
 Drug check
 Reimbursement
 Reporting services
 Drug credit facility
Provider




 Reimbursement
 Reporting services
Payer
Patient
P2P consultation
Task shifting
Education
Patient records
 Call center consultation
 Logistical services
 Education - Prevention
Voice
SMS
Data
Communication
 Mobile vouchers
 Mobile health wallet
Payments, Savings & Loans
Financial transactions
M-PESA is Kenya’s income redistribution model
Usage by region
Amounts sent/received
Transformed from a cash economy to a digital mobile-money economy
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Facts
1. More users in Nairobi & Central region than elsewhere (remitting money from urban to rural)
2. Typical transaction size is KES 500-1000 (5-10 euro)
3. Larger amounts (>25 euro) are sent by a small group of people: more receivers than senders
4. Group structures play an important role in raising and saving money, often with “mandatory”
contribution because of strong peer pressure
Source: FinAccess Annual Survey 2013
Recent study: Shocks, remittances, insurance and M-Pesa, Evidence from western Kenya – VU – Amsterdam - Vera Nicole Ide
CONNECT PAYERS, BENEFICIARIES AND PROVIDER
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Mobile money payments can be made virtual and conditional,
increasing trust and control
Condition: only for health
Condition: only if medical
data is submitted
Das Bild kann nicht angezeigt werden. Dieser Computer verfügt möglicherweise über zu wenig Arbeitsspeicher, um das Bild zu öffnen, oder das Bild ist beschädigt. Starten Sie den Computer neu, und öffnen Sie dann erneut die Datei. Wenn weiterhin das rote x angezeigt wird, müssen Sie das Bild möglicherweise löschen und dann erneut einfügen.
CLINIC
SUPPLIER
Condition: based on pay per use
Start of the M-Pesa - PharmAccess Partnership
Rapid testing of prototypes in the Mobile Health Research Lab (since August 2013)
 Provider signs up with M-PESA
 Provider gets unique “shop” number
 Provider agrees to participate in SafeCare
 Patient uses M-PESA to pay for healthcare by
transferring money / entitlement to the provider
 Patient does not pay transaction fee
 Transaction successful if a) both patient & provider
are known to the system, b) patient has sufficient
balance or entitlements, and c) patient approves the
transaction with their personal PIN (=empowerment)
Currently being installed at
health facilities
Mobile Health Research Lab
Lessons learned (1)
Effects of introducing digital payments
 Safety / Security
Pregnant women coming to the clinic after
# hits
USSD menu
dark can no longer
beonrobbed
of their cash
 More women coming to the clinic to deliver
 More women able to pay for delivery themselves, remittances are received real time
 Less leakage (i.e. money disappearing),
estimated at 25-35%
usage &
byadministration
age group
 Lower cash-handling
cost,
less security risk at the clinic
Mobile Health Research Lab
Lessons learned (2)
Mobile Health Wallet
 People at the bottom of the pyramid have no
trouble operating mobile technology.
# hits on USSD menu
 Both patients & providers are willing to use
mobile health wallet
 Women organized in savings groups
(“chamas”) are willing to save for health
 “Trust” plays an important role— who will be
holding my money?
age group
 Participants usedusage
theirby(donor-supplied)
funds
sparingly. Only one family spent the full
amount, to pay the morgue