Malteser International

Download PDF

Portfolio Title: M-Afya

Grant Type: Innovation

Counties: Nairobi

Timeline: Oct 2015 – Dec 2017

Funding Round: 1

The Problem:

In the informal settlements of Nairobi, accessing health care is challenging for the people who need it most. Rapid urbanization has led to high rates of unemployment, poverty and poor health outcomes among the city’s disadvantaged residents. Health services are delivered through a complex web of public, private and faith based providers. Low income earners who access care in public facilities often face user fees, and are referred to the private sector for laboratory tests, specialized care, and prescription medications. The for-profit sector plays a unique and dominating role in health service delivery in Nairobi, with 50% of the county’s health facilities registered as private1.

In this context, the role of health insurance and medical savings is critical to protect patients from catastrophic health expenditure. However, health insurance coverage in Kenya remains low: only 25% of Kenyans have prepaid medical insurance, while the remaining 75% rely on paying for their health care through out of pocket expenses2. In the informal settlements of Nairobi, the working population often earns its income on a daily or weekly basis. Families are forced to prioritize their basic needs, and health insurance is only thought of once a health emergency strikes. While the National Health Insurance Fund (NHIF) has been revised to include people working in informal sectors, many low income earners cannot afford to pay the entire monthly premium upfront. Free maternity services were also introduced by the government in 2013 to improve health care access, but this remains limited to the public sector. Many women in Nairobi county worry throughout their pregnancies whether they will be able to pay for the costs of their delivery.      

The Innovative Solution: 

Malteser is implementing a flexible payment system to enable patients in informal settlements to make prepayments for maternity services, using their mobile phones. The innovation is based on lessons learned from other sectors, where flexible pre-payment has been shown to increase access to financial products such as personal and business loans, and mobile phones have been used to promote savings for anticipated expenses.

The M-Afya mobile application allows the mother and her family and friends to set aside small amounts of money during pregnancy to cover the costs of delivery, using MPESA. The money is saved in a protected account that can only be used for health services at designated facilities, promoting access to quality care.

Goal & Targets:

The M-Afya project is exploring whether a flexible payment plan for maternity services will increase the number of women seeking these services. Ultimately the project seeks to reduce the cost barriers that women face to accessing maternal and newborn health services in Nairobi’s informal settlements. By addressing cost issues, the project is increasing the number of women able to access quality delivery services in the private sector. 

Preliminary Results (as of May 2017):

  • 275 pregnant women registered in the M-Afya model, using flexible pre-payment to save for the costs of delivery
  • 10,000 health messages sent out to pregnant women, new mothers and their partners, educating clients on maternal and newborn health
  • 28 health care workers trained on maternal and newborn health at participating private facilities, improving the quality of care provided in informal settlements
  • Improved quality of data collection and reporting at participating facilities, to enable performance measurement  

Tania’s Story:

20-year-old Tania Sandaki lives in Embakasi sub-county in Nairobi. She used the M-Afya platform to set aside money for her delivery throughout pregnancy: "It helped me that I knew that I will be able to just walk in and go in a hospital without any struggles’. Prior to the delivery there were no discussions about money, and admission to the hospital was easy because the clinic staff knew she had already set aside the necessary fees". The health messages also assisted Tania to understand how her pregnancy was progressing: ‘I was very green at the beginning. I didn't know anything, because it was my first baby. The messages helped me to understand what was happening with me and my baby.’ 

a family accesses maternal and newborn health care through the m-afya project.jpg
A family accesses maternal and newborn health care through the M-Afya project  

Lessons from the Field:

The Malteser team is documenting their learning from testing this innovation in Nairobi county. The scope for replication of flexible pre-payment is wide in urban settings, as the system has the potential to be self-financing: as women are supported to save for their deliveries, more women are able to access care, and facilities earn higher revenues. Profits can be used to improve quality of care, in turn motivating more women to save early.

A lot is also being learned on how to improve the interface between pre-payment mobile systems and the M-Pesa platform, which can be used to inform other m-health applications – including how to engage through business to business and business to customer modules. Lessons from the CICF project can be used to market the M-Afya model to interested health insurers, such as NHIF and the increasing pool of companies offering micro insurance products.

Women receive health information on their phones throughout pregnancy and after delivery
Women receive health information on their phones throughout pregnancy and after delivery


1Kenya Master Facility Listing

2Netherlands Enterprise Agency (2016): Kenyan Healthcare Sector: Opportunities for the Dutch Life Sciences & Health Sector

This project is funded by the UK government under the County Innovation Challenge Fund (CICF). The CICF invests in innovative interventions, products, processes, services, technologies and ideas that will reduce maternal and newborn mortality in Kenya .

For more information, please contact:

  • Caroline Nyongesa
    Malteser International   

  • Kimani Karuga 
    Options Consultancy Services Ltd.