Setting for Innovation
Universal health coverage is a goal that emphasizes access to health services without suffering financial hardship. However, many health systems in developing countries are funded primarily through out-of-pocket payments, placing sometimes overwhelming financial burdens on families. In Kenya, the poorest households spend a third of their resources on health; nearly 1.5 million Kenyans are pushed below the poverty line annually due to out-of-pocket payments [1]. Financial barriers to health care lead to poor health outcomes, further exacerbating disparities in wealth and health.
M-Tiba Approach
M-Tiba, an innovative mobile money tool, is tackling the issue of financial risk protection among some of the poorest populations in Kenya. Created as a “mobile health wallet†through a partnership between PharmAccess,CarePay, and Safaricom’s M-PESA platform, M-Tiba addresses challenges in the demand, supply, and financing of health care. On the demand side, M-Tiba allows individuals to create an account for health care saving and spending on their mobile phone, send and receive funds dedicated for medical expenses, store vouchers and insurance benefits, and avoid theft and misuse of funds by third parties. On the supply side, M-Tiba has established a Health Payment Infrastructure Network (Health-PIN) of providers. Health-PIN providers receive a Quality and Business Management training opportunity and a free M-Tiba till phone to process payments and vouchers, thereby increasing accountability, ensuring faster payout, improving payment options for patients, and avoiding often unsafe cash handling logistics. Finally, donors, governments, insurers, and other financiers of M-Tiba can track transactions online in real-time, increasing program monitoring and accountability and decreasingleakage.
In a 9-month feasibility pilot that included 44 clinics and reached 10,000 beneficiaries in slums in Nairobi, participants were provided KES 1,000 (USD $10) to enroll in M-Tiba. M-Tiba launched for the public on December 2, 2015.
Challenges for Scale
M-Tiba will need to scale among patients and health providers to achieve impact. Currently, clients can only use M-Tiba to pay for services at registered clinics and hospitals. Medicines and health products sold at pharmacies and drug shops must be purchased with cash or another M-PESA account. With nearly 16% of urban Kenyans using chemists, pharmacies, or drug shops as their main provider of outpatient health services and over 30% self-medicating (potentially getting non-prescription drugs over the counter) [2], M-Tiba champions will need to consider whether and how to include these providers in its network.
Another challenge is that low-income households that already struggle to pay for food, housing, and school fees, may be reluctant to restrict use of their funds to a single purpose (health). Subsidies from public and private sources, vouchers, and other incentives may be needed to overcome this reluctance, and to allow people to become comfortable with using a single-purpose account.
One challenge for providers is that they must upload, by computer or phone, key medical data for each transaction completed in M-Tiba. This may lead to data entry burn-out, poor reporting, and could shift attention from clients to administration. One approach to address this would be for M-Tiba to tie incentives to complete and accurate reporting or to initiate a larger health information technology system integration.
Looking Forward
Innovations like mobile health wallets may play an important role in empowering low-income individuals to better plan and save for healthcare, while also improving transparency and efficiency throughout the health system. The question to be answered, posed by PharmAccess, is: will M-Tiba do for health what M-PESA did for mobile money? The answer to this question will depend on how M-Tiba succeeds in addressing the challenges noted here and scales among clients and providers in the diverse settings and contexts of Kenya. It will be interesting to see how M-Tiba approaches roll-out at scale, and how the public responds.
References
[1] Chuma J, Maina T. Catastrophic health care spending and impoverishment in Kenya. BMC Health Services Research. 2012;12:413. doi:10.1186/1472-6963-12-413. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561146/pdf/1472-6963-12-413.pdf
[2] Ministry of Health, Government of Kenya. 2014. 2013 Kenya Household Health Expenditure
and Utilisation Survey. Nairobi: Government of Kenya. Pages 18, 30.http://www.healthpolicyproject.com/pubs/745_KHHUESReportJanuary.pdf
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