Evaluating the Viability of a Health Savings Card in Kenya

March 2013, SHOPS Project;  In Kenya, a stored-value electronic savings card offered by a local business—Changamka—allows families to save for prenatal visits, deliveries, and postnatal care. The purpose of the savings product is to enable women to meet the relatively large costs associated with maternity care by saving over the duration of their pregnancy. In a country where 80 percent of the population cannot afford bank accounts, this type of savings product has the potential to increase the number of women able to afford delivery in a health facility.


The SHOPS project recently evaluated the card during a trial of the product at Pumwani Hospital in Kenya from 2010 to 2011. Like many early-stage innovations, Changamka faced several challenges: discontinuation of card use was high, only a small portion of card users actually saved money on the card, and further efforts were needed to market the card and educate clients about its use—especially to lower-income groups. Many clients were unaware that the card could be used for non-maternity health expenses, and many women received the card too late in their pregnancies to adequately save for delivery expenses.

Despite these obstacles, card use was associated with a slightly higher number of antenatal care visits, and users appreciated that they were able to enter and leave the hospital more quickly, safely, and easily than cash-paying patients. On the whole, the evaluation offers some important lessons for future savings card interventions:


  • Clients value health financing tools over paying with cash
  • Physical distance is a barrier in accessing health care services, and clients will not accept financial products that cannot be used near their homes
  • Marketing and education are critical to increasing uptake
  • Poorer and less educated consumers appear less willing to accept a new financial mechanism such as the card
  • Locally owned, self-funded start-ups like Changamka face challenges in scaling up their provider networks, and early periods are particularly difficult because clients demand more provider choices


By considering the lessons learned from this pilot, donors, private health insurers, governments, and health entrepreneurs may be able to design health financing tools that offer more affordable healthcare to the poor.

The Changamka pre-paid maternity savings card is now used at nine private hospitals in Nairobi and at hospitals in Mombasa and Naivasha.


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