From Out of Reach to At Your Fingertips: How 1.4 Million Kenyans Are Gaining Access to Healthcare

mSTAR Project

A Project of FHI 360
mSTAR Project clinic photo

Stacey Machayo, at OliveLink Healthcare clinic in Sinai (Nairobi) after receiving treatment though M-TIBA for her daughter. Image provided by FHI 360.

This blog post originally appeared on the website of FHI 360's mSTAR Project.

Digital financial services provide a way for practitioners to strengthen health programs and improve health outcomes, yet few have recognized their full value. In Kenya, where lack of money prevents two out of five people from seeking treatment, a new digital platform is helping to make healthcare affordable and accessible. Known as M-TIBA, the platform enables users to access health savings accounts and pay for insurance premiums, all at a low cost via the mobile phone. The platform has the potential to offer more in the future, with the M-TIBA team currently working on an emergency loan for medical expenses. More than 1.4 million users have joined M-TIBA, with users and insurance policies growing each day.

mSTAR interviewed Kees Van Lede, CEO of CarePay Limited, the developer and administrator of M-TIBA, to illustrate how digital financial services like M-TIBA are changing the face of healthcare.

On December 12th, 2018, mSTAR and USAID are hosting the launch of a guide detailing how digital financial services can accelerate USAID health goals. If you are interested in attending the launch, please register here.

mSTAR: From your perspective, what is the role of digital financial services (DFS) in strengthening health systems and what can be done to further its use?

Kees Van Lede (KL): In Kenya, two out of every five people who need healthcare do not seek treatment because they lack the money. Nearly half of all healthcare expenditures in Kenya are paid out-of-pocket, which is a burden for millions of Kenyans. Demand for health financing solutions, such as insurance, remains low – despite massive progress over the last few years.

Digitization and mobile money, in particular, has improved access to most of what we need in terms of goods, activities, and services. For a few years now, this has also been happening in healthcare. Getting access to dedicated health savings accounts, being able to pay for insurance premiums and the ability to get an emergency loan for medical expenses all have been made available at low cost to the masses via the mobile phone, enabling more and more people to take control over their health expenditure.

mSTAR: Safaricom, CarePay and PharmAccess Foundation created M-TIBA, a digital health payment platform. Can you briefly explain M-TIBA? 

KL: M-TIBA manages healthcare payments and treatment data between funders, patients, and healthcare providers. M-TIBA is a proven health payments integrator, revolutionizing the management of large-scale health schemes and supporting the drive for universal health coverage in Africa. Individuals are using their mobiles phones to save money for treatment and pay for health services and health insurance such as the NHIF (Kenya’s public health insurance agency) through the M-TIBA platform. M-TIBA can also be used by its members to transparently identify the care that can be accessed, and at what price, through a simple app that works on any phone (including non-smartphones). M-TIBA is also used by healthcare providers to submit medical claims digitally, allowing insurers to efficiently review and pay out claims even within a day after the treatment. The enrollment, financial and medical data gathered in all the outlined steps is then shared with key stakeholders in customized dashboards and reports, giving valuable insights into disease patterns, costs of treatment, and health-seeking behavior. M-TIBA now has 1.4 million users and is growing by thousands of new users and insurance policies a day.

PharmAccess and Safaricom are founding partners in creating M-TIBA. PharmAccess acts as a thought leader in innovation on demand-side and supply-side financing and in improving the quality of healthcare in Africa, while Safaricom is the leading mobile telecommunications company in Kenya and has demonstrated market leadership in mobile payment services under their M-PESA brand. CarePay is the developer and administrator of the M-TIBA platform.

mSTAR: What are some of the major challenges and successes of M-TIBA? 

KL: M-TIBA has helped build improved insights into healthcare usage and the quality of delivery thereby changing behaviors amongst vulnerable and indigent groups by sensitizing them to making small, regular payments towards a health-financing scheme.

To date, more than 850 healthcare providers have been activated on the platform and a further 1,400 providers contracted. M-TIBA partners have recorded over 273,282 visits and paid out over Kshs. 476,453,810 [approx. US$4.6 million].

Despite the successful results, savings still present major challenges for individuals. A significant share of the population has no sufficient income to allocate savings regularly towards their health. There is also the fact that some individuals remain averse to using funds they feel are for a speculative need while they have other immediate needs for the money. With the help of the behavioral economists from the Center for Advanced Hindsight of Duke University, we are constantly trying to “nudge” people to do the right thing, despite these challenges described.

mSTAR: In developing countries, healthcare inclusion can be a challenge. How do you believe M-TIBA and other DFS systems can increase health care inclusion for low- and middle- income households?

KL: M-TIBA is transforming how low- and middle-income Kenyans are paying for and accessing healthcare. M-TIBA builds trust that resources are being spent for the right person, for the right care, at the right place, at the right time, at low transaction costs.

With the majority of Kenyans excluded from mainstream health insurance schemes, M-TIBA empowers them to take care of their own healthcare. It is providing long-term benefits to individual customers and the entire healthcare sector.

Users of M-TIBA can save for medical care and pay for and manage their insurance policy in a user-friendly way. For instance, we send regular reminders to people to pay their premium on time and make it a very simple process on their mobile phone to do so. They can also send healthcare funds from their own M-PESA accounts into the M-TIBA account of their dependents, specifically for healthcare needs. The platform channels funds for health services directly to recipients through the mobile platform, allowing them to track and monitor the use of funds effectively.

CarePay is working with a range of health financers on the M-TIBA platform, including government insurance agencies (e.g., NHIF), private insurance companies and brokers (e.g., AON/Minet, UAP), to develop applications for medical payments, remittances, savings, and insurance. By working with public and private insurers alike, we aim to have the largest impact across all income groups in the population.

mSTAR: What do you see as the emerging trends in DFS and health?

KL: We truly believe that mobile phone is the key to not only unlock more pre-payments and risk pooling for healthcare in emerging markets, but also to build constant and engaging relationships between payers (public and private health insurers, but also donors) and their members/beneficiaries. If we get this combination of risk pooling and customer engagement right, we can both stimulate and even financially reward healthy behavior, while decreasing healthcare costs for the payer at the same time.

And the most exciting thing for us at CarePay is that, just like Africa led the way when it came to mobile payments, now Africa again may be able to leapfrog the developed world when it comes to such breakthrough innovations in mobile technology.

mSTAR and USAID will be releasing more blog posts on the power of digital financial services to strengthen health outcomes. Stay tuned at the mSTAR Project to learn creative ways health practitioners can implement digital financial services in their programming.

Additional Links

Kees Van Lede is a Co-Founder of CarePay and has worked extensively in Africa and Europe in the FMCG and technology sectors. Prior to becoming CEO, Kees was the Chief Commercial Officer at Carepay. Kees was previously the mHealth (mobile health) Director of PharmAccess Foundation. In that position he led the organization’s mHealth activities in Kenya and the incubation of CarePay. Kees has also worked for Guidion and Unilever. He holds a Master’s degree in Applied Physics from Delft Technical University and an MBA from INSEAD Business School, France.