Scaling proven mobile maternal health e-vouchers in Western Kenya

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Scaling proven mobile maternal health e-vouchers in Western Kenya

Year Founded:
Organization type: 
for profit
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Changamka Microhealth is a Social enterprise whose mission is to use mobile technology to deliver innovative health financing solutions to those not covered by formal health and insurance programs. Changamka has developed a mobile phone based medical savings program, a maternal health e voucher system and a phone based microinsurance program.

About Project

Problem: What problem is this project trying to address?

The goals of our project are to dramatically increase the rates of skilled and institutional deliveries while generating generalizable knowledge about the effectiveness of this m-health program. Specifically, we plan to (1) double the rates of institutional and skilled deliveries in a population of 10,000 women in Western Kenya; (2) increase the rates of antenatal and postnatal care, in particular the number of women who receive four or more antenatal visits; and (3) improve the quality of care delivered by incentivizing CHWs. We hope to generate generalizable knowledge on: (1) the effectiveness of maternity and transportation vouchers; (2) the impact of SMS messages on the demand for care, (3) ways to reduce gender and cultural barriers by also targeting husbands and Birth Attendants

Solution: What is the proposed solution? Please be specific!

We have engaged Community Health Workers who use a poverty tool to identify eligible women, deserving of maternal health subsidy vouchers. Those who qualify are registered, Bio data and photographs taken and uploaded into our Cloud based Online Payer Provider Platform. The women receive e- vouchers on their phones which they present on their visit to health facilities. Upon validation/verification of identity and schedule of benefits, services are rendered in an absolutely paperless process. Health facilitie are given timely payments without having to lodge any claims or issue statements. Women not qualifying are registered on the microinsurance programme and encouraged to make regular savings on their phones until they reach the insurance premium threshhold.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

For the maternal health e voucher programme, our vision is to at least double the number of women delivering under skilled care in the selected districts, and eventually to scale this to the whole country. For the microinsurance programme, our first objective is to register at least 1 million families in the first twelve months and increase this to five million within three years.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

Since launching in 2009, we have reached approximately 15,000 individuals. However, we were not content with the pace of scaling as our technology was expensive and not always reliable. We thus embarked on a technology upgrade that will now ensure that we reach 1 million families (approximately) 5 million individuals or 12.5% of the population within 12 months. This number is planned reach 5 million families (25 million individuals) or approximately 50 % of the population in 3 years. Awareness creation and behaviour change are critical components of our activities. We have thus engaged with the Government to incorporate our activities into their plans in the areas in which we are operating. This has added critical validation to our operations.

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

To increase the registration of needy mothers from 1,500 in one district to 10,000 in four districts; to register 1 million families into the microinsurance programme within the first 12 months and to increase this to 5 million within 36 months. We aim to engage with the Government's National Health Insurance Fund to cross underwrite the microinsurance product so as to make it more affordable; and to use their countrywide network of accredited facilities as the avenue for achieving Universal Healthcare in Kenya.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Our peers and competitors comprise all who provide some form of health financing plans such as insurance companies and Health Management Organizations

Founding Story

Over 90% of Kenyans have no access to health insurance or any formal health plan. Over 90% of Kenyans have access to mobile phones More than 50% of global mobile money transactions happen in Kenya Aha! We can use mobile telephony and mobile money to deliver healthcare
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Explain what the "innovation" is about, e.g., is it the idea and/or the model you use to accomplish the idea, or your understanding of the target population, etc.?

Our first plan is to dramatically scale a proven e-voucher program that reduces financial, transport, and informational constraints to dramatically increase skilled facility-based deliveries in rural Kenya and to evaluate its impact using a randomized study design. We also further innovate and test ways to overcome cultural and gender-based constraints to maternal health care by engaging traditional birth attendants and husbands, and to improve the quality of care by incentivizing community health workers.
In addition, we have developed a microinsurance product that is procured on an individual's phone to overcome the challenge of distributing microinsurance and health services. Individuals who register, get a sequestered "wallet" in their phones in which they can save little by little as they accumulate enough funds, which automatically convert to premium when the set threshold is reached.

Describe how your innovation model is distinct from any other organization in your field?

Our e voucher program replaces conventional paper voucher subsidy programs and reduces administrative costs by almost 50% whilst increasing reach in an unprecedented way.
Our phone based Microinsurance plan enables anyone with a mobile phone and a mobile money account to subscribe and register for insurance; thereby significantly increasing access whilst lowering the affordability barrier by enabling individuals save little by little in a sequestered account.

What type of operating environment and internal organizational factors make your innovation successful?

Over 90% of Kenyans have no access to health insurance or any formal health plan and over 90% of Kenyans have access to mobile phones. The Government has put in place a conducive environment that supports innovation by eliminating taxes on IT hardware.
Changamka is an innovative organization, where new ideas are encouraged and nurtured; and investments made to support new ideas.

How do you make sure you constantly innovate in light of (potential) external challenges, or your growth plan?

Changamka invests heavily in research, monitoring and evaluation. Each of our projects has a research component to ensure that rigorous randomised evaluation is carried out and that results are fed back to ensure continuous improvement

Organization Country
Business Model
The systemic challenge you are trying to overcome (select one)

Bring accessible healthcare to communities in emerging markets

Health area (target market) where the need is [select only one]

Maternal care

Categories along the health continuum you are covering [select all that apply]


Stage that best applies to your solution [select only one]

Start-up and growth (pilot is successful and starting to expand)

Core strategies of your business model [select all that apply]

Approaches to behavioral change at the individual level, Patient-centered design, Redesign of the public healthcare system for more efficiency (in terms of processes, structure etc.), New/redefined roles for healthcare service provision, New approaches to distribution of health products and services, Unconventional partnerships (between traditional healthcare players and players outside healthcare), New financing strategies for health.

If other, specify here:
Most relevant tools you are using to implement the strategies outlined above [select only two]

Technology, Community financing.

If other, specify here:
What is your value proposition?

The affordability barrier can be reduced if individuals are given the mechanisms for saving in secure, sequestered little instalments on their mobile phones. Health Microinsurance is available to all who have access to a mobile phone and mobile money accounts. Access to healthcare is as easy as making a phone call.

Who is your customer(s)?

Our customer is the mother who needs subsidized Ante Natal, delivery and post natal services; the family which does not have access to health insurance but can put aside 40 US cents per day for this. Our other customer is the urban middle/lower class who need a solution to the health problems experienced by their close relatives living in rural areas

What approaches to you use to reach your customers?

With the support and active involvement of the National and District Ministry of Health officials we introduced innovative Demand Creation activities comprising of among others interactive peer engagement forums at village level as well as SMS messaging with the result that in just over one month, we recruited more than 500 women into the experimental pilot program, demonstrating overwhelming demand for the vouchers.

What are your primary activities?

Our primary activities involve communication and behaviour change campaigns, enrollment of eligible individuals into either the maternal health or microinsurance programs. We also engage Hospitals and make regular, timely payments to them.

What other challenges - individual, organizational, or environmental – are you currently facing or might hinder future success of your business, and how do you plan to overcome those?

Financing a social enterprise is a major challenge. In order to break the affordability barrier, our services have to be very low priced, meaning that we have to on board a large number of individuals. We have overcome this by developing a mobile application to enable individuals do a self subscription.

Briefly describe your growth strategy going forward

We have established unmatched strategic partnerships with Safaricom, the largest mobile network operator; the ministry of health and Britam, one of the largest health underwriters in our market. Our strategy is to leverage the resulting synergies to create sustainable customer value. Safaricom's 17 million customers provide a captive market that can be easily retained through superior service.

What dimensions for growth are you currently targeting for your innovation [select all that apply]

New customer group(s), New regions(s), New market(s)/country(ies).

What makes your business "ready" for growth?

We have carried out the research, developed the products, proved the concepts, carried out the pilot runs, developed the marketing concepts and collateral; and have some of the greatest testimonials- we are therefore ready.

What are your key growth objectives?

To increase the registration of needy mothers from 1,500 in one district to 10,000 in four districts; to register 1 million families into the microinsurance programme within the first 12 months and to increase this to 5 million within 36 months.

Organization's Country of Operation
Social Impact
What methods for quantification of social impact are you applying (if at all)?

We have not yet embarked on measuring social impact

Could your solution work in other geographies or regions? If so, where?

Our solution can work in any geographical region , provided there is a reliable mobile telephone network and a mobile money culture

What is your projected impact over the next 1-3 years?

5 million individuals in 12 months and 25 million in 3 years

Elaborate on your current financing strategy

The company has three product lines. Grants are for specific projects and to the extent of using our resources, get compensated for these resources, thus enabling us to cover a sizeable component of our overheads. Our social entrepreneurial line relies on grants. We have developed a commercial line- microinsurance which we expect to start returning profitability by the end of 2014. This line is planned to cross subsidise the loss making/social entrepreneurial lines of the business. We are currently seekung capital injection into the company to help realise the business goals that we have set.

Share of revenue generation in total income of organization (in percent)


Direct sales to patients or other beneficiaries (in percent)


Of the possible sources of these sales listed below, check all that apply to your current strategy

Individuals, Patients, Private businesses.

Licensing fees, e.g., for technology/franchise model (in percent)

$ 1.25 per customer registered per annum

Of the possible sources of these licensing opportunities listed below, check all that apply to your current strategy

Foundations, NGOs, Private businesses, National government.

Service contract with organizations, e.g., government, NGOs (in percent)


Of the possible sources of the service contracts listed below, check all that apply to your current strategy

Foundations, NGOs, Private businesses, National government.

Explain your revenue generation strategy in more detail

On our microinsurance product we earn a net of 7.5% on each sale made. We have signed up a distribution plan with Safaricom, by developing a mobile application that is integrated to the Safaricom M PESA platform This allows us to directly market via SMS to all, Safaricom clients and to enable them to self subscribe for the insurance services.

Share of philanthropy in total income of organization (in percent)

50% currently but planned to go down to 25% by 2014

Philanthrophy strategies you are using

Diversified strategy.

Explain your philanthropic approach in more detail

We sell a subsidized maternal and family health card to needy individuals. We have the further strategy of engaging with large corporate organizations to subsidize these costs through a structured Corporate Social Responsibility program

Expand on your selections; explain how you will sustain funding over the next 1-3 years.

We are launching a large microinsurance programme in June 2013. The marketing and distribution costs in year one are large and a loss is expected in year 1. However year 2 is expected to realise a small profit. Year three will see a major increase in profitability as the product will have matured and efficiencies also achieved especially in the areas of Marketing and Distribution. As a result we are currently seeking an injection of equity to the tune of $1 million to help us meet the initial costs of taking the product to market.

Years in Operation

Operating 1-5 years

Has the organization received awards or honors? Please tell us about them

Kenya MDG 5 Award in 2010 for Innovation
CIO Award in 2011 for Innovative Health Technologies;
East African CHMI Award for Innovative Health Technologies;
Saving Lives at Birth Grand Challenges Grant Award;
United Nations Foundation Innovation Working Group Grant Award;