Health and Healthcare

How Africa's fintech boom can boost inclusive healthcare

A healthcare worker looks up patient information on her phone at a pharmacy.

Around 43% of Africa's population lacks access to basic healthcare, but the technology behind its fintech could change this. Image: PharmAccess

Nicole Spieker
CEO, PharmAccess Foundation
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  • Innovative, Africa-made fintech solutions are driving greater financial inclusion for those previously unbankable and excluded, like the poor, the young and women.
  • Africa is falling behind on Universal Health Coverage (UHC) targets: around 43% of the population lacks access to basic healthcare and about 11 million people are driven into poverty annually as a result of paying for healthcare.
  • But the technology powering the fintech boom can transform health systems and reach those most excluded.

Mobile technologies are transforming economies and sectors across Africa in ways that nobody imagined 20 years ago: by driving financial inclusion and fast-tracking economic growth.

Fintech is now Africa’s fastest-growing start-up industry and is anticipated to continue growing by 10% annually and reach $230 billion by 2025. This growth is partly fuelled by increased mobile phone adoption and expanding network coverage, coupled with a young and rapidly urbanizing population. Africa is the frontrunner in mobile money innovation and adoption, accounting for almost 70% of the world’s $1 trillion mobile money market. In sub-Saharan Africa, close to 10% of GDP in transactions occur through mobile money, compared to 7% in Asia and 2% in other regions such as the US and Europe.

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This fintech boom has been expedited by the region’s lack of traditional banking services. Sub-Saharan Africa currently has only 4 commercial bank branches per 100,000 adults, compared to 17 in high-income countries. Mobile phone availability has enabled millions to access alternative financial services at their fingertips at very low costs – mobile money accounts now surpass the number of bank accounts in the region. By 2025, there will be more than 600 million unique mobile money subscribers in Sub-Saharan Africa, covering over 50% of the population.

Crucially, the poor do not need smartphones or bank accounts to access mobile money, with the service operating seamlessly on feature phones (for example, old Nokia models) for anyone with a phone number. It has therefore been a gamechanger for financial inclusion in Africa, giving access to those who were unbanked and excluded. Kenya’s M-PESA is the most prominent example, which operates on technology similar to text messaging and is used by 51 million customers across seven African countries.

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The ripple effects of mobile money have been immense: one study suggests a 2% reduction in poverty due to better access to mobile money services in Kenya, driven by increased financial resilience and saving. Mobile money can increase savings too, providing customers with an accessible tool to store and manage their money. For instance, women in Papua New Guinea use MiCash primarily to save money. Increased savings improves the ability to respond to financial needs and exogenous shocks, allowing women to invest in their livelihoods and futures and increasing their economic agency.

Bringing fintech's benefits to healthcare

In most African countries there is inequitable and limited access to healthcare. The sector faces poor quality of care and low public trust caused by inefficient spending, underinvestment and population expansion, which in turn hamper countries’ efforts to achieve Universal Health Coverage (UHC). More than half of Africa’s population lacks access to the basic healthcare services. Furthermore, about 15 million Africans fall into poverty annually as a result of having to use their household income to access basic healthcare.

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At the same time, high mobile phone penetration has connected nearly everyone at almost no marginal cost and the huge potential of this needs to be unlocked to transform healthcare towards UHC. There are apps and websites that inform individuals about their healthcare needs, but most people are not able to take full advantage of mobile technology to access better care.

For example, healthcare facilities store patient data in a fragmented and inefficient manner, and IT systems are not connected, making it difficult for providers and patients to access data to improve health outcomes. Mobile technology can help address these issues while also facilitating the mobilization and equitable redistribution of funds and healthcare services to reach the vulnerable and marginalized populations. By generating real-time data on financial flows and care delivery, technology can also help improve transparency and efficiency in spending and improve the quality of care to drive better outcomes for patients.

Crucially, digitalization and data open the door to develop patient-centric, value-based care models that incentivize efficient spending by healthcare providers by ensuring they are paid based on patient outcomes.

The role of digital technology in financing Universal Health Coverage (UHC).
The role of digital technology in financing Universal Health Coverage (UHC). Image: PharmAccess

For governments, digital tools generate timely data to guide decisions around resource allocation and build the health system resilience needed during health emergencies. For patients, innovations empower individuals to access services and take control of their own healthcare. For health financing, in particular, digitalization can help expand low-cost health insurance coverage to large uninsured segments of the population at low marginal cost.

CarePay, a Dutch-Kenyan social enterprise, for example, supports countries through an inclusive digital platform that connects patients, providers and payers (health insurers) for the financing and delivery of care to increase access, improve efficiency and reduce costs. Named M-TIBA in Kenya, 5 million people and 4,000 healthcare providers are connected to the platform. It includes a mobile health wallet, empowering individuals to save money, access entitlements and pay for health services using their phone. For governments, donors, healthcare providers and health insurers, the platform channels financial data and collates health data.

Stimulating investments and empowering female entrepreneurs

Mobile technology is also driving funds into the private health sector, which delivers 50% of care on the continent but is saddled with underinvestment. Cash Advance from the Medical Credit Fund (MCF) allows health SMEs to quickly and easily access loans using their mobile phone. Repayment is based on mobile money revenues and no collateral is required. This is a gamechanger, especially for female healthcare entrepreneurs who often lack the collateral needed to access capital and can now expand their businesses and improve the care they provide to patients (many of whom are low-income or from the informal sector). So far, MCF has disbursed $150 million to 2,000 small-size healthcare providers with a loan repayment rate of 96%.

Telemedicine and remote care

In Ghana, a new non-communicable disease (NCD) care app has been developed by digital health innovator Luscii together with the University of Ghana Medical Center, 37 Military Hospital and the Greater Accra Regional Hospital. It allows patients with diabetes and hypertension to track their blood pressure and blood sugar, which are then monitored and managed remotely by doctors in real-time. Similar remote monitoring solutions are being developed in countries including Kenya and Tanzania, and will be important for managing the growing burden of NCDs on African health systems.

Healthcare staff at Gertrude’s Githogoro Children’s Clinic, Kenya, use mobile phones for administration and to verify patients' entitlementsstaff using mobile phone for administration and to verify patients' entitlements
Healthcare staff at a children's clinic in Kenya use mobile phones for administration and to verify patients' entitlements. Image: PharmAccess

Innovative financing models for greater impact

Perhaps most transformative is that digital tools can deliver innovative financing models for resource allocation. Value-based healthcare (VBHC), for example, shifts health systems from a focus on volume to value, described as delivering the best possible outcomes for patients in a cost-effective way. Technology can help deliver VBHC by digitally tracking care quality and making payments for providers conditional to good health outcomes.

In Kenya and Tanzania, the MomCare initiative developed by PharmAccess, in collaboration with MSD for Mothers, Children’s Investment Fund Foundation (CIFF) and the Dutch Ministry of Foreign Affairs, is a leading example of a digital VBHC model and supports 50,000 mothers with quality pregnancy care. Meanwhile Ghana, one of Africa’s pioneers in health insurance with 17 million people insured, is preparing to implement VBHC using digital tools and data to increase efficiency of spend and expand services to more people.

As these examples show, using digitalization and data as a public good can result in a healthier society, bringing social and economic benefits for all, including those who need our solidarity the most.

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Health and HealthcareFinancial and Monetary SystemsEmerging Technologies
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