Learning from Financial Inclusion to Improve Health Access in Nigeria

There is a strong link between financial exclusion and health exclusion in Nigeria. The North-West and North-East regions have the highest rates of financial exclusion, with many states above 60 percent. These areas also face significant health exclusion and health equity issues. Women, especially in the North, experience the highest financial exclusion, which relates to health challenges. Financial exclusion mainly affects people in rural areas, and health exclusion follows the same pattern.

You can almost lay Nigeria’s financial exclusion data from the EFINA Access to Finance Research over the health exclusion data from the Nigeria Demographic Health Studies (NDHS). The two sets of data look very similar. The common link between financial and health exclusion in Nigeria is poverty. The more severe the poverty, the higher the barriers to both health and financial access. We need to find ways to apply what Nigeria has done to improve financial access to fix health access problems and equity issues.

Nigeria has a serious health exclusion and equity problem. The under-five mortality rate is 102 per 1,000. This means one out of every ten children dies before reaching five years. Maternal mortality stands at 500 per 100,000. Malaria affects 15 percent of the population, and Nigeria carries the largest share of the global malaria burden at 27 percent. Meanwhile, Nigeria has made significant strides in financial inclusion, with formal financial inclusion rising from 36 percent in 2010 to 64 percent in 2023. Access to digital payments more than doubled from 22 percent in 2010 to 52 percent in 2023, according to EFINA Access to Finance data. Here are ten lessons from financial inclusion that could help improve health solutions and tackle health equity issues in Nigeria.

1. Scale, Reach and Access as the Core Mindset for Solving the Problem: Financial exclusion is viewed as a chance for innovators to create large-scale solutions. This is what fintech companies and banks have done to improve financial access. They focus on finding solutions that can greatly increase financial access rather than just making small improvements. How can we apply this mindset to innovate health access solutions in Nigeria?

2. Digital Technology as a Tool for Scaled Innovations: Digital technology has lowered transaction costs significantly. People no longer need to travel to bank branches for transactions, especially in rural areas. They can use their mobile phones or visit a nearby POS agent. A $100 POS terminal can now do what used to require expensive bank branches. Digital technology connects people, expands markets, and provides services at much lower costs. How can we use digital technology to reduce costs in healthcare and improve access on a large scale?

3. Technology as An Enabler of New Innovative Business Models: Digital technology has also allowed the creation of new business models in financial services. It has lowered transaction costs and opened up markets that were previously ignored. Banking has changed from a physical location to a service that can be accessed anywhere. What similar changes can we make in the health sector? What new business models can digital technology create to improve health equity?

4. Progressive Regulations that Support Innovators and Competition: Nigeria’s success in financial inclusion is partly due to supportive regulations from the Central Bank of Nigeria (CBN). The CBN introduced new fintech licenses to promote competition with traditional banks. It also formed a new Department of Payment Services to oversee this area. If left to traditional banks, many people would still need to rely on bank branches for financial services. How can we replicate this supportive environment for health systems to encourage innovators addressing health access challenges?

5. Digital Public Infrastructure as Public Good: Financial inclusion in Nigeria has thrived on digital public infrastructure like the national digital identity system (NIN) and the Bank Verification Number (BVN). These systems allow private innovators to build financial services on top of them. Without this infrastructure, scaling would be too costly for many. What digital public infrastructure do we need in health systems to support private innovators solving health access issues?

6. Interoperable Systems to Enable Complemented and Accelerated Scaling: Today, money can move easily between banks and fintechs because of interoperable systems. This connectivity has been key to expanding financial access. How can we create interoperable health platforms that enhance cooperation among health service providers to improve access and equity?

7. Platform Thinking: Players in the financial system think in terms of platforms, not just individual solutions. They build systems that can offer various services like payments, loans, and insurance on a single platform. This approach creates efficiencies. For example, Ping An in China started with health insurance and evolved into a comprehensive health service platform. How can we develop a similar platform approach in health systems for better access?

8. Ecosystem Partnerships: Strong partnerships have helped financial services scale. Successful transactions involve many players like banks, apps, and payment processors working together. How can we build partnerships among health service providers using digital technology to enhance access, even in remote areas?

9. Data as Gold: Nigeria's health system has a lot of disconnected data that could be valuable if linked. By connecting health data, we can create targeted products and services to improve access and equity, similar to financial services that emerged from better data use.

10. Design Thinking: Customer Co-creation of Solutions with Scale: Financial inclusion has thrived in Nigeria thanks to well-designed products that are easy to use. Successful services involve customers in the design process. How can we apply this design thinking in health systems to ensure solutions meet the needs of users?

Conclusion

The goal of Health for all by the year 2000 was set by the World Health Organization. Nigeria adopted this goal three decades ago, aiming for an inclusive health system where no one is left behind. We have fallen short of this goal, but with digital technology, we can still close the gaps. Digital technology can reach far and do so affordably, just like financial inclusion has shown. Both health and financial sectors can learn from each other to create a more inclusive society. These ten lessons from financial inclusion should guide our health access and equity programs. Let us work together for success.