Health4Moni

Aisha is an average Nigerian, a farmer who noticed a lump in her breast and despite knowing she needs to go to the hospital to have it checked she doesn’t have the money to pay for the hospital bills she will incur. Months roll into years and Aisha still has the lump, until it begins to deteriorate. When she finally goes to the hospital, she is diagnosed of stage IV breast cancer and needs over 4 million naira (about $8000) for treatment that may or may not save her life. This is the case of many average, informal sector Nigerians.

There is an outrageous high reliance on Out-Of-Pocket (OOP) health payments as a means of financing health system in Nigeria. According to the World Bank, the WHO Health Expenditure Database shows Nigeria’s OOP spending at 70.5% as at 2019 compared to Rwanda at 11.6% and Ghana at 36.2%.

This reflects a significant financial burden on Nigerians when they need to access healthcare which eventually affects their health seeking behaviour. So an average Nigerian has two options when they get sick, one; delay getting medical care due to unaffordable Out Of Pocket payment and like Aisha the sickness eventually maims or kills them, two; pay out of pocket causing financial distress eventually pushing them below the poverty line (impoverishment). About 1.3 million Nigerians are pushed below the poverty line due to OOP payment.

In an attempt to address the lack of financial risk protection, the Federal Government of Nigeria in 2005 kick-started the National Health Insurance Scheme (NHIS). However over the years, evidence suggests that less than 5% of Nigerians mainly federal government workers are insured under this scheme and less than 3% of the Nigerian population are under the private health insurance. Over 90% of Nigerians pay OOP for healthcare and this is supported by both WHO and World Bank statistics.

Factors that contribute to the problem of high reliance on Out Of Pocket includes: lack of adequate information about existing financial risk protection services, ignorance and bias about health insurance, nonchalance of the public sector to invest in health financing, poor health seeking behaviour and poverty.

WHO estimates that globally over 150 million people incur catastrophic health expenditure while over 100 million are pushed into poverty due to OOP health payment. On average globally, OOP payments for people in low- and middle-income countries (LMICs) represent around 40% of health spending and present a significant barrier to access and utilization of health services.

There is an apparent need for an urgent intervention, hence our innovation.

Health4Moni provides informal sector Nigerians access to healthcare services without fear of financial burdens via an affordable and instalmental community based health insurance plan with premium payments of less than $1.5 per month and $16 per year and provision of poverty alleviation services to enrollees via collateral free, small interest loans, entrepreneurship education, financial literacy and links to markets.

 
Via our research, we realised that poverty was an underlying rationale for a bulk of the informal sector Nigerian’s preference for OOP payments and this is why we developed a poverty alleviation program to fix the problem of poverty and to serve as an enrollment-bait for members of the community.
Health4Moni works along this pathway: 
1. We partner with Community Health Workers (CHW) to provide the communities with adequate information about the community based health insurance plan and its benefits, as well as erase doubts and bias about health insurance. We also invest in strategic relationships with stakeholders in the communities such as community leaders, influential persons in the community, religious and group leaders who help us sell the idea of community based health insurance to the members of their community.
 
2. We enroll members of the communities into the community based health insurance program. During our design thinking stage, we realised in order to cut cost we did not have to start an health insurance program from scratch. Hence why we integrated the existing and effectively running Oyo State Health Insurance Agency services for our Community based health insurance program. This in turn saves us time, cost, human and material resources and starting from scratch.

3. We provide entrepreneurship training and assessment to enrollees interested in starting or funding a viable business. Collateral free, small interest loans will also be issued to interested and qualified enrollees coupled with financial literacy and matching entrepreneurs with existing local and international markets. 

We can save millions of Nigerians from highly preventable deaths if only they don’t have to rely on out of pocket payments before they can access healthcare. With Health4Moni, Nigerians especially the informal sector who seem neglected by the existing federal government financial risk protection services can be covered and protected by our community based health insurance plan and not only so, they have an opportunity to rise above poverty. 

For example, using Aisha as a case study, if she was enrolled in the Health4Moni Community Based Health Insurance Program with premium payment of $1.33 monthly (  weekly and $0.04 daily) she would have immediately gone to the hospital to check the lump in her breast as she wouldn’t be afraid of the financial burdens of out of pocket payment as Health4Moni will have her covered. A lumpectomy could have been done as this is covered under the plan and Aisha would still be alive today.

Evidence suggests that less than 5% of Nigerians mainly federal government workers are insured under this scheme and less than 3% of the Nigerian population are under the private health insurance covered by their employees. So the question is how does the market woman and her kids access affordable, financial risk protection services? 

Via Health4Moni, we can serve the over 90% of the Nigerian populace without health coverage, especially the informal sector. 

We do this by providing instalmental premium payments and this was developed based on our interactions with our beneficiaries and realising how they earn their income, most of the informal sector Nigerians are daily earners so an instalmental premium payment seemed best and note that this is not provided by the government health insurance plan.
Health4Moni will impact the lives of our beneficiaries in two major ways:
1. Reduce drastically the number of highly preventable deaths via our affordable access to healthcare services without fear of financial burden or risks.
2. Alleviate poverty amongst this demography of people via our entrepreneurship training and small interest loans; informal sector happen to make up a large percentage of those living below the poverty line in Nigeria.

Beyond our sterling professional capabilities to effectively deliver and scale the reach of Health4Moni, this problem hits closer to home. We got tired of seeing friends and family open GOFUNDME and fundraiser accounts in order to pay for healthcare services they couldn’t afford out of pocket when they got critically sick. I decided to pursue a Masters in Public Health while focusing on Health Financing Options for community settings. 

At the very early stage of our start up, we would fundraise a pool of money and then support chronically sick persons in our communities but before we knew it the money was finished and then we fundraise again. But we knew this model wasn’t sustainable so we took a design thinking route. 

We went to our communities, the people we cared about and whom had been victims and asked how could we help and we compared the existing models and how we could adjust them with the answers from our survey with our beneficiaries, thereby creating the Health4Moni innovation.

One of the results of our design thinking was discovering that most of the informal sector are daily/weekly earners so we incorporated the instalmental premium payment option. We also discovered the underlying cause of poverty as a major determinant in the grand scheme of things and hence why we created the financial and entrepreneurship literacy services to fix the problem of poverty. The whole model is built on design learning and communication with our beneficiaries.

We currently have a committee of stakeholders in the community who 'own' the idea, brainstorm with us, voice the interest of their community and ensure the project goes on.

Our biggest challenge and why we are applying to Solve is the need to incorporate a technological system to simplify the entire Health4Moni innovation.

We also look forward to the wealth of knowledge of mentors as well as mutually benefiting partnerships to scale the reach of our solution to millions of Nigerians.