NaYa: digital health financing for low income and providers

80% of Central and West Africa's population works in the informal sector, with women accounting for 89% of the workforce, lack universal medical coverage. According to the World Bank, more than half billion people fall into extreme poverty due to impoverishing out of pocket health care costs. We are solving for the lack of resources faced by low income informal workers to withstand health crises-induced poverty and maintain productivity.
  While  informal community saving groups "African tontines"  have been a prevalent savings and shock resilient tool for vulnerable informal workers, they are underfunded to address health crises-induced poverty. Furthermore, low earning and sporadic income exclude most informal workers from accessing funds and risk management resources to withstand sudden health crises and maintain the productivity necessary for wealth building. 

To address the lack of reliable access to funding access and risk management resources for low income informal workers to withstand crises and thrive, our proposed solution offers a portable health-only saving account bundled with a tailored affordable digital health credit, secured by their tontine savings contributions and good standing membership. With the cashless credit, informal workers can: 
a) access healthcare services even when they have limited funds and pay for it later, 
b) ensuring payments to small business primary care providers, 

c) informal workers can easily make portable contributions to health-only savings accounts for future health expenses at no cost.

d) In addition, our cashless health credit and health saving solution can incentivized Tontines' membership and increase related-cashflow capability for strategic communities wealth building initiatives. 

The digital solution, facilitated by an integrated health savings and health loans digital platform connected to savings groups and healthcare providers, addresses individual- health risk management, cost barriers, and providers' payment collection. Thereby, reducing illness-induced poverty and enabling better revenues for local medical providers while maintaining affordable services.
Overall, the "care now and pay" later structure of our health credit facility is  adapted to the irregular revenues of informal workers and acts as a safety net extending the African tradition of Tontines: allowing now patient member to access affordable funding for sudden illness without delays, and maintain their productivity.

Our solution will serve : informal workers, medical providers and insurance companies. 

1.Informal workers 

In sub-Saharan African, 89% of informal workers are women., with the majority lacking social and medical benefits. This putting them at high risk to fall into health-crises induced poverty. 

 1 in 2 people in Cameroon are tontines members. Learning from our pilot phase providing digital health credit to uninsured people in Cameroon, we established  that over 70% of our clientele comes from the informal sector with the two third being African women market. They seek  informal high-interest loans from peers and tontines to cover for unexpected medical expenses and loss of revenues. As small business owners, they have some financial knowledge necessary to understand the benefit of maintaining productivity for wealth growth and cash. Our digital solution improves their lives by providing them with: 

a) The peace of mind with a credit facility to act as a safety net when money is short

b) Quick access to cashless funds to return to productivity with minimum impact on their business cashflow

d) Timely and fast access to funds without delays associated to cash loans approvals 

e) Wealth protection mechanisms through the health saving card making easy to make portable contributions to a health-only accounts for future medical expenses, shielding their savings from non-medical spending.

f) mental space for recovery with our get care care now and pay later , adapted o irregular revenues.

2.Medical providers needs steady cashflow to source and maintain affordable medicine. However, the irregular demand in health services from low income population affects care affordability and results in providers  missing out revenue opportunity for providers. With the integration of payment to care disbursement in our solution, providers will secure payments from a population they traditionally underserve.

3. Insurances need current health consumption data on the target population to effective micro-insurance cost-pricing. Anonymized Health population data generated during care delivery in our network will provide insights to them for designing affordable insurance coverage fitted for low income.

Born and raised in Central Africa (Cameroon), with an international and African experience in health care innovation and finance, our founding team members have the cultural understanding of the preferences, perceptions of the targeted population vis-à-vis innovation.

Building on our proof-of-concept phase for our digital health credit, our local team representatives has the field experience of working and gaining adoption of informal workers for digital health financing tools, which insights are necessary to achieve market fit.  Therefore, to insure  that the design and the implementation of our solution is guided by real target population's insights we have two key processes in place:

 1. Insights gathering at advisory meetings  from medical providers and local associations

2. A North Star Metric centered on customer satisfaction of top expressed pain points. 

Moreover, NaYa managing team has complementary expertise in financial/investment services, team building, health care products launch, partnerships and Data analytics in Africa and North America.

Lastly, with the expertise of a key member of our advisory team, we will develop strategic plan anticipation of Cameroon MOH's pilot of a universal health coverage Cameroon program in the coming months. The advisor is a former bank officer at the reserve bank of Cameroon (BEAC), founder of Cameroon finance advisory and SME funding firm Marabout Finance and the current Regional Coordinator for Central Africa of the African Business Roundtable.

Usage statistics from the NaYa's digital interfaces per 1.01.2023                           

• Registered and pre-registered users: 1400
• Medications accessed: 300
• Affiliated pharmacies and primary care providers: 5
• Patient associations and captive community: 100
• Health records (medication history): 600
• Socio demographic records:4470

We tested our solution with a selected group of medical providers in Yaounde (Cameroon's capital), and a subset of our target population identified. To implement the solution through strategic partners distribution channels and recruit more providers we would need:  

1. Partnership-focused introductions with countries' association of African market women market, medical insurance companies, pharma industry, the World Bank and government agencies to establish market access dynamics which can drive impact locally in Cameroon and at scale in the Central African region.
2. Expertise in market expansion
3. To ensure the solution sustainability in targeted markets we need advisory services from business strategists with experience in African Fintech in the following domains:

• • Technology and AI innovators 
  • Legal requirements 
  • Pricing: for the development of license agreement for data access
  • Access to in-kind resources in marketing as well as media exposure

Our solution is rooted into decades-old well accepted African tradition of community assistance ''tontine'' which enables cultural unlike tradition cash medical assistance from banks. With our digital we are innovative because:

1. We extend existing tontine' support to its members and grow the group cashflow for future wealth building communities initiatives

2. We increase the digital and financial inclusion for an underserved low income population with a credit facility requiring no upfront spending from beneficiaries

3. We provide revenue growth opportunity to local medical providers 

4. we allow planning of social protection mechanism: individuals can grow health savings and insurance can access health data to offer fitted  health-related wealth management insurance product.

Traditionally bank lenders focus on business loans and require monetary collateral to service the loans, all factors which preclude  low income to access funds for health crises threatening their productivity not serve.
We anticipate that our bundle of health saving and health credit coupling to population health data will  open opportunities for micro medical insurances to identify and serve an until-then hard to reach  and serve low-income population. 

One Year Impact Goal:

1. Provide reliable access to healthcare services for 10,000 low-income informal workers through our portable health-only saving account and affordable digital health credit. Achievement:

• Implement the digital platform and establish partnerships with savings groups and healthcare providers.
• Conduct targeted outreach and awareness campaigns to reach the informal worker population.
• Offer training and support to ensure understanding and utilization of the health-only saving account and digital credit facility.
• Track and measure the number of informal workers accessing healthcare services and making contributions to their health savings accounts.

Five Years Impact Goal:

1. Improve the financial resilience and well-being of 100,000 low-income informal workers through our solution, reducing illness-induced poverty and increasing access to affordable healthcare. Achievement:

• Scale up the implementation of the portable health-only saving account and digital health credit to reach a larger number of informal workers.
• Establish partnerships with additional savings groups and healthcare providers across the target regions.
• Enhance the digital platform with additional features to improve user experience and accessibility.
• Conduct impact assessments to measure the reduction in illness-induced poverty and improvement in financial resilience among the informal worker population.
• Collaborate with local stakeholders and government agencies to advocate for supportive policies and regulations that benefit low-income informal workers' access to healthcare and financial resources.

These impact goals will be achieved through a combination of strategic partnerships, targeted outreach, user education and support, continuous improvement of the digital platform, and ongoing monitoring and evaluation to track progress and make necessary adjustments.

Progress indicators are listed against 1-year and 5-year goals described in the previous section and are indicated below with the numbers 1, 2, etc... 

Current and Next Year Indicators:

1. Number of low-income informal workers enrolled in the portable health-only saving account and digital health credit program.
2. Number of partnerships established with savings groups and healthcare providers.
3. Percentage of targeted outreach and awareness campaign goals achieved.
4. Number of informal workers trained and supported in utilizing the health-only saving account and digital credit facility.
5. Number of healthcare service utilization by informal workers through the digital platform.
6. Number of contributions made by informal workers to their health savings accounts.

Five Years Indicators:

1. Total number of low-income informal workers benefiting from the portable health-only saving account and digital health credit.
2. Number of partnerships established with savings groups and healthcare providers across different regions.
3. Level of user satisfaction and feedback on the enhanced digital platform features.
4. Percentage reduction in illness-induced poverty among the informal worker population.
5. Improvement in the financial resilience of informal workers, measured by indicators such as increased savings, reduced reliance on informal loans, and increased ability to cover unexpected health expenses.
6. Number of impact assessments conducted to evaluate the effectiveness of the solution in improving financial resilience and reducing poverty.
7. Policy and regulatory changes implemented through collaboration with local stakeholders and government agencies, supporting low-income informal workers' access to healthcare and financial resources.

These indicators will help track the progress towards the goals and assess the impact of the solution in providing reliable access to healthcare services, improving financial resilience, and reducing poverty among low-income informal workers.

We expect that a) activities related to the implementation of our solution, a portable health-only saving account and digital health credit system, b) will generate immediate outputs c) which in turn will contribute to longer-term improved financial resilience outcomes. These improved outcomes include: the reduction of illness-induced poverty, and increased access to affordable healthcare services. By incentivizing Tontines' membership and connecting savings groups and healthcare providers through a digital platform, our solution aims to create a positive impact on the target population and facilitate economic stability for low-income informal workers.

Theory of change flow elements:

1.     Problem Statement: Low-income informal workers lack reliable access to funding and risk management resources, which hinders their ability to withstand crises and thrive.

2.     Activities: a) Offer a portable health-only saving account bundled with a tailored affordable digital health credit, secured by tontine savings contributions and good standing membership. b) Develop a cashless credit system that allows informal workers to access healthcare services even with limited funds and pay for it later. c) Facilitate easy and portable contributions to health-only savings accounts at no cost. d) Incentivize Tontines' membership and increase cashflow capability for wealth-building initiatives in strategic communities. e) Establish an integrated digital platform connecting savings groups and healthcare providers to address individual health risk management, cost barriers, and providers' payment collection.

3.     Immediate Outputs: a) Portable health-only saving accounts and digital health credit system implemented. b) Informal workers have access to healthcare services despite limited funds. c) Informal workers contribute to health savings accounts for future health expenses. d) Increased Tontines' membership and enhanced cashflow capability for communities. e) Digital platform connecting savings groups and healthcare providers established.

4.     Outcomes: a) Reduction in illness-induced poverty among low-income informal workers. b) Improved financial resilience and well-being of informal workers. c) Increased access to affordable healthcare services. d) Better revenues for local medical providers. e) Maintenance of productivity and economic stability for informal workers.

Our multifaceted digital health saving & financing platform with health record system capability integrates:
a. A patient and provider facing -chatbot app for health financing request/approval, health savings contribution and data capture
b. SMS technology for patient education and offline access to health financing
c. Artificial intelligence and data analytics powered website for providers and patient visualization of health history and related-costs.

Equity and diversity are at the heart of our operations and leadership approach. 

1. Our managing team is woman-led and with a local team composed of different ethnic tribes representing the social diversity of the country where we we operate. 
2.  In our operations, we've establish a patient care satisfaction survey to collect data to benchmark health equity gaps in the patient experience at partner health facilities. 
3. Understanding that care costs is, for our human talent living in countries with no universal health coverage, we provide health coverage support to our local staff in form of prepaid in-pharmacy /hospital digital credits and paid time-of for family emergency.
4. In our business model, to increase access to treatments and reduce costs to patient, we've made accessible free resources for low income patients to find comparable medicine costs, allowing them to discuss treatment affordability transparently with their caring team and family caregivers. 
5. We purposely designed our approach to serve low income women with our offering and outreach strategy as they form the bulk of our target market: informal workers.

We provide service to three customers types: individuals informal workers via their tontine membership, medical providers, and medical insurances

1. Individuals: pay-as-you go service flat fee when using the digital health credit with differed payment.  Impact value: there is no charge for holding or requesting a pre-approved health credit which makes is attractive and affordable for individuals customers who are cash constrained. b) free health saving accounts c) reduce productivity loss to sick days. 
2. Impact on tontines: freemium subscription comes with increase and retention of membership  as well the growth of the group's cashflow via member's access to our offering
3. Medical providers access the free-subscription allowing them to serve a new customer universe with the promise of stable revenue  inflows at no costs. In addition, they benefit from a free digitalization of the pharmacy and care interventions records helping them understand costs of care and plan health care service supply and availability.
4. Medical insurances will access health data through licensing. Incentives to buy licenses from NaYa include:

1. • Obtaining current population heath data to reach the right populations with the most relevant offerings.
   • Designing competitive micro insurance products  which address vulnerable patients' affordability levels and personalized local care needs.

We plan on becoming financially independent by:

1. Entering customer agreements with:
   1. Informal communities savings groups known as ''tontines'' and offer a fee-for-service digital health financing (care now pay later) and health-only saving option to their members.
   2. Medical insurance companies  and the World bank programs developing risk management and social protection mechanisms to address vulnerable populations' resilience to crises.

2. Offering licenses to NGO's, MoH and health insurance companies to access anonymized geographic- relevant population health data. 

3. Market linkage partnerships with healthcare providers, savings groups, and other stakeholders to enhance the reach, credibility, and revenue potential of the solution.

4. Expansion and Scalability: leveraging the adaptable nature of the digital platform, the solution can be expanded to other regions and countries facing similar challenges.

1. The founding team: self-funding over the past 5 years contributing towards  capital investment: $75 000
2. We secured ''pay later'' agreements with medical providers
3. Provided access to 300 medicines to low-income informal workers (pilot)
4. Grants:
   1. ORANGE Cameroon Social entrepreneur 1st and women's prizes: $ 6000
   2. OLIN Competition and crowdfunding: $4190