Lafya HealthShare

Over the years I have seen first hand how people can find it difficult to pay for medical expenses, how it affects their health and cause them to loose their social dignity. It is almost a cultural norm in Nigeria to visit a sick friend or family member and part with a little amount of money because you know they might have a challenge paying the bill.

About 15 years ago my late dad was diagnosed with Parkinson’s disease, it was nothing serious at the beginning until the disease progressed to a stage where he couldn’t do anything without his drugs. During that time we were always going for follow-up visits at the hospital to consult with neurologists on a bi-monthly basis. The cost of the maintenance drugs required to keep my dad going at that time was more than one-third of his monthly pension and while we could afford to pay for the medication and consultation visits, it was not entirely easy. During the follow-up visits with my dad, I witnessed how other people suffering from different kinds of illnesses would struggle to pay for their medication at the hospital pharmacy or a lab test at the medical laboratory, sometimes they even request that a part of the medication be reduced and they pay for the ones their money can afford, the same goes for laboratory tests that have been ordered by a doctor. This was always happening and you could see the sense of insecurity, confusion, and frustration on the faces of these people and their loved ones. After my dad passed away in July 2017, my frequent visits to the hospital stopped but my observation of the financial sufferings of Nigerians due to medical bills didn’t. A lot of fund solicitations on social media for people faced with various illnesses started catching my attention and sometimes the money required is as little as N500,000 (About $1200). From all of these, I realized that a large number of people could be suffering from different kinds of medical conditions and were unable to afford the treatment cost(s) and even when they do, it is at the risk of falling into financial distress. So I decided to do some digging to find out why. What I discovered was the painful reality of catastrophic healthcare spending suffered by most Nigerians. A World Bank report shows that over 65% of Nigerians are at risk of being pushed to poverty when forced to have surgery and more than 77% of healthcare expenditure in Nigeria is from out of pocket. A total of $10.7 billion was spent in 2019 by Nigerian households on healthcare expenditure and this amount is expected to increase to $12 billion in 2021. This data shows that there is a fundamental problem with health financing in Nigeria and with increasing unemployment and income volatility, paying for medical bills out of pocket becomes a financial burden for most people. Another disturbing fact I discovered was that less than 5 percent of Nigerians are subscribed to any kind of health insurance. So I asked myself, why are most Nigerians paying for their medical bills out of pocket when they could barely afford it, and why are they not subscribed to health insurance plans offered by insurance companies? The answers to these questions have more to do with whether Nigerians are aware of health insurance in the first place than affordability. A combination of culture, lack of awareness, and trust are what have been impeding the health insurance market in Nigeria and while affordability is widely perceived as the key to reversing this, awareness and adoption are the most critical. An Access to Financial Services Survey done by EFInA in 2018 revealed that out of about 98 million adults without insurance, 77% of them say they are not aware of it while only 2.5% say they either cannot afford it or do not know where to get it. While it might be okay to hypothesize that Nigerians don’t have health insurance because they either don’t know about it, don’t understand how it works, or are not interested in it, to some, the concept of having to pool money that they may never see in the name of insurance is discouraging. This behavioral tendency of Nigerians to not be so adoptive of insurance even when they may be able to afford it means it will take much more to create and sustain an awareness project that will convince the larger population about health insurance and while healthcare cost keeps rising, the cost of health plans keeps going higher as well. But perhaps we could try something different, something that is familiar to Nigerians but has not been tried on healthcare financing at scale. A known tradition that Nigerians perform every other day but for different reasons is splitting of bills and Ajo savings. I am writing based on the hypothesis that Nigerians understand Ajo savings and bill splitting more than they have figured out the workings of insurance. Ajo saving is a scheme where a number of people come together and pool a fixed amount of money monthly, and then they take turns on who gets the sum total. This rotation continues until everyone benefits after which they restart the process sometimes with more members. Also, other models of saving via cooperative societies or small groups have been existing for years but none of them has been tailored towards healthcare financing. Members can only have access to low-interest loans and can withdraw their savings after a number of months.

So what if people come together to split the cost of their healthcare expenses? What if they save money on a mobile wallet just like Ajo but for health emergencies? What if you have a dedicated platform where you connect with thousands of friends, co-workers, church members, school mates or any person within your network to save money and split the cost of your medical bills together with them? Would it work? will people want this? Well maybe but that is why we are building Lafya HealthShare to test this model. We are creating a community-based system of saving money and sharing healthcare bills such that people do not have to bear the risk of their medical expenses alone. I strongly believe in the power of community, and any concept that is driven by the power of community is bound to make a huge impact. The universal bond that connects humanity is why Lafya HealthShare will make an impact and help more people have access to healthcare finance especially when they don’t have any form of health insurance.

My vision for Lafya HealthShare is to see people in Africa and other regions of the world pay for healthcare without having to suffer financial distress. I want to see people live in good financial health and personal health.