Digital Financial Services for Health: Consideration for Integrating DFS in Health Systems Strengthening

DFS for health applications include digital health insurance, health savings accounts, credit, transfers, remittances, and loans, vouchers for health care, payments for health care or insurance by participants, and bulk purchases and payments across the health system. The global evidence review conducted by Abt Associates through the USAID Local Health System Sustainability Project (LHSS) found that key factors serve as enablers or barriers to DFS for health. Political and regulatory environments, including clear regulations on digital banking, mobile money, and insurance, protect customers and create opportunities for new products. A political mandate or high-level government support can expedite DFS implementation. The digital infrastructure and ecosystem, including an insufficient digital infrastructure, can be a barrier to equitable uptake of DFS in health. Establishing interoperable systems and digital payment ecosystems are key to expanding DFS. Health system maturity and facility readiness, including the digitization of parallel and upstream systems, facilitate DFS implementation. Digitizing the claims process of a national health insurance program incentivizes digitization at the health facility level. Financial infrastructure and culture, including labeled accounts and transaction fees, can deter social appropriation and improve self-control. Consumer understanding of the value of financial protection products is still low. The case study research led by Management Sciences for Health (MSH) in Rwanda and Kenya produced important learning on the influence of DFS on health system performance and the participant's experience with regard to financial protection and demand for and use of health services. The Rwanda case study looked at the community-based health insurance (CBHI) program managed centrally by the Rwanda Social Security Board. This program uses digital technologies for client management and mobile payments for clients to pay their insurance premiums. The CBHI Mutuelle Membership Management System (3MS) was developed as an interoperable software platform that supports participant and premium management through online registration, membership validation, and connection to electronic payment gateways. The 3MS platform was first developed to support registration and membership validation for the national CBHI program. The system also integrates the national household income categorization database, known as Ubudehe, which is used to determine insurance premium tiers. Integrating the government-wide digital payment gateway, Irembo, with 3MS enabled mobile payments for CBHI membership annual premiums. The Kenya case study focuses on several programs introduced by the PharmAccess Foundation. The social enterprise CarePay runs a digital health platform called M-TIBA that connects users, health providers, and payers in real-time, allowing for identification of users, and claims submission and handling by providers and payers. The case study included the Innovative Partnership for Universal Sustainable Healthcare initiative using the M-TIBA mobile platform to connect low-income women of reproductive age and their families to a digital savings plan to contribute to enrollment in Kenya's National Health Insurance Fund. The case study research identified numerous perceived benefits of DFS for health, including increased financial protection, improved health outcomes, and enhanced access to health services. The Rwanda and Kenya case studies illustrate some of the ways DFS can be utilized in health systems. The case study research and global evidence review highlight implementation considerations relevant to national policy makers, health system and financial managers, implementing organizations, and donor partners. Key factors that can facilitate the implementation of DFS for health include mature public insurance schemes and network of health facilities, existing community-based networks of mobile money agents and community health workers to bridge the digital divide, effective collaboration among private, public, and NGO sectors, multisectoral investments in the general information and communication technology infrastructure, a strong government vision for digital technology and high-level political support, a strong community of software developers to manage and improve the platform, and trust built across institutions to enable interoperability with national population registration systems. Critical barriers to implementation identified through the case studies include outdated infrastructure not capable of meeting peak demand, spotty internet in some remote areas, low digital literacy at the household level, lack of electronic payment gateways and APIs, inadequate training for implementing staff on digital systems, and target participants facing competing demands on their limited income and having limited experience with DFS.