Who Pays When Africans Fall Sick?

Across Africa, millions in the informal sector remain uninsured—not from apathy, but due to the exclusionary nature of health systems. In Tanzania and beyond, digital innovations offer promising models for more inclusive health insurance. 

It was a Tuesday afternoon when I first heard the words that would haunt me for years: Siwezi kulipia bima ambayo ni utapeli, which means, ‘I can’t pay for insurance—that is a scam.’ The voice belonged to a woman who introduced herself as Mama Asha, probably in her mid-30s, standing beside her frail, dehydrated child suffering from acute diarrhoea. I was a frontline intern nurse at one of the regional hospitals in Tanzania. My simple question about health insurance to Mama Asha triggered a flood of frustration and pain. Her story was not unique; it was the echo of millions. 

Mama Asha sold food at a local market in Moshi-Kilimanjaro, rising before dawn to prepare chapati and beans. Her daily earnings barely sustained her family. She once invested her hard-earned money into a health insurance scheme, hoping it would be her safety net. When illness struck, reality shattered that hope. Essential drugs were ‘out of stock’ and she had to pay out-of-pocket to save her life. That day, insurance became a cruel joke to her. 

I remember her eyes: defiant, tired, and deeply sceptical. Her rejection of insurance was not ignorance; it was survival. And she was not alone...