Request for Application #2019-020

Digital Financial Services on Health Outcomes and Health Systems

Gateway, enabler, accelerator: the relationship between DFS and improved access to quality health

Executive summary: 

Globally countries are grappling with critical questions of how to increase access to affordable quality healthcare for the most vulnerable in our society. Increasingly, digital financial services (DFS) is seen as part of the solution as it can increase financial protection and improve efficiency, which in turn improves the use of health services and decreases the cost of delivery. This concept note is in response to Request for Application (RFA) #2019-020 ‘Digital financial services on health outcomes and health systems.’ Our proposed project will conduct a deep dive in three low-and middle-income countries (Kenya, Rwanda and South Africa (or possibly Ghana)[1] to analyse the DFS ecosystem relevant for healthcare. More detailed assessment of three DFS innovations that operate within the health environment will supplement the country analysis by providing a practical illustration of the barriers and challenges that DFS face in implementation as well as key components necessary for successful implementation. We will undertake in-country primary research through qualitative analysis and interviews in two of the selected countries. Finally, we will synthesise the findings from across the countries and innovations in a framework. The framework will identify elements that will form part of a theory of change from DFS to health outcomes and opportunities for DFS at the micro, meso and macro level. The research method will include desktop research and discussions with experts in the relevant countries. This project will be done through a partnership between Cenfri and Percept. Combined, the two organisations have substantial technical expertise in DFS and health system development in less resourced countries.


[1] We propose three of the four countries listed, but are willing to focus on other African countries instead, if preferred.

Consortium Team: 

Consortium: Cenfri will lead the project in partnership with Percept. Combined we have deep technical experience in DFS and health system development on the Africa continent and globally.

Cenfri ( is an independent, not-for-profit think-tank, established in 2008 and based in South Africa. Our work focuses on unlocking the contribution of the financial sector and the digital economy to alleviate poverty and contribute towards economic development. In the last decade we have worked across 35 countries in Africa, Latin America and Asia.

Examples of our work include diagnostics and market landscape studies to understand barriers and opportunities and develop actions to improve how financial services can contribute towards development. We have conducted diagnostic studies in over 20 countries with the focus ranging from financial sector development and inclusive insurance to digital skills.[1] These diagnostics include an assessment of consumer needs, provider landscape, regulatory constraints and political economy, as well as a roadmap to prioritise interventions. We have experience in developing and implementing financial sector market development approaches in Africa and other developing countries through multiyear programs that support private sector innovation and regulatory strategies. We have expertise in identifying key innovations that could act as solutions for barriers faced in insurance, payments, behavioural interventions and digital identity. We have worked with a range of partners and organisations including the UNCDF, DFID, GiZ, the Gates and Mastercard foundations, the South African National Treasury etc.

Percept ( is a multi-disciplinary consultancy established in 2017 and based in Cape Town, South Africa with extensive health sector expertise. We bring together public health, health economics, data science, actuarial, medical anthropology and health-financing skills. We have worked extensively on both public and private health financing mechanisms, healthcare innovation, digital solutions for healthcare, strategic purchasing of healthcare and technical tools to support health-system planning. We work across both the financing and supply-side of the health system and understand the ways in which these relate to each other.

Percept’s past projects that provide an expertise base for this study include helping to design a low-income insurance product in Uganda that would have drawn extensively on mobile-based distribution and care delivery, involvement in various projects using alternative reimbursement approaches (and the data systems that support these approaches), costing of universal health coverage systems and the creation of health-worker-demand project models that require a deep understanding of the drivers of epidemiological change. The Bill & Melinda Gates Foundation contracted Percept to assist with a large project on primary healthcare redesign in the Western Cape of South Africa. The project requires the establishment of an in-depth understanding of the management information systems (MIS) that collect data on patient encounters with the health system, and the factors that enable and limit the use of data collected through these systems.


[1] See: to see research by country.

Final Technical Application: 
Application Status: 
Not Approved


The mixed methods approach of the deep dives, and the planned outputs, are appropriate, but please elaborate on how you would address implementation considerations effectively.

The delineation of the actors of the health delivery value chain (from micro to macro) is appreciated.