Request for Application #2019-020

Digital Financial Services on Health Outcomes and Health Systems

About 100 million people are still being pushed into “extreme poverty” (living on $1.90 or less a day) because they have to pay for health care. Over 800 million people (almost 12 percent of the world’s population) spend at least 10 percent of their household income to pay for health care. Women are especially vulnerable to extreme poverty as they typically have more restricted access to financial and productive assets than men, and they shoulder a greater burden of unpaid time use. Gender inequality is high in many countries facing high extreme poverty rates, and women in low- and middle-income countries are less likely than men to own mobile phones and to access internet-based mobile services.

Financial protection is achieved when direct payments made to obtain health services do not expose people to financial hardship and do not threaten living standards. Financial protection is at the core of universal health coverage and is one of the final coverage goals of the Sustainable Development Goals. Out-of-pocket payments for health care can cause households to incur catastrophic expenditures, which in turn can push them into poverty. A key to protecting people is to ensure prepayment (savings) and pooling of resources (insurance) for health, rather than relying on people paying for health services out-of-pocket at the time of use.

Advances in digital technology have made it more efficient and affordable to reach people with key services. For example, the ubiquity of mobile telephony and mobile phone penetration provides opportunities for public and private service provision, at new and unprecedented levels, amplifying population reach and coverage. Likewise, data from digital channels and solutions provide key information, feeding analysis for decision-making, which can support continuous improvement of health system management and performance.

What is financial inclusion and why does it matter?

Financial inclusion is when individuals and businesses have access to useful and affordable financial products and services—savings, loans, insurance, remittances, and bill payments—that meet their needs, delivered in a responsible and sustainable way.

Financially included people have access to financial services that can support well-being (savings, remittances, and insurance) during stable times and prevent deepening levels of poverty during crisis. Likewise, people with access to lending or other forms of financing can use these services to build productive assets like businesses, fostering enterprise growth and development.

What are digital financial services?

Digital financial services (DFS) are financial products and payment services (e.g., savings, loans, insurance, remittances, and bill payments) that are enabled via electronic channels. Products and services can be accessed using mobile phones, electronic cards (e.g., credit cards, debit cards, and prepaid cards), computers, and other electronic instruments.

Purpose of the landscaping exercise

Building on the March 2019 publication of The Role of Digital Financial Services in Accelerating USAID’s Health Goals, USAID’s Global Health Bureau, via its Office of Health Systems and its Center for Innovation and Impact, is considering commissioning a landscaping assessment on the role of digital financial solutions in the context of efforts both to advance financial protection and to support improved health system performance. If funded, the purpose of this report would be to help audiences understand the factors (beyond digitization) that make these solutions successful and the role that digitization can play in enhancing and leveraging these factors.

Generally, the assessment may seek to understand the following questions:

  • To what extent have digital financial services in low-resource health systems contributed to the following outcomes:
    • Increased financial protection among health system clients, including the poor and vulnerable.
    • Increased demand and use of health services among clients, including the poor and most vulnerable.
    • Improved health systems performance, defined as improved quality and responsiveness of service providers.
  • Implementation considerations, including
    • What barriers/challenges were faced in the implementation of DFS?
    • How did programs adapt?
    • Where successful, what were the critical components in implementation?
    • How and why have providers and implementations incorporated DFS into broader digital solutions or complemented DFS with broader digital solutions?
    • In regard to digitalization, what are examples of successful change management processes (effective approaches of moving from paper-based to digital management systems) to maximize potential results?

This assessment fundamentally aims to understand whether digital financial solutions can enhance the impact of HSS activities, and in what contexts. The research questions aim to identify, where possible, the potential contributions specifically of DFS to advancing financial protection and strengthening health systems, even when those solutions are embedded within broader service delivery packages. Through a literature review and remote consultations at minimum, this exercise will engage leading digital health service providers, associated health facilities, and their clients in key geographies to understand results and gather lessons.

The main deliverable is expected to be a final, detailed landscape report that describes the context, methodology, findings, and conclusions of this work. The final report will be made publicly available. A shortened version of the report may also be submitted as a commentary or similar type of paper for an appropriate peer-reviewed journal.

As part of the anticipated collaboration, the partner(s) will be expected to engage regularly with USAID.


Click here to access RFA #2019-020 Digital Financial Services on Health Outcomes and Health Systems.


  • September 23-October 18: Concept note development

    Digital Square issues a call for applications, and applicants upload concept notes to Digital Square's public-facing OAP platform. In the first 2 weeks, applicants will submit concept notes.

  • October 21-28: Digital Square review of concept notes

    Following the concept note review, Digital Square assesses concept notes to ensure alignment with funding round objectives identified in the RFA #2019-020. Digital Square eliminates concept notes that are not strategically aligned with the above.

    Digital Square identifies a set of short-listed concept notes based on the RFA criteria and emails applicants who are eligible to move on to the application phase.

  • October 29-November 18: Preliminary technical application co-creation

    Using feedback received in the Concept Note Phase, applicants will begin preliminary application development.

    Applicants must post an application iteration on the OAP platform in the first 2 weeks.

    The comment feature is available beginning the day of application posting.
    At the conclusion of this step, Digital Square will close the ability to upload new content to OAP platform.

  • November 19- December 5: Preliminary technical application comment period

    Following preliminary application development step, Digital Square will close the ability to upload content to the OAP platform.

    During this time, other applicants and other stakeholders in the community should provide feedback, comments, and suggestions.

  • December 6-20: Application finalization

    Using feedback during the preliminary technical application comment period, applicants revise the technical application, develop a budget and budget narrative, and submit these to the Digital Square OAP platform

    The budget and budget narrative are not shared publicly on the platform. Commenters see only the high-level summary budget provided in the technical application.

  • January 15 - 31st 2020: Evaluation Committee (EC) review

    Digital Square provides applications to evaluation committee for scoring and technical feedback. 

  • February 2020: Award phase

    Digital Square shares the investment decisions by the funder with applicants and shares with results with the Governing Board

    Investment decisions are contingent on funder approval.

Applications (20 total)

Displaying 16 - 20

NepalEHR for universal health coverage: Scalability of an integrated solution for financial protection in a newly decentralized health system

Application Status: 
Not Approved
Executive summary: 

Possible is an innovative healthcare delivery organization in Nepal that partners directly with local governments to identify challenges to integrated primary healthcare systems, design and implement solutions to address gaps, and evaluate and iterate on solutions for quality and efficiency in the country’s new municipal health system environment. Over the last five years, Possible has developed NepalEHR ( as a leading public sector, home-to-facility health information system.

Opportunities for Digital Financial Services in Health: a Landscaping Diagnostic

Application Status: 
Not Approved
Executive summary: 

A focus on health services can help ensure that financial inclusion and the use of formal financial services benefits people. The Sustainable Development Goal for health envisions universal coverage for “essential health services,” but achieving this will require context driven and innovate digital financial products that are linked to improved health outcomes. The investment from Digital Square will focus on conducting a 360 review of digital financial services for health.

Realizing Global Health_SIA: Performance and Outcome Study of the Pathway for Integrating DFS and Health Systems

Application Status: 
Not Approved
Executive summary: 

Our consortium team with global and local partners proposes that the landscape exercise be structured as a performance and outcome landscaping study. The study would identify and describe digital health initiatives with digital financial services (DFS) components in three countries at different stages of digital health and health system development. The study will include an in-depth analysis to identify performance success factors, barriers, and opportunities for the expansion of financial inclusion and protection in these three settings.

Theory of Change for Digital Financial Services to Improve Health Outcomes

Application Status: 
In Scope - withdraw
Executive summary: 

Tomorrow Global seeks to develop a theory of change for digital financial services to improve health outcomes. By drawing on the literature in health and development economics combined with operational expertise from other sectors, we will delineate the causal pathways through which these products can protect households against the financial risks from illness as well as the evidence base to support the model's underlying assumptions.

Vital Wave Holistic DFS and Health System Assessment

Application Status: 
Not Approved
Executive summary: 

To better understand the opportunity presented by DFS, Digital Square seeks to conduct a landscaping assessment. This assessment will explore the role that DFS could play in the context of efforts to advance financial protection and support improved health system performance across low-resource settings. The assessment will also seek to understand the factors that make these solutions successful and the role that digitization can play in enhancing and leveraging these factors.