NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

As global health funding contracts — most notably with recent reductions in U.S. foreign aid — low- and middle-income countries are confronting a hard truth: Traditional models of delivering healthcare at scale are no longer financially or operationally sustainable. Yet within this challenge lies an opportunity to reimagine how the global health sector delivers on the promise of universal health coverage.

The need for innovative new pathways toward universal coverage is a key focus at the HealthTech Hub Africa, a pan-African innovation platform implemented by Jhpiego and Villgro Africa that catalyzes collaboration between emerging healthtech enterprises, funders and governments to strengthen health systems. Collectively, the HealthTech Hub Africa and its implementors have worked with hundreds of high-potential companies across Africa. One promising idea we’ve generated from this experience is what we call “Access-as-a-Service.”

This concept draws inspiration from the familiar model of Software-as-a-Service, in which companies like Netflix, Zoom and Dropbox provide software over the internet for a basic subscription fee, eliminating the need for users to purchase, install and maintain local software. The provider handles updates, security and storage, allowing users to simply access the service when needed. We have seen many Africa-based companies adopt similar models to address the unique challenges and opportunities the continent presents.

Access-as-a-Service proposes a similarly seamless approach for governments. Instead of requiring them to build and operate additional complex, costly, brick-and-mortar health system infrastructure to expand their delivery of basic primary care, this model envisions a pluralistic delivery system. While maintaining their existing in-person care options, governments would also contract multiple private healthtech providers to deliver first-line healthcare access through scalable, cost-effective digital channels, including: AI-powered chatbots, health hotlines, mobile apps, and telemedicine platforms that connect patients to diagnostics, pharmacies and clinicians.

Rather than contracting these companies as vendors to develop software for government ownership and management, payments would be outcomes-based, with healthtech providers receiving a regular fee (a “subscription”) based on population coverage and the quality of care delivered.

The Benefits of Access-as-a-Service in Healthcare

Think of Access-as-a-Service as “publicly funded, privately delivered” primary care —  with digital infrastructure at the core. This model enables greater flexibility, innovation and responsiveness, especially in rapidly changing environments or underserved geographies, with the cost efficiencies that technology can provide. To take one example of how these advantages can play out in Africa, consider the response to the emergence of diseases like COVID or Ebola: It is much faster to disseminate up-to-date information and access communities via digital channels, rather than relying upon a network of in-person health workers who have to travel long distances for training and patient visits. By investing in digital-first models, governments can also decongest their existing brick-and-mortar facilities, enabling them to focus on patients who require in-person treatment, or who lack digital access.

Much like the transformation in Africa’s energy sector — where governments opened markets to independent power producers (IPPs) to complement or replace inefficient state-owned utilities — the continent’s health systems can benefit from a more decentralized, tech-enabled approach to primary care. In countries across sub-Saharan Africa, IPPs have added over 11 GW of installed capacity through 126 projects, backed by more than $25 billion in investment. These efforts have improved energy access and affordability, particularly in underserved areas.

If that same model were applied to healthcare, the government’s role would shift from sole provider to regulator, enabler and strategic purchaser — setting clear standards for data privacy, clinical quality and equity (i.e., making sure that companies are taking measures to address any obstacles that could lead to the exclusion of more vulnerable groups). The government would still pay (or co-pay, alongside philanthropies, large employers, etc.) for services, but delivery would be decentralized, with multiple private businesses and nonprofits providing care under a unified regulatory and financing framework. This would allow innovation and competition to flourish by addressing the lack of clarity around regulatory pathways and public procurement that prevents many healthtech enterprises from engaging successfully with governments. To that end, transparent frameworks would need to clarify what companies would need to demonstrate to be eligible to participate, and how different kinds of services would be reimbursed. Companies would have the freedom to innovate around user design/user experience, but governments would need to set standards that ensure that all participating providers are delivering an acceptable level of access and quality.

Three Converging Trends that Enable Access-as-a-Service

Access-as-a-Service is a practical, scalable solution for countries that must stretch their limited healthcare budgets while expanding access to care. It’s more feasible than ever due to three converging trends:

• Widespread mobile and internet penetration: Even in rural areas, mobile connectivity is improving. According to the GSMA, sub-Saharan Africa will have an estimated 751 million mobile subscribers by 2030, with 81% using smartphones.
• Advances in AI and automation: Tools like symptom checkers, triage bots and remote diagnostics are becoming more accurate, affordable and locally adapted. For example, PROMPTS in Kenya has provided AI-powered triage to 2.4 million expectant mothers at a lifetime cost of just $0.74.
• A growing ecosystem of African healthtech innovators: Startups like HealthX Africa, Zuri Health and TanzMED — all members of the HealthTech Hub Africa — are already delivering virtual care, remote diagnostics and AI-powered triage tools to thousands. While their initial customers have largely been other businesses in Africa’s nascent private healthcare sector, promising public-private partnerships are emerging — such as HealthX Africa’s collaboration with Murang’a County in Kenya. Meanwhile, thriving AI modelling companies such as Afya intelligence and Palindrome Data are already leveraging AI to inform government health decision-making in Tanzania, South Africa and Nigeria.

What’s Needed to Make It Work

Of course, Access-as-a-Service isn’t without challenges. To succeed in this approach, governments and partners must invest in:

• Robust regulatory frameworks: including licensing for digital health providers, clinical quality standards, and quality assurance and grievance redress mechanisms.
• Interoperable data systems: including national health information exchanges, standardized APIs and clear data ownership rules.
• Equity safeguards: including subsidies or zero-rating for low-income users, offline access options, and inclusive design to prevent digital exclusion.
• Outcome-based financing: including payment models that reward quality, continuity and coverage — not just service volume — with appropriate inclusion and reimbursement through public health insurance schemes. These finance schemes will be vital to unlock the additional private investment that will be necessary for this model to achieve scale, since participating companies will be able to demonstrate to investors that they’ve tapped into a sizable and ongoing government funding stream. This can help enable both direct investment and social impact bonds that involve government as the outcome payer.

A Resilient, Value-for-Money Approach

Critically, this model builds resilience. By diversifying the ecosystem of care providers, countries reduce their dependence on any single system or funding stream. And by leveraging private sector efficiency and innovation, they can deliver more value for money — something urgently needed in today’s constrained fiscal environment.

Access-as-a-Service also creates a feedback loop that can inform public policy: Digital platforms generate real-time data on service delivery, patient outcomes and system bottlenecks, enabling smarter, faster government decision-making.

The alternative — clinging to outdated, underfunded brick-and-mortar public systems while millions go without care — is no longer tenable. It’s time to think differently. Access-as-a-Service offers a bold, pragmatic path forward: one that could help us finally make universal health coverage a reality, even in the most resource-constrained settings — and one that does so by invigorating local innovation ecosystems.

The technology exists. The innovators are building. The models are emerging. What comes next is a concerted effort — bringing together governments, businesses, funders, NGOs and other ecosystem players — to scale what works, with urgency, creativity and a shared commitment to health for all.

Joanne Peter is Director of Jhpiego’s Innovation Hub, and a Senior Advisor to the HealthTech Hub Africa; Rob Beyer is Villgro Africa’s Co-Founder and Executive Chairman, and a Senior Advisor to the HealthTech Hub Africa.

Photo credit: nappystudio