Examining the potential of mobile money-based health insurance for people living with HIV and hypertension or diabetes in Uganda

Abstract

Background: Digital technologies are increasingly promoted as alternative pathways for financing universal health coverage (UHC) in sub-Saharan Africa, yet evidence on their acceptability among informal-sector populations remains limited. This study explored the acceptability of mobile money–based private health insurance among people living with HIV (PWH) with comorbid hypertension or diabetes in Uganda. Methods: We conducted an exploratory qualitative study in Fort Portal City, midwestern Uganda. Data were collected through four focus group discussions with PWH (n = 48) and 18 key informant interviews with representatives of telecom companies, private health insurers, regulators, and health providers. Data were analyzed thematically using an established analytical framework on facilitators and barriers to mobile health technologies. Results: PWH reported rising out-of-pocket expenditures for managing hypertension and diabetes compared to HIV care, which remains largely donor-funded. Facilitators to uptake included high mobile phone ownership, widespread use of mobile money, perceived affordability of monthly premiums (USD 1.35–8.20), prior experience with mobile money insurance, and convenience of digital payments. Barriers included limited understanding of insurance principles, mistrust of private insurers, fears of mobile money fraud, high internet data costs, intermittent electricity supply, and widespread poverty. Conclusion: Mobile money–based health insurance was perceived as affordable and acceptable among PWH with NCD comorbidities. However, low insurance literacy and mistrust of insurers remain major obstacles. Mobile money–based health insurance warrants further research as a complementary pathway for expanding health insurance coverage in Uganda and similar settings.