Assessing the Role of Digital Technologies for Health Financing (DTHF) in Strengthening Public Health Financing Systems in Nigeria

Abstract Background Nigeria's health financing system remains heavily dependent on out-of-pocket payments, leaving large segments of the population, particularly those in rural and informal-sector settings, exposed to catastrophic health expenditure. The 2022 National Health Insurance Authority (NHIA) Act mandated universal health insurance enrollment, intensifying the need for financing mechanisms capable of reaching populations that traditional cash-based systems have struggled to serve. Digital Technologies for Health Financing (DTHF), including mobile money platforms, digital payment gateways, and API-driven interoperability between insurers, telecommunications providers, and FinTech companies, have emerged as a potentially transformative strategy, yet empirical evidence on their implementation and the operational, behavioural, and regulatory factors shaping their effectiveness in Nigeria remains limited. Methods This qualitative descriptive study used semi-structured Key Informant Interviews (KIIs) with 17 senior personnel and technical experts drawn from national and state health insurance agencies, Health Maintenance Organizations, FinTech companies, and payment service providers across Lagos, Oyo, Ondo, and the Federal Capital Territory. Data were analyzed using Braun and Clarke's six-phase reflexive thematic analysis framework, with trustworthiness established through Lincoln and Guba's criteria of credibility, dependability, confirmability, and transferability. Results Six themes emerged: digital transformation as an equity and revenue modernization vehicle; ecosystem interoperability and multi-sectoral integration; operational constraints and systemic enablers; trust, governance, and regulatory compliance architecture; reminder systems and automatic renewals; and scaling digital health financing for universal health coverage. Participants viewed DTHF as simultaneously expanding access for underserved populations and strengthening financial transparency, but implementation was constrained by infrastructural fragility, workforce turnover, fragmented interoperability standards, and an evolving regulatory landscape. Behavioural design of reminders and automatic renewals emerged as an important, underutilized lever for improving enrollee retention. Conclusion DTHF holds substantial promise for advancing Universal Health Coverage in Nigeria, but its impact is bounded by institutional, infrastructural, regulatory, and behavioural factors beyond the technology itself. Strengthening these underlying systems, alongside continued technological investment, is essential for sustainable scale-up.