Meet Ruth. She is a 26-year-old Nigerian woman and the owner of a mini pharmacy in Ilesha town in southwestern Nigeria.
Ruth, like many other Nigerian women, is particularly vulnerable to health risks and faces gender-specific challenges related to maternity. According to the latest Findex, sixty-two percent of Nigerian women report being “very worried” about not being able to pay for medical costs in case of a serious illness or an accident1. Ruth herself said that she felt “not confident at all” about paying medical expenses.
But in 2023, Ruth received a loan from First City Monument Bank (FCMB) in Nigeria in Nigeria and enrolled in their health insurance product, FCMBeta Health–her first experience with insurance. Later, when she gave birth to her first child in a hospital, she felt at ease knowing that she would receive a benefit to help cover the procedure and stay. Thanks to the insurance product, she received the equivalent of 80% of her average monthly income, which she used to pay her loan instalments and buy various necessary goods. Thanks to FCMBeta Health, she now feels “very confident” that she will be able to cover future medical expenses.
The solution: insurance that centers women’s needs
Microinsurance offers a powerful solution to support low-income women when they are hospitalized. However, the path to widespread insurance adoption faces significant barriers. Nigeria, despite being one of the largest economies in Africa, has an insurance penetration rate of only 0.5%.
Microinsurance offers a powerful solution to support low-income women when they are hospitalized. However, the path to widespread insurance adoption faces significant barriers. Nigeria, despite being one of the largest economies in Africa, has an insurance penetration rate of only 0.5%.
In response to this challenge, Women’s World Banking partnered with FCMB, Hygeia HMO, and Swiss Re Foundation to develop the FCMBeta Health solution, a women-focused health insurance product in Nigeria. The project received funding support from Swiss Re Foundation and the Financial Inclusion Fund, initiated and funded by the Government of Luxembourg and managed by the European Investment Bank. The FCMBeta Health solution aims to reduce the financial strain women face during hospitalization and is bundled with FCMB’s E-Don Beta loan, a group microlending product. For just 0.1 USD (N150) per week, which represents less than 1% of the average weekly income in Nigeria, the product provides a fixed benefit per night of hospitalization, a childbirth benefit, and coverage for the client, her spouse, and children.
Since its launch in 2023, the product has already provided coverage to over 90,000 customers, including women and their families. Throughout the project, Women’s World Banking conducted two in-depth research activities with 60 FCMB’s low-income women customers to better understand their needs for hospital cash insurance and their level of trust in insurance and provided recommendations to increase trust.
Our research uncovered key insights into how women customers view hospital cash insurance—and how we can strengthen their trust in it. Here’s what we found.
What we learned: customer insights
A vast majority of women recognize the need for hospital cash insurance solutions
90% of women participants in the customer research expressed a need for hospital cash insurance, as it helps them cope with both the direct and indirect costs of hospitalization.
“Financially, [if you are hospitalized] it will not be a burden to you. They have removed some burden away from you.” (Female customer, Ikwerre)
The financial burden of hospitalization, especially among low-income households, often forces women to delay seeking care or return to work prematurely. Hospital cash solutions, which serve as income replacement tools, could alleviate this pressure and provide women with the time they need to recover.
“With this product, our customers are not afraid to go to hospitals anymore.” (Amos Ikubese, Regional Sales Manager, Abuja/North, FCMB)
Insurance is a powerful tool for maintaining savings, particularly during maternity. Maternity-related costs are a significant concern for women, and, as one respondent explained, the availability of an insurance product with a childbirth benefit would help women avoid depleting their savings during childbirth—an expense that many women save for specifically.
Developing hospital cash solutions also offers an affordable support to women customers. Most customer research participants perceived the weekly premium of USD 0.10, embedded in weekly loan payments, as affordable.
Although they understand how the insurance benefit could support them, some women remain skeptical about receiving it even if they are hospitalized or giving birth.
Our research found that 44% of women participants did not believe they will receive a benefit from insurance at the time of enrolment. Even among those who received payouts, some were initially surprised.
“When I gave birth, the promise they made, they fulfilled it, I didn’t even believe it before that they can give to people, but when it happened to me, they gave me money.” (Female customer, Ilesha)
The primary reasons for distrust were negative past experiences with insurance, either personal or involving family members, and concerns about hidden exclusions.
How to build trust in women-centric health insurance
To strengthen trust in women-centric health insurance, our experience in Nigeria suggests the following key strategies:
- Bundle insurance with a product that women trust. Given the general lack of trust in insurance companies, women are more likely to consider purchasing insurance if it is bundled with a financial product they already trust and value. Women’s World Banking recommends conducting both quantitative and qualitative research to identify financial services that are already trusted by the target audience.
- Start with a simple and affordable option. When offered three insurance plans—individual cover (₦150/week), family cover (₦350/week) and a malaria top-up (₦100/week)—95% of clients chose the basic individual plan. The added complexity of presenting multiple options proved burdensome for loan officers, and most customers preferred to start with a simple, low-cost option to test its value. In 2024, the team simplified the offering: all customers received a single insurance plan at ₦150/week. While this raised concerns about fairness, mainly that individual clients would pay more per person compared to a family plan, pilot data showed that even customers with families rarely opted to cover them. The flat-rate approach prioritized greater outreach and ease of implementation while maintaining the same blended premium rate as the original pilot. This simplification also allowed FCMB to embed the premium directly into loan instalments.
- Enhance the insurance knowledge of the sales force to build trust. The product is sold by loan officers, many of whom were introducing insurance for the first time. If these loan officers lacked trust in insurance themselves, they would struggle to confidently promote the product to their clients. To address this, Women’s World Banking provided regular insurance training for loan officers, alongside field visits to ensure they fully understand the product’s benefits, are equipped to pitch it effectively, and can handle customer concerns. Offering the product to the loan officers themselves, allowing them to experience it firsthand and build their own confidence in its value, can also build trust.
- Publicize claims. By showcasing claims, insurers can demonstrate the tangible benefits of having insurance coverage. Women customers can see real-life examples of how the insurance helped other women, having a direct effect on the trust they have in the product. One way to publicize claims can be organizing public claims disbursement events where the insurer announces and distributes claim payments to policyholders during public gatherings, highlighting the financial support provided through the insurance solution.
Women’s World Banking will continue to support FCMB, Hygeia HMO and Swiss Re to increase uptake and usage of the hospital cash solution among low-income women in Nigeria. With continued efforts, FCMBeta Health aims to provide insurance cover to 150,000 low-income Nigerians- including women customers and their families by December 2025, helping them build resilience in the face of health-related financial shocks.
Although this solution offers crucial financial support to FCMB customers, the needs for women-centric insurance across Africa remain immense. Collective efforts of financial service providers, funders, and development organizations are required to create insurance solutions that women can trust.
