AI and High-Quality Data: Unlocking Health Insurance Access in Africa

By Irene Nafula, Head of Enterprise Business at M-TIBA

Health insurance penetration in Kenya remains below 3%, compared to the global average of 7%. This highlights a critical challenge in Africa’s insurance landscape: while vast amounts of data exist, much of it is not digitally available, connected, or fully utilized.

Insurers process large volumes of data daily, but much of it remains paper-based or fragmented across disconnected systems. These inefficiencies lead to significant errors—up to 50% of data becomes inaccurate by the time it is analyzed—and delays, with reporting timelines stretching from weeks to months. This fragmentation limits insurers’ ability to seize market opportunities, innovate products, or prioritize customer-centric growth.

To bridge this gap, the insurance sector must adopt accurate, real-time, and integrated data systems, powered by transformative technologies like Artificial Intelligence (AI) and Machine Learning (ML).

Building a Data Foundation for AI

AI has the potential to revolutionize insurance in Africa, but its effectiveness depends on the quality of the data it processes. Without accurate, connected, and secure data, even the most advanced AI tools will fail to deliver on their promises.

Creating this foundation requires eliminating data silos and ensuring that data is consistent, connected, and secure. This not only protects insurers and customers from risks like fraud and cyberattacks but also enables faster, more reliable decision-making.

Real-World AI Applications

One of the most transformative applications of AI in insurance is claims automation. AI-powered platforms, with the support of human oversight, can instantly process claims while flagging complex cases for further review.

For instance, M-TIBA’s technology platform has revolutionized claims management for health insurers in Kenya. Insurers using M-TIBA report a 500% increase in daily claims processing, with approval times reduced to under a minute. In contrast to traditional systems—where payouts could take months or even a year—claims are now settled within 30 to 60 days. These advancements significantly improve operational efficiency and enhance customer satisfaction, a key factor in retaining members.

Combating Fraud

Fraud remains one of the most pressing challenges for the insurance industry. A recent report by the Insurance Regulatory Authority (IRA) revealed a 47% increase in suspected fraud cases between September and December 2023.

AI and ML are game-changers in addressing fraud. By analyzing historical data, AI can detect suspicious patterns—such as duplicate claims or inflated billing—early in the process. This proactive approach not only reduces costs but also reinforces trust among members by ensuring transparency and fairness.

Beyond Operations: Personalization and Preventive Care

AI enables insurers to move beyond traditional operations by offering personalized, need-based insurance products and services. These tailored offerings make insurance more affordable and relevant, allowing insurers to reach previously underserved populations.

Additionally, AI-driven insights into health trends enable insurers to design products and services that promote healthier lifestyles. By identifying early indicators of illness, insurers can offer preventive care measures that improve health outcomes while reducing treatment costs. This proactive approach creates a win-win scenario, benefiting both insurers and their members.

The Way Forward

The potential for transformation in Africa’s health insurance sector is immense. By investing in high-quality data and adopting advanced technologies like AI, insurers can revolutionize their operations, create innovative products, and expand access to underserved populations.

By prioritizing connected, secure, and actionable data, insurers can build a future where financial inclusion, healthier populations, and stronger economies go hand in hand. This transformation will create a lasting impact, benefiting millions across Africa and unlocking the true potential of health insurance on the continent.