Mobile Money Integration: Building Healthcare Payment Systems That Actually Work

Hamza Asumah, MD, MBA

The elderly woman in front of me at the Nairobi clinic pulled out a worn Nokia phone. Three taps later, she’d paid for her consultation. No cash. No card. No queue at the payment window. Just send, confirm, done.

This is the promise of mobile money in African healthcare—and it’s already saving the system $6.1 million annually in East Africa alone by eliminating travel costs to payment centers. Yet here’s the paradox: while M-Pesa handles over $314 billion in transactions yearly, healthcare payments remain stubbornly complex for most providers.

If you’re building a healthtech startup in Africa, getting payments right isn’t optional—it’s existential. Here’s how to do it.

Why Healthcare Payments Are Different

Unlike buying airtime or paying for groceries, healthcare payments come with unique challenges:

• Patients often can’t predict costs upfront
• Emergency situations require instant payment processing
• Insurance reimbursements add layers of complexity
• Trust is paramount when health is on the line

The good news? Platforms like M-TIBA have cracked the code, creating dedicated health wallets that give users control and transparency. The even better news? You can build similar systems without starting from scratch.

The Integration Roadmap

Start with the Big Three

In Kenya, M-Pesa isn’t just popular—it’s infrastructure. In Uganda, Airtel Money dominates. Tanzania splits between both. Your first integration should match your primary market’s preference.

For M-Pesa integration, you’ll work with Safaricom’s Daraja API. The developer sandbox is surprisingly forgiving, and you can have a test integration running in a weekend. The real challenge isn’t technical—it’s understanding STK Push (the payment prompt users receive) and how to handle callback confirmations reliably.

Think Multi-Country from Day One

Here’s where most founders stumble: they build for one market, then discover each country requires separate integrations, different compliance requirements, and unique user behaviors. A patient in Lagos expects different payment flows than one in Kigali.

This is where aggregators like pawaPay and Onafriq become game-changers. Instead of managing five separate integrations with five mobile money providers, you integrate once and access multiple markets. pawaPay, for instance, connects you to mobile money operators across eight African countries through a single API.

Yes, aggregators take a small percentage. But what you save in development time, compliance headaches, and maintenance costs makes it worthwhile—especially for early-stage startups.

Don’t Forget the Feature Phones

We obsess over sleek apps with biometric payments, but 40% of your users might be on feature phones. USSD (Unstructured Supplementary Service Data—those codes you dial like *544#) isn’t sexy, but it’s essential.

The brilliance of USSD is its universality. No smartphone required. No internet connection needed. Just a working SIM card. Companies like Helium Health use USSD as their backup payment channel, ensuring that even when the app fails, payments don’t.

The Zero-Chargeback Strategy

Credit cards have chargebacks. Mobile money doesn’t. Once that payment is confirmed, it’s yours. This fundamentally changes how you build your payment system.

Your focus should be on prevention, not resolution. Clear pricing before payment confirmation. SMS receipts sent instantly. A customer service number prominently displayed. These aren’t nice-to-haves—they’re your chargeback prevention strategy.

Reliance Health learned this the hard way. Early on, unclear pricing led to angry patients demanding refunds. The solution wasn’t a refund system—it was transparent pricing at every step and confirmation screens that showed exactly what patients were paying for.

Building Subscription Models for Chronic Care

Here’s where mobile money gets really interesting: recurring payments for chronic disease management.

Imagine a diabetic patient in Kampala paying 5,000 UGX ($1.35) weekly for medication delivery, glucose monitoring strips, and teleconsultations. The traditional banking system makes this economically impossible—transaction fees alone would exceed the payment. Mobile money’s low transaction costs make micro-subscriptions viable.

The technical implementation is straightforward: store the user’s mobile money number with their consent, initiate weekly STK Push requests, and handle failures gracefully (not every patient will have money in their wallet every week). The business model innovation is what matters—you’re creating predictable revenue while improving patient outcomes.

Learning from Those Who’ve Done It

Helium Health processes thousands of healthcare payments daily across Nigeria, using a combination of direct mobile money integration and card payments. Their insight? Start with the payment method most familiar to your users, then expand. Don’t try to be everything immediately.

Reliance Health took a different approach, building their payment infrastructure to support their health insurance product. Every premium payment flows through mobile money, creating a seamless experience from enrollment to claims payment.

Both succeeded because they understood this truth: in African healthcare, the payment system isn’t infrastructure—it’s the foundation of trust.

Your Next Steps

Pick one mobile money platform dominant in your target market. Build a basic integration in the sandbox. Test it with real users—not your tech-savvy friends, but actual patients who represent your target demographic.

Then expand methodically. Add aggregators when you’re ready for multi-country. Implement USSD when feature phone users complain. Build subscriptions once your single payments work flawlessly.

The elderly woman with the Nokia phone? She’s not thinking about APIs or STK Push. She just knows that paying for healthcare is finally as simple as everything else in her digital life.

That’s when you know you’ve built a payment system that actually works.