"Sometimes I just work until the pain gets too strong." – Informal worker, Namibia
Informal workers often delay or avoid seeking health care until the illness becomes critical or pain becomes acute. Basic health insurance could provide timely protection for these workers to access better quality health care, yet existing products rarely reflect how they earn, work, or seek care.
What if the biggest barriers to health insurance coverage for informal workers are not the ones insurers assume? In Guatemala and Namibia, participants of A2ii's 5th Inclusive Insurance Innovation Lab found out that informal workers often turn to pharmacies first for advice and treatment, could potentially afford health insurance but not the fixed monthly premiums, and face health systems that do not fit with their working hours.
These experiences challenged some of the assumptions insurers and authorities had about why health protection gaps exist – and informed their solutions.
Challenging common assumptions: A deeper understanding of customer behavior
At the beginning of the Lab, key public and private sector stakeholders working in inclusive insurance held certain assumptions about customer needs – but direct engagement revealed a different reality. In Guatemala, the team interviewed 593 domestic and informal workers as well as small business owners. In Namibia, the team engaged with semi-informal workers, including security guards, taxi drivers, and hospitality workers. What they heard challenged some of their basic assumptions and changed the way they designed solutions to address the real needs.
Assumption: People cannot afford insurance
Many informal workers can and want to pay, but irregular incomes make fixed monthly premiums unworkable. In Namibia, heavy out-of-pocket spending remains common despite widespread reliance on public healthcare. In Guatemala, people spend between $3 and $20 USD per health incident at the pharmacy. This suggests there is both willingness and some capacity to pay, but products and payment schedules must align with irregular incomes.
Assumption: People don't know about insurance
Awareness is low, but the more revealing finding was summed up by an interviewee. "I don't have insurance because it hasn't been offered to me." – Business owner, Guatemala. The gap is therefore not simply one of awareness; it is also one of distribution, trust, and product relevance. Existing products do not currently reach these workers through channels they trust.
Assumption: People only care about the price point
Price matters, but so does the way insurers treat customers. Across both countries, people consistently emphasized the value of respect, dignity, and clear communication. In Guatemala, distrust of insurers contrasts with trust placed in local shopkeepers: over 60% consider their tendero a friend. In Guatemala, potential customers viewed very low premiums with suspicion, assuming they may signal poor quality. This tells us that price is not only a barrier - it also signals quality.
This tells us that price is not only a barrier - it also signals quality.
Assumption: When people are sick, they go to the hospital
Pharmacies – fast, affordable, and trusted – are where people go first when health needs arise. "When I get sick, I go to the pharmacy because it is faster and cheaper." – Male carpenter, Guatemala. For insurers, this is more than a behavioral insight – it is a distribution opportunity. To reach underserved customers, products must be made available where people already seek care.
Assumption: Smartphones are ubiquitous, so insurance apps will work
Mobile usage is high in both countries, but the channels people already use and trust are WhatsApp, SMS, and calls – not complex apps. Digital insurance must therefore use channels people already rely on. “Just give me a text message.” – Female domestic worker, Namibia.
How can innovative solutions be designed to better manage health risks?
Customer insights helped the teams identify who needs protection most urgently, and the common needs a single solution could address.
In Guatemala, the team identified tenderos as an underserved segment. These small shop owners run their corner stores from dawn to dusk, unable to close without losing income. What do tenderos need? Basic coverage for the health episodes they are already paying out of pocket. The product therefore has to be accessible and payable in a way that fits an irregular income. Keeping these restraints in mind, the Guatemala team reflected on the challenge and came up with the following: How might we sell health protection to and through tenderos as simply as they already sell a solar top-up or an internet code?
The prototype the Guatemala team developed is called "Salud en la Tienda", and bundles telemedicine, illness coverage, and a daily allowance when the shop has to close. Because of their trusted position in the community, the team is exploring tenderos as a distribution channel for the health insurance product. For this to happen, regulatory change may be needed, as complex rules and paperwork currently put a burden on promising distribution channels aiming to reach underserved populations.
In Namibia, the team identified security guards, taxi drivers, and hospitality workers as vulnerable groups they want to innovate for — people in semi-formal jobs whose non-standard working hours make daytime clinic visits costly. They need fast, affordable access to care and medication without taking half a day off. Coverage for acute conditions, chronic disease management, and emergencies, delivered simply, with dignity – and flexible payments. The team distilled the challenges into a single question: How might we design an affordable and sustainable product under the Financial Institutions and Markets Act (FIMA) that gives informal workers fast, dignified, and effective treatment?
The prototype the team developed is called Atushe (meaning “all of us” in Oshivambo), a voucher-based health solution for employed but uninsured Namibians, sold at grocery stores and post offices and offering access to telemedicine, consultations, and medication. Some regulatory questions still have to be resolved. Under FIMA, in force since May 2026, only registered non-profit medical aid funds may cover the actual cost of health services. Private insurers, by contrast, are limited to defined benefits. We are confident that involving supervisors throughout product design, as we do in the Inclusive Insurance Innovation Labs—not only at the end—can widen the scope for solutions that close the protection gap.
Speaking to potential customers in both countries showed that even if contexts and livelihoods differ, the core needs to close the protection gap are the same: affordable, accessible protection designed around people’s realities. Guided by customer insights, the teams in Guatemala and Namibia will now refine their prototypes and pilot their solutions.
Add new comment