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By Lasisi Hassan Ishola
When we designed iWello, a healthcare coverage platform starting at ₦500 (about $0.30) per day, our goal was simple: make healthcare accessible to millions of Nigerians excluded from traditional insurance.
We believed our product and price point were straightforward. Six months of research, however, transformed my understanding of inclusive design. It’s not about “designing down” for lower-income users. It’s about recognizing that underserved users manage complex financial and social systems, and our design must respect that sophistication.
Nigeria’s healthcare paradox lies in its brilliant doctors and world-class private hospitals, yet 97% of citizens lack health insurance. Most pay out-of-pocket, with basic treatments costing ₦15,000–₦25,000, often exceeding weekly earnings. Traditional insurance models fail because income is irregular and unexpected expenses are common. iWello’s solution was daily healthcare coverage starting at ₦500, active only on the days a user pays.
Three users reshaped our approach. Chioma, 32, sells provisions in Ikeja Market. She earns ₦3,000–₦8,000 daily, supports two children, and sends money to her mother in Enugu. Her phone screen is cracked, and her data bundle often runs out. Tunde, 28, drives an okada in Surulere. His income swings from ₦4,000 on slow days to ₦12,000 on busy ones. He pays daily remittances, buys fuel, and navigates police checkpoints. Two recent accidents left him unable to afford hospital care. Patience, a domestic worker in Lagos, travels 4–5 hours daily in traffic for three families. She receives monthly, weekly, and daily payments, respectively. Due to high blood pressure, she sometimes skips medication to manage costs.
Far from edge cases, Chioma, Tunde and Patience represent the core of our user base: hardworking people with complex, irregular financial lives.
We assumed inclusive design meant stripping away complexity, fewer features and simpler language. This was only half-right.
Chioma’s budget is not simple. Her cash flow fluctuates by 200–300% daily. She juggles multiple obligations, participates in three “Ajo” (rotating savings) groups, and constantly makes high-stakes trade-offs. Our first interface offered a toggle: “₦500/day” or “₦3,000/week (save 14%).” Chioma’s response: “What if I can only afford four days this week? With the weekly plan, I waste money.” Our design favored financial optimization. Chioma needed flexibility, even if it cost slightly more. True inclusion for irregular-income users prioritizes flexibility over optimization.
Usability wasn’t the biggest barrier—trust was. Nigerian consumers have been burned by pyramid schemes and insurance companies denying claims on technicalities. Chioma’s first question about iWello was: “How do I know this is real? Will you pay when I go to the hospital?” No “simple UI” could overcome this. We needed proof of reliability in every interaction. Inclusive design for excluded users requires radical transparency and constant proof of value.
We built a calendar view with “pause and resume” options, giving users full control over coverage days. Result: 67% of users who paused their plan resumed within 30 days.
Lagos traffic and poor connectivity demanded offline solutions. We integrated USSD codes for core functions—balance checks, menu access, and coverage confirmation, without needing data or a smartphone. Connectivity could no longer be a baseline assumption.
We rewrote explanations rather than just translating into Yoruba, Igbo, and Hausa. “Inpatient coverage” became “If you stay in the hospital overnight, we cover it.” “Pre-existing conditions” became “Health problems you had before joining are still covered after 90 days.”
Before purchase, we showed real hospital photos, claims data (“423 people used coverage at this hospital last month”), and exact treatment costs. During coverage, we sent daily reminders (“You’re protected today”) and running savings totals. After claims, we provided immediate confirmation, status updates, and follow-ups. This wasn’t marketing—it was core infrastructure for building trust.
This project taught us that inclusive design is built on respect. Respecting intelligence: Users manage irregular income with remarkable sophistication. Design should empower, not patronize. Respecting context: Poor connectivity, limited devices, and interrupted attention are realities. Designing for these first improves the product for everyone. Respecting dignity: Users don’t need simplified products; they need products that function in their financial reality. Respecting trust barriers: Skepticism is rational. Products must earn trust continuously through transparency.
Inclusive design is often dismissed as charity. iWello’s success proves otherwise. Access to a 100+ million underserved market. 60% month-over-month retention. Strong organic growth via user referrals. Operational efficiency from building resilient, scalable systems.
Spend real time with users in context, markets, homes, and streets, not labs. Rethink “simplicity.” For users with complex lives, true simplicity often means more options: flexibility, transparency, and control. Design trust into the product from day one. Build offline-first, ensuring resilience in low-connectivity environments. Measure dignity, not just metrics—confidence and respect predict long-term adoption.
Designing for excluded users is designing great products. Chioma’s irregular income inspired better financial flexibility for everyone. Tunde’s connectivity struggles led to a faster, more resilient app. Patience’s language needs led to clearer communication for all users.
Nigeria’s diverse population taught us that accessible healthcare isn’t charity, it’s product excellence aligned with human dignity. Healthcare is a human right, and rights without access are hollow. iWello is our answer: technology that respects financial realities, digital contexts, and user dignity.
That is inclusive design as standard, not as charity.
Lasisi Hassan Ishola is a Senior UX Researcher and Product Designer specializing in inclusion and accessibility.
