Why Africa’s $100B HealthTech opportunity is shifting to the “Back-End”

For nearly a decade, African HealthTech was defined by what can best be described as the Pilot Era: a proliferation of donor-funded experiments, short-lived proofs of concept, and consumer-facing apps promising to be the “Uber for doctors.” These solutions were visually impressive and rhetorically compelling, but structurally fragile.

The data is now unequivocal. After analysing more than 430 active health tech startups across Sub-Saharan Africa, a decisive shift is underway. The companies gaining real traction are no longer building glossy front-end applications for patients. They are constructing the digital and physical rails of a $100bn healthcare economy. African HealthTech has entered its Infrastructure Phase, transitioning from Business-to-Consumer (B2C) telemedicine to Business-to-Business (B2B) and Business-to-Government (B2G) models that digitise the supply chain, financing, and operational backbone of care.

From pilot experiments to full-stack infrastructure

To understand why this shift matters, we must abandon Western definitions of HealthTech. In Silicon Valley, HealthTech often refers to CRISPR, AI drug discovery, or telemedicine layered onto an already functional health system. In Sub-Saharan Africa, HealthTech is something far more fundamental: frugal, systems-level innovation designed to compensate for structural absence.

This is a continent with an average physician-to-patient ratio of 1:10,000, pharmaceutical supply chains where an estimated 30% of drugs are counterfeit, and health financing models where nearly 97% of people lack formal insurance coverage. In this context, a HealthTech company is as likely to be a motorbike logistics network or a procurement platform as it is a software firm. African HealthTech resembles electricity generation before national grids: decentralised, improvised, and essential. Success lies not in isolated tools, but in full-stack solutions that bridge multiple infrastructure gaps simultaneously, clinical, financial, and logistical.

The first wave of B2C HealthTech, circa 2015–2019, misunderstood this reality. They attempted to replicate Western pay-per-use consumer models, assuming patients would adopt apps as they do subscription-based fintech or lifestyle platforms. Yet healthcare is a grudge purchase in most African households: episodic, urgent, and rarely repeatable. Customer acquisition costs often exceeded lifetime value, and retention was minimal. Patients might use an app once during an acute illness and never return. These ventures failed not because the technology was insufficient, but because it did not embed itself in the rhythms, behaviours, and constraints of African healthcare.

Value is created at the enablement, distribution, and financial integration layer

The companies thriving today focus on enablement, not direct care delivery, and have discovered that distribution and revenue sustainability are inseparable. Three verticals dominate this infrastructure-focused phase.

First, asset-light supply chains. mPharma, Maisha Meds, Advantage Health Africa, and Remedial Health are digitising the fragmented pharmacy ecosystem, aggregating demand, enforcing quality control, and improving working capital efficiency. By becoming the operating systems for retail healthcare, they capture margin and trust in a market exceeding $1bn annually.

Second, embedded fintech and risk pooling. Rather than selling “health” directly, platforms such as Reliance HMO, WellaHealth, and Turaco integrate credit, savings, and micro-insurance into workflows that already exist, airtime purchases, gig economy payments, or employer benefits. This approach aligns financial products with real usage patterns, increasing adoption and retention.

Third, specialised B2B SaaS for providers. Helium Health demonstrates the power of digitising hospital records and administrative workflows. Beyond efficiency gains, it enables data-driven credit products like HeliumCredit, filling the chronic financing gap for clinics. Together, these models scale because they are repeatable, revenue-generating, and deeply embedded within the healthcare value chain.Distribution and trust remain the ultimate moat. In Africa, pharmacies serve as the primary interface for 80 percent of patients. Startups do not bypass them; they co-opt them. Similarly, technology must be offline-first, with USSD, SMS, and asynchronous synchronisation accommodating intermittent connectivity in peri-urban and rural areas. Success is not measured by an app download but by integration into operational realities.

Capital, Market Discipline, and Regional Arbitrage

Despite global venture headwinds, African HealthTech deal flow remains resilient. The character of investment is, however, changing. Investors are executing a flight to quality, favouring Series A and B companies capable of generating sustainable revenue over pre-seed pilots. The greatest systemic risk is the “grantpreneur trap”: ventures surviving solely on donor funding without building commercial engines. Grants have catalysed experimentation, but they can distort incentives, promoting pilot proliferation over durable, investable models.

Geography and founder background increasingly influence success. While Nigeria, Kenya, South Africa, and Egypt capture roughly 80 per cent of capital, Francophone markets such as Senegal and Côte d’Ivoire receive less than 5 per cent despite promising demographics. This represents a clear arbitrage opportunity for patient capital willing to navigate emerging regulatory and operational contexts. Simultaneously, founders with Western degrees attract disproportionate funding, a “halo effect” creating a form of capital apartheid. The most locally integrated or operationally effective companies are often undercapitalised, while diaspora-linked founders receive outsized attention.

The next decade: consolidation, payviders, and AI-enabled task shifting

Looking ahead, three trends will define the next decade. First, consolidation. Fragmented electronic medical record systems cannot survive indefinitely; regional champions will acquire smaller operators to standardise workflows and capture scale efficiencies.

Second, the rise of “payviders”. Controlling both payment and care delivery, insurance and clinics, allows companies to protect margins, manage risk, and ensure continuity of care. This trend mirrors integrated models in fintech and telecoms, adapted to healthcare’s unique constraints.

Third, AI-enabled task shifting. Artificial intelligence will not replace clinicians but will augment nurses and mid-level providers, enabling rural practitioners to interpret diagnostics such as ultrasounds and ECGs at near-specialist levels. By doing so, HealthTech can extend access without adding scarce physicians, a critical multiplier in resource-limited settings.The companies that dominate the next decade will not be those measuring success by pilots launched or lives touched in donor reports. They will be those whose solutions become the operational backbone of African healthcare, embedded in hospital workflows, pharmacy shelves, and insurance claims.

In conclusion, Africa’s $100bn HealthTech opportunity belongs to those who understand a fundamental truth: on this continent, you do not merely build the solution; you often have to build the system it runs on. The era of grant-led pilots is ending. The era of durable, infrastructure-driven HealthTech has begun.

Article by Dr Isaac Ekundayo, MD, Included VC Africa Fellow

Report Methodology Note: This report leverages proprietary data from over 430 startups extracted from the provided research datasets, integrated with deep-dive qualitative reports on the East African ecosystem, Nigerian market dynamics, Francophone regulatory landscapes, and investment outlooks. The synthesis aims to provide an operational reality check beyond the high-level investment narratives often found in public media.