|By Adeola Olaniyi
Nigeria’s digital health sector attracted record investment in 2022 and 2023. Now, the companies that raised the largest rounds are discovering something that veteran healthcare and financial services practitioners warned about: you cannot scale a product that patients do not trust.
In the twelve months between mid-2022 and mid-2023, Nigerian healthtech startups collectively raised more than $340 million in disclosed funding, according to data compiled by Disrupt Africa and Partech Africa. The sector — encompassing digital pharmacy platforms, telemedicine services, electronic health records systems, and medication adherence applications — became the most funded vertical in Nigerian tech after fintech, attracting attention from pan-African venture funds, international development finance institutions, and a growing number of global impact investors.
The coverage was, on balance, celebratory. Nigeria’s healthcare system — chronically underfunded, geographically uneven, and operating under severe infrastructure constraints — had found its saviour in digital technology. The startups entering the space were, by and large, led by credible founders, staffed by talented engineers, and backed by patient capital. The product narratives were compelling.
But in the offices of companies that had moved past the fundraising stage and into the harder work of user growth, a quieter conversation was beginning to surface. The conversation was about scale, and about the specific, structural reasons why scaling a digital health product in Nigeria was proving to be considerably more resistant than the pitch decks had anticipated.
Product-market fit, in the Nigerian healthtech context, is being declared too early. This is the central argument being made by a cohort of practitioners who have observed the sector’s scaling challenges from an analytical distance — and, in some cases, from the inside of the affected organisations.
The problem is definitional. In the conventional startup framework, product-market fit is confirmed by a combination of retention metrics, net promoter scores, and organic growth signals. In markets where the user base is educated, digitally literate, and operating within a functional formal healthcare system, these metrics are reasonably reliable indicators. In Nigeria’s market, they are not — because the users who generate these metrics are not representative of the market the product needs to reach to justify its valuation.
Adeola Olaniyi, a product and financial services practitioner whose cross-sector work has given her an unusual vantage point on both the fintech and healthtech challenges, has been making a version of this argument for the better part of a year. Her framing is direct.
“Most of the healthtech startups I observe have achieved product-market fit within a very specific user segment: urban, educated, digitally active, and already engaged with formal healthcare. That segment is real, but it is small. The Nigerian health crisis is not a crisis for that segment. It is a crisis for the 70 per cent of the population that interacts with healthcare informally, episodically, and with deep structural mistrust of formal health institutions. When a startup says it has achieved product-market fit in Nigeria, I ask: fit with which Nigeria?” Adeola Olaniyi, a Product Management Practitioner & Financial Inclusion Analyst.
This is not a new critique. Versions of the same argument have been made about fintech, agtech, and edtech in the Nigerian context. But Adeola’s formulation carries additional weight because it is grounded in direct observation of how trust or its absence operates as a structural variable in digital product adoption among Nigerian users outside the urban formal economy.
The scaling wall that Adeola describes is not a technical problem. It is a user behaviour problem and, at its root, a product design problem.
Digital health products designed for the engaged, urban user segment work well within that segment. They are intuitive for users who already navigate smartphone interfaces fluently, who have a prior relationship with formal medical consultation, and who are willing to share health data with a digital platform on the basis of a terms-and-conditions agreement they do not read. When the same products are deployed to users outside this segment — lower digital literacy, no prior formal healthcare relationship, operating within social networks where health information is considered private and often sensitive — the experience breaks down rapidly.
“The language is wrong,” Adeola notes. “The flow is wrong. The trust assumptions embedded in the product design are wrong. A digital pharmacy platform that asks a user in rural Osun State to upload a prescription, confirm a dosage, and enter a delivery address is asking that user to perform four discrete acts of institutional trust that they have no prior basis for. They have never uploaded a document to a digital platform. They have never had a formal prescription. They have never used a courier service. You cannot abstract away that experience gap with a good UI.” Adeola explains further.
The consequence, she predicts, is a pattern that the Nigerian healthtech sector will encounter — if it has not already — with increasing frequency over the next eighteen to twenty-four months: plateauing user growth as the addressable urban-digital market saturates, followed by a forced reckoning with the product design assumptions that were never tested against the broader population.
Adeola’s prescription for healthtech companies that want to reach beyond the initial addressable segment is consistent with the framework she has applied across multiple product contexts. It begins with a diagnostic question that most product teams are not asking: what does a user who has never trusted a formal health institution need to experience before they are willing to engage with a digital health product?
“That question changes your product roadmap fundamentally,” she says. “It means your first product interaction cannot be a medication order or a telemedicine consultation. It has to be something that costs the user nothing — no money, no data, no irreversible commitment — and delivers something concrete and immediately verifiable in return. Information, perhaps. A reminder. A resource that is useful without requiring the user to trust you first. You earn the right to ask for trust. You do not assume it.”
She identifies what she calls a trust-sequencing gap in how healthtech products currently structure their user journeys — a tendency to front-load the actions that require the most trust (registration, data sharing, payment) while back-loading the experiences that build it. This sequencing, she argues, is precisely backwards for a user population that has no prior relationship with formal healthcare institutions.
“Reverse the sequence. Give first. Ask later. Make the first five interactions ones that the user controls completely. Let them experience value before you ask them to contribute anything including their trust. This is not a new idea in product design. But it is not being applied in the Nigerian healthtech context, and the absence is going to become very visible very soon.”
“Give first. Ask later. Make the first five interactions ones that the user controls completely.”
The Nigerian healthtech sector is not failing. It is succeeding in a segment that is too small to justify its current valuations, using product design assumptions that will not survive contact with the broader market. This distinction matters because the correction, when it comes, will be attributed to macro conditions, regulatory uncertainty, or investor sentiment — rather than to the product-level decisions that are its actual cause.
Practitioners like Adeola are not making this argument to be contrarian. They are making it because they have direct experience of the failure mode from the vantage point of a professional who has spent years at the intersection of formal financial institutions and the populations those institutions most struggle to serve.
The healthtech companies that listen now, recalibrate their product strategy, and invest in understanding the trust architecture of the broader Nigerian market will be the ones that are still operating and growing when the current wave of venture capital enthusiasm subsides. The ones that do not will be case studies in how a sector mistook the enthusiasm of early adopters for evidence that the hard work of building mass-market trus
