We conclude that it is possible to extend MHI to ISW as long as their premiums are subsidized. The annual subsidy is estimated at 4.1% of the state current general budget or 96% of the health sector budget. In setting the premium, policy makers should take into account the MHI benefits package, subsidies from the government, and information about the WTP. It is important to emphasize that resource mobilization and management, as well as health services delivery, would be effective only in a context of improved governance.

Purpose The agriculture sector in Africa is a major employer, but production levels have fallen short of demand. To match future demand, public investment in research and development (R&D) is required. The purpose of this paper is to investigate how foreign direct investments (FDIs) moderate the effects of public R&D on Africa’s agricultural production. Design/methodology/approach This study estimates an unbalanced panel fixed effect model that consists of 28 African countries covering the period 1980–2014. Findings Public R&D increases production in the agriculture sector, however, the effects reverse after ten years. Though FDIs have direct positive effects on production, indirectly, it reduces the productivity potential of public R&D due to the possible dependency syndrome associated with FDIs. Traditional inputs like land, capital, and labour and good political institutions positively drive production, but adverse changes in the weather reduce production. Practical implications There should be a frequent update of R&D and improvement in maintenance culture. FDIs should be seen as complementary efforts, and not as substitute efforts to domestic investment efforts in R&D. Originality/value Insufficient domestic investment has increased the dependence on FDIs. In this regard, FDIs effect on production could be tricky since it increases the volatility in agricultural R&D. This paper contributes to the literature by examining how FDIs moderate the effects of public R&D on output.

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Background Despite the implementation of a mandatory health insurance (MHI) scheme in Togo since 2011, its coverage rate remains low, resulting in a high out-of-pocket payment rate. More than 10 years after its implementation, there are few empirical studies investigating the extent to which Togo’s mandatory health insurance has improved beneficiaries’ access to health care. Examining how MHI and healthcare use in Togo are related is the goal of this study. Methods We use data from the Harmonized Survey on Living Conditions of Households (EHCVM), conducted in the member states of the West African Economic and Monetary Union (WAEMU) in 2018–2019 and covering 6,171 households in Togo. We employ multinomial logistic regression, given that the dependent variable is polytomous. Results The results reveal a high rate of non-utilization of healthcare professionals in the case of illness, even among individuals with MHI coverage. Furthermore, the findings show that the MHI increases the likelihood of seeing a specialist physician and other formal health care professionals when sick. The results also reveal that a household’s wealth is positively correlated with the likelihood of seeing formal health care professionals. Urban residents are statistically and significantly more likely than rural residents to see both a specialist physician and a general practitioner. The Grand Lomé region has a statistically and significantly higher likelihood of seeing a specialist physician than the Maritime region. Conclusion The results support the government’s plan to implement universal health insurance. The government should take action to raise the standard of treatment provided to insured patients in health care centers. Additionally, the government should consider waiving medical fees for low-income policyholders. When waiving medical costs for low-income policyholders, the Togolese government should focus on the regions with the worst economic conditions. These interventions should be essential to ensure that no one is left behind. The difference between urban and rural communities should be reduced through supply-side policies that focus on rural areas.