Highlights 1400 poor households in two major African cities were interviewed during lockdowns. The lockdown had a high economic impact in Ghana. In South Africa, COVID-19 had an adverse impact on the urban poor’s mental health. Lack of information was an issue, while misinformation appeared to be limited. Stricter regulations do not always lead to higher compliance with social distancing.

Many low‐income countries are in the process of scaling up health insurance with the goal of achieving universal coverage. However, little is known about the usage and financial sustainability of mandatory health insurance. This study analyzes 26 million claims submitted to the Tanzanian National Health Insurance Fund (NHIF), which covers two million public servants for whom public insurance is mandatory, to understand insurance usage patterns, cost drivers, and financial sustainability. We find that in 2016, half of policyholders used a health service within a single year, with an average annual cost of 33 US$ per policyholder. About 10% of the population was responsible for 80% of the health costs, and women, middle‐age and middle‐income groups had the highest costs. Out of 7390 health centers, only five health centers are responsible for 30% of total costs. Estimating the expected health expenditures for the entire population based on the NHIF cost structure, we find that for a sustainable national scale‐up, policy makers will have to decide between reducing the health benefit package or increasing revenues. We also show that the cost structure of a mandatory insurance scheme in a low‐income country differs substantially from high‐income settings. Replication studies for other countries are warranted.

No abstract

No abstract

Ghana and South Africa proactively implemented lockdowns very early in the pandemic. We analyze a three‐wave panel of households in Accra and Greater Johannesburg to study the mental and economic well‐being of the urban poor between the COVID‐19 lockdown and the “new normal” one year later. We find that even if economic well‐being has mostly recovered, life satisfaction has only improved slightly and feelings of depression are again at lockdown levels one year into the pandemic. While economic factors are strongly correlated with mental health and explain the differences in mental health between South Africa and Ghana, increasing worries about the future and limited knowledge about the pandemic (both countries) as well as deteriorating physical health (South Africa) and trust in government (Ghana) explain why mental health has not recovered. Therefore, we need broad and country‐specific policies, beyond financial support, to accelerate the post‐pandemic recovery of the urban poor.