Challenges in Financing Universal Health Coverage in Sub-Saharan Africa

Abstract

Within the context of the Sustainable Development Goals, it is important to critically review research on healthcare financing in sub-Saharan Africa (SSA) from the perspective of the universal health coverage (UHC) goals of financial protection and access to quality health services for all. There is a concerning reliance on direct out-of-pocket payments in many SSA countries, accounting for an average of 36% of current health expenditure compared to only 22% in the rest of the world. Contributions to health insurance schemes, whether voluntary or mandatory, contribute a small share of current health expenditure. While domestic mandatory prepayment mechanisms (tax and mandatory insurance) is the next largest category of healthcare financing in SSA (35%), a relatively large share of funding in SSA (14% compared to <1% in the rest of the world) is attributable to, sometimes unstable, external funding sources. There is a growing recognition of the need to reduce out-of-pocket payments and increase domestic mandatory prepayment financing to move towards UHC. Many SSA countries have declared a preference for achieving this through contributory health insurance schemes, particularly for formal sector workers, with service entitlements tied to contributions. Policy debates about whether a contributory approach is the most efficient, equitable and sustainable means of financing progress to UHC are emotive and infused with “conventional wisdom.” A range of research questions must be addressed to provide a more comprehensive empirical evidence base for these debates and to support progress to UHC.

Who enrols in voluntary micro health insurance schemes in low-resource settings? Experience from a rural area in Bangladesh

“…This is primarily due to the fact that the client base for MHI schemes mostly consists of the informal sector and charging a sliding scale premium according to people’s level of income is complex. However, a flat rate premium tends to make the system highly regressive as poor people in this system contribute a higher proportion of their income than wealthier people [34–36]. Safety-nets where premium for those with lower ability-to-pay are subsidized or exempted have the potential to bring in the desired level of equity [34].…”

COVID-19 Pandemic, a War to be Won: Understanding its Economic Implications for Africa

“…Until recently, analyses of the economic implications of the COVID-19 pandemic in public media and academic writing have focused mainly on global and macroeconomic impacts, which, as I argue, is only one part of the bigger picture of economic impact. This is especially the case in Africa, with its high disease burden, poorly developed infrastructure and safety nets and weak health systems [4][5][6]. For instance, the first comprehensive report on COVID-19 from the Brookings Institution [7] modelled the implications of the COVID-19 pandemic on macroeconomic outcomes and financial markets.…”

Patient costs of hypertension care in public health care facilities in Kenya

“…Kenya is committed towards attaining UHC by 2022 . The Kenyan health sector is funded by different sources including; the government, out‐of‐pocket payments (OOP) and donors . The high level of OOP payments increases the risk of catastrophic health expenditure where households spend a large proportion of their budget on health care, which consequently have negative implications on living standards as they forego other goods and services .…”

“…8 The Kenyan health sector is funded by different sources 9 including; the government, out-of-pocket payments (OOP) and donors. [10][11][12][13][14] The high level of OOP payments increases the risk of catastrophic health expenditure where households spend a large proportion of their budget on health care, which consequently have negative implications on living standards as they forego other goods and services. 15 The incidence of catastrophic health care expenditure (at the 40% of annual non-food expenditure threshold) related to direct health care payments to providers in Kenya is estimated to be 4.52%.…”