Prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa: Multilevel analyses of demographic and health survey data

Abstract

Introduction With the vision of achieving Universal Health Coverage (UHC) by the year 2030, many sub-Saharan African (SSA) countries have implemented health insurance schemes that seek to improve access to healthcare for their populace. In this study, we examined the prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa (SSA). Materials and methods We used the most recent Demographic and Health Survey (DHS) data from 23 countries in SSA. We included 120,037 women and 54,254 men residing in urban centres in our analyses which were carried out using both bivariable and multivariable analyses. Results We found that the overall prevalence of health insurance coverage was 10.6% among females and 14% among males. The probability of being covered by health insurance increased by level of education. Men and women with higher education, for instance, had 7.61 times (95%CI = 6.50–8.90) and 7.44 times (95%CI = 6.77–8.17) higher odds of being covered by health insurance than those with no formal education. Males and females who read newspaper or magazine (Males: AOR = 1.47, 95%CI = 1.37–1.57; Females: AOR = 2.19, 95%CI = 1.31–3.66) listened to radio (Males: AOR = 1.29, 95%CI = 1.18–1.41; Females: AOR = 1.42, 95%CI = 1.35–1.51), and who watched television (Males: AOR = 1.80, 95%CI = 1.64–1.97; Females: AOR = 1.86, 95%CI = 1.75–1.99) at least once a week had higher odds of being covered by health insurance. Conclusion The coverage of health insurance in SSA is generally low among urban dwellers. This has negative implications for the achievement of universal health coverage by the year 2030. We recommend increased public education on the benefits of being covered by health insurance using the mass media which we found to be an important factor associated with health insurance coverage. The focus of such mass media education could target the less educated urban dwellers, males in the lowest wealth quintile, and young adults (15–29 years).

Pooled coverage of community based health insurance scheme enrolment in Ethiopia, systematic review and meta-analysis, 2016–2020

“…On the other hand, our reported coverage is higher than the coverage (28%) reported by mini-EDHS, 2019 [ 23 ] EDHS is a population-based survey covering all regions of Ethiopia given that significant number of regions did not initiate the scheme which dragged the national coverage down. A study in Ghana also reported a lower rate of (38%)enrolment than our reported coverage [ 46 ] in addition to other sub-Saharan African studies which have challenges of low enrolment rates [ 47 , 48 ] except Rwanda which has achieved a higher coverage [ 49 ].…”

Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey

“…The frequency of reading newspaper or magazine, frequency of listening to radio, and frequency of watching television were respectively captured as not at all, less than once a week, at least once a week, and almost every day. Our study variables were based on previous literature [1] [2] [12].…”

“…Many countries in Africa are also implementing health Insurance (HI) [4]. For example, Ghana, Kenya, Mali, Nigeria, Rwanda, South Africa, Tanzania, and Zimbabwe have implemented health insurance schemes that seek to improve access to healthcare for their populace [1] [5] [6].…”

“…The key finding of the assessment by Gheorghe et al is that HI is feasible in Malawi and that the National Health Insurance Scheme’s (NHIS) is a way of generating additional health revenue [4]. Several studies in SSA have shown limited access to health insurance [1] [9]. Furthermore, there have been very few studies that assess the uptake of health insurance in Malawi.…”

“…As one of the strategies aimed at achieving the Universal Health Coverage (UHC) by the year 2030, many sub-Saharan African (SSA) countries are at various levels of implementing health insurance schemes in order to improve access to healthcare for their population [1]. The UHC is a key health priority in Sustainable Development Goals.…”