Challenges in Financing Universal Health Coverage in Sub-Saharan Africa

2018 ◽  
Author(s):  
Diane McIntyre ◽  
Amarech G. Obse ◽  
Edwine W. Barasa ◽  
John E. Ataguba
Keyword(s):  
Health Expenditure ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Healthcare Financing ◽  
Current Health ◽  
Out Of Pocket Payments ◽  
The World ◽  
Sub Saharan ◽  
Ssa Countries ◽  
Universal Health

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.

scholarly journals Risk for COVID-19 among Migrants from different areas of the World in Spain: A population-based cohort study in a country with universal health coverage

2020 ◽  
Author(s):  
Carlos Guijarro ◽  
Elia Pérez-Fernández ◽  
Beatriz González-Piñeiro ◽  
Victoria Meléndez ◽  
Maria José Goyanes ◽  
...  
Keyword(s):  
Latin America ◽  
Universal Health Coverage ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Relative Risks ◽  
Increased Risk ◽  
The World ◽  
Sub Saharan ◽  
Universal Health

AbstractObjectiveTo evaluate the COVID-19 incidence among migrants from different areas of the world as compared to Spaniards living in AlcorcónDesignPopulation-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 cases until April 25 (2020) among adult residents at Alcorcón (Spain) attended at the only public hospital serving this city. Crude incident rates for Spaniards and migrants from different areas of the world were estimated. Age and sex-adjusted relative risks for COVID19 were estimated by negative bomial regression.SettingUniversity public Hospital at Alcorcón, Madrid, SpainParticipantsAll adult residents living in Alcorcon classified by their country and region of the world of origin.Main outcomePCR confirmed COVID-19.ResultsPCR confirmed COVID-19 cumulative incidence was 6.81 cases per 1000 inhabitants among residents of Alcorcón. The crude incidence among migrants (n=20419) was higher than among Spaniards (n=131599): 8.81 and 6.51 and per 1000 inhabitants respectively (p<0.001).By regions of the world, crude cumulative COVID-19 incidence rates were: European Union 2.38, Asia 2.01,, Northern Africa 3.59, East ern Europe 4.37, Sub-Saharan Africa 11.24, Caribbean 18.26 and Latin-America 20.77 8 per 1000 inhabitants. Migrant residents were markedly younger than Spaniards (median age 52 vs 73 years, p<0.001). By negative binomial regression, adjusted for age and sex, relative risks (RR) for COVID-19 were not significantly different from Spaniards for individuals from Europe, Asia or Northern Africa. In contrast, there was an increased risk for Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p=0.007), Caribbean (RR 6.35, 95% CI 3.83-10.55, p<0.001) and Latin-America (RR 6.92, 95% CI 4.49-10.67, p <0.001).ConclusionsThere was a marked increased risk for COVID-19 among migrants from Sub-Saharan Africa, Caribbean and Latin-America residing in Spain. The reasons underlying this increased risk and health and social implications deserve further attention.What is known about the topicRecent reports suggest an increased burden of COVID-19 among migrants or ethnic minorities in the United Kingdom and the USA, particularly regarding mortality. Reports have failed to dissociate clinical outcomes from differences in access to medical care or pre-existing medical conditions. There is no information regarding COVID risk for latinos in countries with universal health coverageWhat this study addMigrants from subsaharian Africa resident in Spain exhibit an increased risk for COVID-19. This risk is further increased for migrants from the Caribbean and Latin-America and cannot be attributed to unequal access to medical care. Studies in countries with universal health coverage may help to dissociate COVID burden in migrants and ethnic populations from access to health care.

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2019 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Significant Proportion ◽  
Health Spending ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health ◽  
Out Of Pocket Payments

Abstract Background About 5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia and examine the factors associated with this impoverishment.Methods This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment.Results Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts.Conclusion In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2020 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Addis Ababa ◽  
Significant Proportion ◽  
Health Spending ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health ◽  
Out Of Pocket Payments

Abstract Background: About5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia and examine the factors associated with this impoverishment. Methods: This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. Results: Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. At regional level, impoverishment ranged between 2.35% in Harari and 0.35% in Addis Ababa. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts. Conclusion:In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

scholarly journals Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
A. S. Wigley ◽  
N. Tejedor-Garavito ◽  
V. Alegana ◽  
A. Carioli ◽  
C. W. Ruktanonchai ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
National Level ◽  
District Level ◽  
Sub Saharan Africa ◽  
World Health ◽  
Health Coverage ◽  
Availability Analysis ◽  
Sub Saharan ◽  
Geographical Accessibility ◽  
Universal Health

Abstract Background With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes. Methods Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services. Results Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other. Conclusion While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.

What determines financial inclusion in Sub-Saharan Africa?

2017 ◽  
Vol 8 (1) ◽  
pp. 8-18 ◽  
Author(s):  
Sydney Chikalipah
Keyword(s):  
International Development ◽  
World Bank ◽  
Financial Inclusion ◽  
Sub Saharan Africa ◽  
Data Set ◽  
Content Type ◽  
The World Bank ◽  
The World ◽  
Sub Saharan ◽  
Ssa Countries

Purpose The purpose of this paper is to investigate the determinants of financial inclusion (FI) in Sub-Saharan Africa (SSA). Design/methodology/approach The paper uses the World Bank country-level data from 20 SSA countries for the year 2014. Findings The empirical findings in this study indicate that illiteracy is the major hindrance to FI in SSA. The findings provide useful information to government agencies and international development organisations. Also, the findings can help accelerate and strengthen FI strategies among SSA countries. Research limitations/implications Some countries were excluded from the final analysis due to lack of data. Practical implications In the last two decades, there has been renewed interest in fighting financial exclusion in Africa. Therefore, this study provide evidence which clearly shows that enhancing literacy levels in a country can immensely contribute towards building the financially inclusive societies in the SSA region. Originality/value To the best of the author’s knowledge, this is the first study to empirically test the determinants of FI in SSA using the World Bank FI data set. Furthermore, this is the first attempt to estimate the determinants of FI with a combined data of SSA countries.

scholarly journals COMPARATIVE ANALYSIS OF THE IMPACT OF GLOBALISATION ON HUMAN WELFARE IN SUB-SAHARAN AFRICA

10.23856/3002 ◽  
2018 ◽  
Vol 30 (5) ◽  
pp. 25-42
Author(s):  
Olukayode Emmanuel Maku ◽  
Bolaji Adesola Adesoye ◽  
Awoyemi Olayiwola Babasanya ◽  
Oluwaseyi Adedayo Adelowokan
Keyword(s):  
Comparative Analysis ◽  
Random Effects ◽  
Trade Openness ◽  
Sub Saharan Africa ◽  
Human Welfare ◽  
Fixed And Random Effects ◽  
The World ◽  
Sub Saharan ◽  
The Impact ◽  
Ssa Countries

The world has become more linked owing to the increased intensity of globalisation across regions. Sub-Saharan Africa (SSA) has become more relatively integrated into the world economy as shown by increasing degree of trade openness and foreign direct investment. Over the same period, quality of life of people in SSA in terms of access to basic necessity, monetary and non-monetary indices of poverty have been on the declining trend. This study adopted endogenous growth theory in analysing the comparative effects of globalisation between the highly and weakly globalised economies in SSA countries. Four channels of transmission of impact of globalisation were considered: trade openness, financial and capital flows labour mobility and access to telephone. Data for 16 SSA countries – 8 weakly globalised and 8 strongly globalised countries based on KOF globalisation index, were sourced from the world Development indicator for the period of 1980-2012. The feasible generalised least square (GLS) estimator was utilized to estimate the fixed and random effects panel regression models. Hausman test was used to determine the efficient estimator between fixed and random effects. All estimated coefficients were evaluated at 5% level of significance. The outcome of the comparative analysis revealed a mix result in some cases and unidirectional in some. In all, countries with higher intensity of globalisation have a greater improvement in their human welfare indicators compared to countries with weak globalisation indices. The study then recommended an improved reform in global integration to enable the region maximize the immense benefits inherent in global connections.

scholarly journals A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa

2021 ◽  
Author(s):  
Abigail Nyarko Codjoe Derkyi-Kwarteng ◽  
Irene Akua Agyepong ◽  
Nana Enyimayew ◽  
Lucy Gilson
Keyword(s):  
Policy Implementation ◽  
Universal Health Coverage ◽  
Health Sector ◽  
Sub Saharan Africa ◽  
Narrative Synthesis ◽  
Health Coverage ◽  
Implementation Gap ◽  
Street Level ◽  
Sub Saharan ◽  
Universal Health

Background: "Achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all" is the Sustainable Development Goal (SDG) 3.8 target. Although most high-income countries have achieved or are very close to this target, low- and middle-income countries (LMICs) especially those in sub-Saharan Africa (SSA) are still struggling with its achievement. One of the observed challenges in SSA is that even where services are supposed to be "free" at point-of-use because they are covered by a health insurance scheme, out-of-pocket fees are sometimes being made by clients. This represents a policy implementation gap. This study sought to synthesise the known evidence from the published literature on the ‘what’ and ‘why’ of this policy implementation gap in SSA. Methods: The study drew on Lipsky’s street level bureaucracy (SLB) theory, the concept of practical norms, and Taryn Vian’s framework of corruption in the health sector to explore this policy implementation gap through a narrative synthesis review. The data from selected literature were extracted and synthesized iteratively using a thematic content analysis approach. Results: Insured clients paid out-of-pocket for a wide range of services covered by insurance policies. They made formal and informal cash and in-kind payments. The reasons for the payments were complex and multifactorial, potentially explained in many but not all instances, by coping strategies of street level bureaucrats to conflicting health sector policy objectives and resource constraints. In other instances, these payments appeared to be related to structural violence and the ‘corruption complex’ governed by practical norms. Conclusion: A continued top-down approach to health financing reforms and UHC policy is likely to face implementation gaps. It is important to explore bottom-up approaches – recognizing issues related to coping behaviour and practical norms in the face of unrealistic, conflicting policy dictates.

scholarly journals Extending freight flow modelling to sub-Saharan Africa to inform infrastructure investments - trade data issues

2012 ◽  
Vol 6 (1) ◽  
Author(s):  
Jan Havenga ◽  
Zane Simpson ◽  
David King ◽  
E. J. Lanz ◽  
Leila Goedhals-Gerber ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Demand Model ◽  
Initial Flow ◽  
Trade Data ◽  
The World ◽  
Sub Saharan ◽  
Infrastructure Investments ◽  
High Level ◽  
Freight Flow ◽  
Ssa Countries

This paper highlights the first attempt by researchers at Stellenbosch University to model freight flows between and for 17 countries in sub-Saharan Africa (SSA). The model will be informed by and linked to the South African surface Freight Demand Model (FDM) given these dimensions. By analysing and collating available datasets and developing a freight flow model, a better understanding of freight movements between countries can be obtained and then used for long-term planning efforts. A simple methodology is envisaged that will entail a high-level corridor classification that links a major district in the country with a similar district in another country. Existing trade data will be used to corroborate new base-year economic demand and supply volumetric data that will be generated from social accounting matrices for each country. The trade data will also provide initial flow dynamics between countries that will be refined according to the new volumes. The model can then generate commodity-level corridor flows between SSA countries, and between SSA countries and the rest of the world, as well as intra-country rural and metropolitan flows, using a gravity-based modelling approach. This article outlines efforts to harmonise trade data between the 17 countries identified, as well as between these countries and the rest of the world as a first step towards developing a freight demand model for sub-Saharan Africa.

Sign in / Sign up

Export Citation Format

Share Document