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Universal health insurance in Africa: a narrative review of the literature on institutional models
INTRODUCTION: Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to st...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9052052/ https://www.ncbi.nlm.nih.gov/pubmed/35483710 http://dx.doi.org/10.1136/bmjgh-2021-008219 |
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author | Ly, Mamadou Selly Bassoum, Oumar Faye, Adama |
author_facet | Ly, Mamadou Selly Bassoum, Oumar Faye, Adama |
author_sort | Ly, Mamadou Selly |
collection | PubMed |
description | INTRODUCTION: Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals. METHOD: This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection). RESULTS: Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa. CONCLUSION: Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale. |
format | Online Article Text |
id | pubmed-9052052 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-90520522022-05-12 Universal health insurance in Africa: a narrative review of the literature on institutional models Ly, Mamadou Selly Bassoum, Oumar Faye, Adama BMJ Glob Health Original Research INTRODUCTION: Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals. METHOD: This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection). RESULTS: Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa. CONCLUSION: Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale. BMJ Publishing Group 2022-04-28 /pmc/articles/PMC9052052/ /pubmed/35483710 http://dx.doi.org/10.1136/bmjgh-2021-008219 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Ly, Mamadou Selly Bassoum, Oumar Faye, Adama Universal health insurance in Africa: a narrative review of the literature on institutional models |
title | Universal health insurance in Africa: a narrative review of the literature on institutional models |
title_full | Universal health insurance in Africa: a narrative review of the literature on institutional models |
title_fullStr | Universal health insurance in Africa: a narrative review of the literature on institutional models |
title_full_unstemmed | Universal health insurance in Africa: a narrative review of the literature on institutional models |
title_short | Universal health insurance in Africa: a narrative review of the literature on institutional models |
title_sort | universal health insurance in africa: a narrative review of the literature on institutional models |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9052052/ https://www.ncbi.nlm.nih.gov/pubmed/35483710 http://dx.doi.org/10.1136/bmjgh-2021-008219 |
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