Abstract
BackgroundUniversal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings.MethodsA systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 to 30 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. Studies describing health financing approaches for UHC in SSA were included. Evidence was synthesised in form of a table and thematic analysis.ResultsOf all records, 39 papers were selected for inclusion. Among the included studies, most studies were conducted in Kenya (n = 7), followed by SSA as a whole (n = 6) and Nigeria (n = 5). More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC. The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments. Another common financing mechanism was donor funding, which was reported by most of the studies. The average quality score of all studies was 81.6%, indicating a high appraisal score. The interrater reliability Cohen’s kappa score, κ=0.43 (p = 0.002), which showed a moderate level of agreement.ConclusionsAppropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC. It is evident from the review that innovative health financing strategies in SSA are needed. Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA. Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.
Highlights
Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship
In Sub-Saharan Africa (SSA), 27 out of 48 countries are affected by direct out-of-pocket payments (OOPs) for healthcare services that are greater than 30% (Additional file 1)
A health financing framework was developed by the World Health Organization (WHO), highlighting that financing strategies should be integrated within a national health policy and include a service delivery plan [3]
Summary
Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). Access to quality health services, whether preventative or curative, remains a prerequisite in order for a population to attain health and achieve healthy lifestyles [1] In this context, universal health coverage (UHC), embedded within the 2030 Agenda for Sustainable Development, is defined by the World Health Organization (WHO) as all individuals and communities having access to any health services they need, of sufficient quality to be effective, without suffering financial hardship. Such access barriers contribute to high burdens of preventable deaths [4]
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