Abstract
BackgroundA majority of health systems in the sub-Saharan Africa region are faced with multiple competing priorities amid pressing resource constraints. Health financing reforms, characterized by expansion of health insurance coverage, have been proposed as promising in the quest to improve health sustainably. However, in many countries where these measures are being attempted, their broader implications have not been fully appreciated. MethodsThis study was based on perspectives of 37 health system stewards from Botswana who were interviewed in order to understand opportunities and challenges that would result in the quest to expand health insurance coverage in the country. Thematic synthesis of their perspectives, focusing on the key aspects of the health systems, was done in order to draw informative lessons that could be applicable to a broader set of low- and middle-income countries. FindingsHealth systems attempting to expand health insurance coverage would be faced with various opportunities and challenges that have implications on performance. By increasing the pool of resources available to spend on health, health insurance would afford health systems the opportunity to increase population access to and use of health services. However, if unchecked, this could also translate to uncontrolled demand for expensive medicines and other health technologies, leading to cost escalation and inefficiencies within the system. Therefore, the success of any health financing reform is dependent on embracing sound policies, regulations, and accountability measures. ConclusionsHealth financing reforms have broader implications to health system performance that should be fully appreciated and anticipated before implementation. Therefore, health system leaders who are keen to improve health must view any health financing reforms through the broader framework of the health system framework in order to make progress.
Highlights
Over the past 2 decades, there has been progress in many countries in the sub-Saharan Africa region in addressing some of the priority population health needs
Given the interconnectedness of the health system, the proposed health financing reform would have a number of impacts that would present opportunities and challenges to the overall functioning of the health system
It was clear that the proposed health financing reform had the potential to increase the resources available to spend on health service provision as a result of increased employee contributions and the government subsidy offered for each employee that joins the scheme
Summary
Over the past 2 decades, there has been progress in many countries in the sub-Saharan Africa region in addressing some of the priority population health needs. Many health systems in low- and middle- income countries are trying to secure their recent progress in improving population health. This is urgent when considering that many of these countries are faced with a health transition characterized by emerging noncommunicable diseases, in the backdrop of the unfinished agenda of communicable diseases.[2,3] This situation has led to a vibrant debate on sustainable health financing options as means toward universal health coverage (UHC). It remains true that majority of low- and middle- income countries in Africa are heavily reliant on donor financing to deliver essential health services This puts into the question the very sustainability of health programs that have led to the recent achievements in population health in many African countries.[2,3,5]
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