Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania

Abstract

Although many sub-Saharan African countries have made efforts to provide universal health coverage (UHC) for their citizens, several of these initiatives have achieved little success. This study aims to review the challenges facing UHC in Ghana, Kenya, Nigeria, and Tanzania, and to suggest program or policy changes that might bolster UHC. Routine data reported by the World Bank and World Health Organization, as well as annual reports of the national health insurance schemes of Ghana, Kenya, Nigeria, and Tanzania, were analyzed. The data were supplemented by a review of published and gray literature on health insurance coverage in these four countries. The analysis showed that some of the challenges facing UHC in these countries include (1) large proportion of the population living in extreme poverty and unable to pay premiums, (2) large informal sector whose members are mostly uninsured, (3) high dropout rate from insurance schemes, (4) poorly funded primary health care system, and (5) segmented health insurance fund pool. In order to achieve UHC by 2030, it will be important for these countries to (1) raise sufficient revenue to finance their health systems, (2) improve the efficiency of revenue utilization, (3) identify and provide coverage for the very poor, (4) reduce the proportion of the population that is underinsured, and (5) improve access to quality health care in rural areas.

Mobile money use and social health insurance enrolment among rural dwellers outside the formal employment sector: Evidence from Kenya

“…One of the main challenges of achieving UHC is a large informal sector that does not have health insurance . Roughly 83.6% of employment in Kenya is in the informal sector with almost two thirds (64.5%) being in rural areas .…”

Patterns and predictors of private and public health care utilization in an informal settlement in Nairobi, Kenya: A cross-sectional study

“…Cost of care remains a paramount issue in accessing health care in Kenya especially in low resource settings and is a major contributor to health care inequity. (Chuma & Okungu, 2011;Turin, 2010;Umeh, 2018). Kenya's commitment towards universal health coverage aims at cushioning citizens against OOP expenditure on health which pushes approximately one million Kenyans into poverty each year.…”

The emergence of the national medical assistance scheme for the poorest in Mali

“…However, the formulation of its content can be classed more as a compilation of the preexisting actions, against a background of aid dependency [17], rather than a genuine and coherent re ection of the interventions needing to be organised in order to meet the needs of the poorest [18]. In Benin, the extensive process of targeting the poorest seen since 2013 has primarily resulted from the impetus of the World Bank, without any quota being explicitly set [19]. In Senegal, the state has, since the same year, been running a programme aimed at the poorest which not only grants them direct cash transfers but also allows them to become members of the community-based health insurance (CBHI) schemes free of charge.…”