Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

Abstract

Background High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia. Methods We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing. Results A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments. Conclusion Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis

“…The pooled PC, HSU, FRP, HRQoL, and HSQ, respectively, were 40.1%, 64.5%, 79.4%, 63%, and 92.1%. A narrative review also revealed that health financing initiatives contributed to income generation, risk pooling, and the acquisition of healthcare services to support the road to UHC [ 65 ]. Other evidence in Africa and Asia also showed that health insurance has been found to have an impact on resource mobilization, FRP, service utilization, quality of care, social inclusion, and community empowerment [ 66 ].…”

“…Schemes that emphasize patients’ bargaining power at the patient-provider interface, however, appear to increase access to high-quality care [ 93 ]. In fact, Ethiopia’s CBHI had a considerable positive impact on healthcare infrastructures, medical supplies, diagnostic capacity, pharmaceuticals, FRP, and healthcare services [ 65 ]. However, the thrust of the service delivery process seems to be far behind.…”

“…Low healthcare funding and high OOP payments contribute to limited access to equitable and high-quality healthcare services. These service discrepancies can be controlled through the standardization of benefit packages, ensuring beneficiaries have equal access to care, and establishing an accreditation system to uphold healthcare quality [ 65 ].…”

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study

“… 68 Most of the health related millennium development goals have been achieved in Ethiopia and are considered to be attributed to a comprehensive approach to health development, including health financing and other socioeconomic systems. 69 70 Palestine is a refugee area that has received high levels of aid and a considerable amount of charitable resources per capita. 71 Even the poorest countries seem to have achieved important reductions in all cause mortality by implementing these multi-tiered strategies.…”

Quality and Nutrient Loss in the Cooking Vegetable and Its Implications for Food and Nutrition Security in Ethiopia: A Review

“…63 Additionally, the cost of vegetables is a barrier for low-income families, including those in Ethiopia, to make healthier food choices. 64 Many researchers report that, 65 people of higher socioeconomic status are more likely to have healthier food choices, while those of a lower social class have nutrient profiles that are less consistent with dietary recommendations or dietary guidelines, which contributes to their poorer state of health. For example, in Africa (Ethiopia, Eritrea, Sudan, Nigeria, and others), the root causes of malnutrition are poverty, inadequate food production, inadequate food intake, ignorance and unequal distribution of food, poor food storage techniques, improper food preparation, food restrictions and taboos and poor hygiene.…”