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Growing Africa’s health Insurance.

Growing Africa’s health Insurance.

By Angela Kisakye

Health insurance is attracting more and more attention in low- and middle-income countries as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. In many African countries, large percentages of the population are too poor to afford check-ups and medical treatment, and for many the transport costs to treatment facilities are too prohibitive in the first place. Health insurance is desperately needed, but poverty has undermined efforts, particularly in rural areas. Direct payment at point of use is the least optimal way of financing healthcare, as in poor countries in particular dramatic and expensive ailments can push the poor into bankruptcy, or else high costs can dissuade people from seeking desperately needed medical care. The World Health Organization (WHO) considers health insurance a promising means for achieving universal health-care coverage (UHC).

A number of African countries have established various types of health insurance as a means of achieving UHC. National or social health insurance (SHI) is based on individuals’ mandatory enrolment. Several low- and middle-income countries, including Ghana have established the SHI. Ghana, which has very successful health insurance, the National Health Insurance Scheme (NHIS) was formally launched in December 2004 and since then it has been mandatory for all residents to be members of a district mutual health scheme, a private commercial insurance scheme or a private mutual health scheme. Around nine million Ghanaians, almost 40% of the total population, are now covered, and the scheme’s beneficial effects on health have been evident: infant mortality has dropped 19% since 2000, and the number of infant deaths from malaria has dropped by almost a third since the scheme’s inception. Rwanda, DRC and Senegal have established community-based health insurance, which is implemented in such a way that it benefits the poor. In all the countries where it is implemented, the goal of CBHI is to insure that the population is protected against financial risk and catastrophic payments in the event of illness, and therefore ensure universal and equitable access to quality health services. Other countries for have established private health insurance, which serves the affluent segments of the population.

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Countries wishing to introduce health insurance schemes into their health systems should be aware of their impact and introduce the most appropriate schemes. It is important to evaluate whether the scheme to be introduced can: (i) mobilize resources, i.e. generate sufficient and stable resources for adequate functioning of health services; (ii) provide financial protection to clients against catastrophic health expenditures; (iii) improve utilization of health-care services by all socioeconomic groups; (iv) improve health care quality; (v) improve social inclusion, i.e. the provision of health services in alignment with the needs of various population groups, especially the poor and vulnerable; and (vi) improve community empowerment, i.e. involvement of the community in the organization of health services.

For any country wishing to establish a health insurance scheme, the impact of the scheme to be established in terms of enrolment, financial management and sustainability should be carefully considered.


1. Spaan, Ernst, et al. "The impact of health insurance in Africa and Asia: a systematic review." Bulletin of the World Health Organization 90.9 (2012): 685-692.

2. UNICEF. "National health insurance in Asia and Africa: advancing equitable social health protection to achieve universal health coverage." New York: UNICEF (2012).

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