A Systematic Review of the Literature on Health Systems Financing Mechanisms in sub-Saharan Africa Öffentlichkeit

Crawford, Lucy Reddin (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/2801pg908?locale=de
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Abstract

Introduction: Over the past decade, significant international attention has been given to the role of health financing in obtaining universally providing health care and preventive services to all populations. A multitude broadly agreed upon international declarations, resolutions and agreement have called for increased funding of health systems. Given the growing importance of health systems financing - a better understanding of the current situation in all sub-Saharan African countries is needed. The spectrum of financing efforts in sub-Saharan Africa can be categorized by four methods/descriptions: Community Health Insurance (CHI), National Health Insurance (NHI), Private Health Insurance (PHI), and Social Health Insurance (SHI). Methods: We systematically searched the MEDLINE electronic database (using the PubMed gateway) for articles focused on health systems financing in sub-Saharan Africa. To map and describe the type of financing, results are stratified by the health financing categories described above, namely the NHI, PHI, CHI, and SHI mechanisms. The discussion of each health financing scheme is further grouped by literature emerging from each region (Central, East, Southern, and West Africa). Within each regional grouping, we describe the specific investigations and challenges from each study to illustrate the main findings that are relevant to this review. Results: The electronic searches returned 1039 articles. After excluding articles not focused on health systems financing and hand-searching the relevant gray literature, we identified 47 articles for inclusion in this review. This review of the literature seeks to map the use of the aforementioned financing mechanisms across countries in sub-Saharan Africa and to understand which geographic, socio-demographic, or macro-economic drivers are associated with the choice of which health financing mechanisms countries eventually implement. This this review shows that information regarding the health financing structure in a majority of sub-Saharan Africa and specifically in Central Africa is lacking. Conclusion: Additional research in these countries would provide their governments with useful information regarding successes and failures of current financing systems and add to the body of current literature, thus aiding other countries in similar settings working towards improving their health financing system.

Table of Contents

Table of Contents Chapter 1: Introduction 1 Chapter 2: Project Contents 6 I. Methods 6 II. Results 10 III. Health Financing Mechanisms 12

i. National Health Insurance 12

ii. Private Health Insurance 26

iii. Community Health Insurance 18

iv. Social Health Insurance 32

Chapter 3: Discussion, Conclusions and Recommendations 36

Figure 1: Article review and selection 10

Table 1: Countries and regions represented in the literature review 11

Table 2: NHI papers by region and country 14

Table 3: PHI papers by regions and country 16

Table 4: CHI papers by regions and country 18

Table 5: SHI papers by regions and country 33

Table 6: Total Health Expenditure by GDP per capita (PPP) 39

Bibliography 44

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