The Potential Contribution of Community-Based Health Financing Schemes Towards Achieving Universal Health Coverage in Sub-Saharan Africa

Abstract

The objective of this article is to review different models of integrative Social Health Insurance (SHI) systems of low-income countries in sub-Saharan Africa concerning their contribution to Universal Health Coverage (UHC). The focus is on four country case examples, where community-based approaches played a crucial role within the implementation of the national SHI system.

Besides an extensive desk review, a comparative analysis of Strengths, Weaknesses, Opportunities and Threads (SWOT) of the chosen country case examples is presented. The SWOT analysis complements qualitative data from the country cases.

The research undertaken reveals that each of the analysed country case examples chose unique approaches and tools to approach UHC, with the common element of considering community-based approaches as integral parts of the national SHI system. On this basis, common factors that may hamper or favour a national integrated SHI system can be identified.

An integrative national SHI system in a low-income context of sub-Saharan Africa should be based on an integrated bottom-up approach. Main drivers are a step-by-step method, public and private commitment as well as comprehensive participation, communication and inclusion of relevant stakeholders. Components that could be considered as the core of any integrated SHI system are the existence of a mandatory element, adequately designed indigents for various marginalized groups and most vulnerable parts of the population and the regular monitoring of quality of provided health care.