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Equity of national publicly funded health insurance schemes under the universal health coverage agenda : a systematic review of studies conducted in Africa

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Anjorin, Seun S., Ayorinde, Abimbola, Abba, Mustapha, Mensah, Daniel, Okolie, Elvis A., Uthman, Olalekan A. and Oyebode, Oyinlola (2021) Equity of national publicly funded health insurance schemes under the universal health coverage agenda : a systematic review of studies conducted in Africa. Journal of Public Health . doi:10.1093/pubmed/fdab316 ISSN 1741-3842.

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Official URL: https://doi.org/10.1093/pubmed/fdab316

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Abstract

Background
The implementation of publicly funded health insurance schemes (PFHIS) is the major strategy to drive progress and achievement of universal health coverage (UHC) by 2030. We appraised evidence on the equity of insurance schemes across Africa.

Methods
We conducted a systematic review of published studies that assessed equity in health insurance schemes implemented under the UHC agenda in Africa. Seven databases, Web of Science, Medline, CINAHL, Scopus, Cochrane Library, EMBASE and World Bank eLibrary, were searched; we operationalized the PROGRESS-Plus (place of residence; race/ethnicity/culture/language; occupation; gender/sex religion; education; socioeconomic status; social capital) equity framework to assess equity areas.

Results
Forty-five studies met the inclusion criteria and were included in the study, in which 90% assessed equity by socioeconomic status. Evidence showed that rural residents, those self-employed or working in the informal sector, men, those with lower educational attainment, and the poor were less likely to be covered by health insurance schemes. Broadly, the insurance schemes, especially, community-based health insurance (CBI) schemes improved utilization by disadvantaged groups, however, the same groups were less likely to benefit from health services.

Conclusions
Evidence on equity of PFHIS is mixed, however, CBI schemes seem to offer more equitable coverage and utilization of essential health services in Africa.

Item Type: Journal Article
Subjects: H Social Sciences > HG Finance
K Law [Moys] > KR Africa
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Equity -- Africa, Health insurance policies -- Africa, Health insurance -- Africa, Health services accessibility -- Africa, Medical care -- Africa
Journal or Publication Title: Journal of Public Health
Publisher: Oxford University Press
ISSN: 1741-3842
Official Date: 14 August 2021
Dates:
DateEvent
14 August 2021Published
23 July 2021Accepted
DOI: 10.1093/pubmed/fdab316
Status: Peer Reviewed
Publication Status: Published
Reuse Statement (publisher, data, author rights): This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Public Health following peer review. The version of record Seun S Anjorin, Abimbola A Ayorinde, Mustapha S Abba, Daniel Mensah, Elvis A Okolie, Olalekan A Uthman, Oyinlola O Oyebode, Equity of national publicly funded health insurance schemes under the universal health coverage agenda: a systematic review of studies conducted in Africa, Journal of Public Health, 2021;, fdab316, is available online at: https://doi.org/10.1093/pubmed/fdab316
Access rights to Published version: Restricted or Subscription Access
Copyright Holders: © The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Date of first compliant deposit: 17 September 2021
Date of first compliant Open Access: 14 August 2022
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
u1374395National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
Chancellor’s International Scholarship University of Warwickhttp://dx.doi.org/10.13039/501100000741

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