Professor Edwine Barasa, Deputy Executive Director of the KEMRI-Wellcome Trust Research Programme, highlighted Ghana and Rwanda as the frontrunners in health insurance coverage in Africa.

Alongside Gabon and Burundi, these two nations are the only African countries boasting health insurance coverage levels exceeding 20 percent. This revelation comes amid the backdrop of an overall low level of health insurance coverage across the African continent.

Professor Barasa emphasized the importance of health insurance authorities in sub-Saharan Africa and other Low/Middle-Income Countries (LMICs) adopting tax funding and mandatory contributory health insurance as sustainable mechanisms for resource mobilization within the health sector. Such measures, he contended, would facilitate the realization of Universal Health Coverage (UHC) and ensure health security.

Addressing a gathering at the inaugural NHIA-WHO Regional Conference on financing UHC and health security, themed “Overcoming Financial Barriers and Providing Financial Risk Protection,” Professor Barasa noted the growing trend of African countries adopting mechanisms to enhance access to healthcare and extend financial risk protection to their populations. He observed that media exposure, socioeconomic status, and education level significantly influenced the distribution of health insurance coverage.

The disparity in health insurance coverage within sub-Saharan Africa is evident as only eight out of 36 countries surveyed exhibited an average coverage rate exceeding 10 percent. This inequality is compounded by the prevalence of substantial income disparities.

Professor Barasa emphasized, “Coverage of health insurance in sub-Saharan Africa is low and pro-rich. The four countries that had health insurance levels greater than 20 percent were all characterized by substantial funding from tax revenues. The other study countries featured predominantly voluntary mechanisms.

” In light of the high informality in labor markets, he encouraged sub-Saharan African countries and LMICs to shift their focus from voluntary contributory health insurance to tax funding for more sustainable resource mobilization within the health sector.

Meanwhile, Dr. Bernard Okoe Boye, the Chief Executive Officer of the National Health Insurance Authority (NHIA), provided insights into Ghana’s journey in health insurance financing. He highlighted the country’s transition from free healthcare in 1957 to a national health insurance scheme, supported primarily by earmarked funds from social security and tax.

Dr. Boye expressed Ghana’s commitment to achieving universal health coverage by reducing cost-sharing, expanding the range of services offered through the scheme, and extending its reach to the uninsured population. However, he acknowledged the existing inequalities in the healthcare system, with around 45 percent of Ghanaians not enrolled in the scheme.

To address this issue, Professor Irene Akua Agyepong, from the Dodowa Health Research Centre of Research and Development, called for a national dialogue to make health insurance enrollment mandatory, similar to other schemes like driver’s licenses and the Ghana Card. She stressed the importance of universal participation in the national health insurance levy, which currently funds the scheme, to ensure that all Ghanaians can benefit from its coverage.

Professor Agyepong emphasized, “We need to sit down as a nation and find a way to get 100 percent of Ghanaians enrolled in the scheme so that we are all paying taxes and benefiting from the scheme. It will help all of us because the aim is for all of us to be healthy.”

As Ghana and Rwanda set an example in health insurance coverage in Africa, the continent is presented with an opportunity to enhance healthcare access, reduce financial barriers, and work towards Universal Health Coverage. The challenge now is to address disparities and make health insurance more inclusive and equitable for all citizens.


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