Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies

Sydney N N T Odonkor; Ferdinand Koranteng; Martin Appiah-Danquah; Lorena Dini

doi:10.1371/journal.pgph.0001286

Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies

PLOS Glob Public Health. 2023 Aug 9;3(8):e0001286. doi: 10.1371/journal.pgph.0001286. eCollection 2023.

Authors

Sydney N N T Odonkor^{1

2}, Ferdinand Koranteng³, Martin Appiah-Danquah⁴, Lorena Dini²

Affiliations

¹ Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
² Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
³ Life Sciences Institute, University of British Columbia, Vancouver, Canada.
⁴ Department of Surgery, NES Healthcare, Parkside Hospital, London, Wimbledon, United Kingdom.

Abstract

To facilitate the drive towards Universal Health Coverage (UHC) several countries in West Africa have adopted National Health Insurance (NHI) schemes to finance health services. However, safeguarding insured populations against catastrophic health expenditure (CHE) and impoverishment due to health spending still remains a challenge. This study aims to describe the extent of financial risk protection among households enrolled under NHI schemes in West Africa and summarize potential learnings. We conducted a systematic review following the PRISMA guidelines. We searched for observational studies published in English between 2005 and 2022 on the following databases: PubMed/Medline, Web of Science, CINAHL, Embase and Google Scholar. We assessed the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two independent reviewers assessed the studies for inclusion, extracted data and conducted quality assessment. We presented our findings as thematic synthesis for qualitative data and Synthesis Without Meta-analysis (SWiM) for quantitative data. We published the study protocol in PROSPERO with ID CRD42022338574. Nine articles were eligible for inclusion, comprising eight cross-sectional studies and one retrospective cohort study published between 2011 and 2021 in Ghana (n = 8) and Nigeria (n = 1). While two-thirds of the studies reported a positive (protective) effect of NHI enrollment on CHE at different thresholds, almost all of the studies (n = 8) reported some proportion of insured households still encountered CHE with one-third reporting more than 50% incurring CHE. Although insured households seemed better protected against CHE and impoverishment compared to uninsured households, gaps in the current NHI design contributed to financial burden among insured populations. To enhance financial risk protection among insured households and advance the drive towards UHC, West African governments should consider investing more in NHI research, implementing nationwide compulsory NHI programmes and establishing multinational subregional collaborations to co-design sustainable context-specific NHI systems based on solidarity, equity and fair financial contribution.

Copyright: © 2023 Odonkor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The authors received no funding for this work. SO obtained a scholarship from Deutscher Akademischer Austauschdienst (DAAD) for a master program which resulted in the project underlying this publication. The DAAD had no role in the project conceptualization, the study design, data collection and analysis, decision to publish, or preparation of the manuscript.