Role of Social Health Insurance towards Universal Health Coverage for East African Community: An Analytical Review

Abstract

Background: Social Health Insurance (SHI), a health financing model for Universal Health Coverage (UHC), is an organizational mechanism for raising and pooling funds to finance health services, along with tax-financing, private health insurance, community health insurance and others.

Objective: To analyze successful experiences, lessons learnt and best practices among selected middle income countries in the efforts of the East African Community member states to attain UHC through SHI.

Methods: A 11-year (2009-2019) electronic peer-reviewed articles that met eligibility criteria were collated. PubMed, Medline and Google Scholar search engine. Only papers published in English from the 9 countries (Thailand, Philippines, Colombia, Ghana, Kenya, Tanzania, Uganda, Rwanda and Burundi) were reviewed. A Scoping review methodology was used to improve data validity.

Results: A total of 9649 papers were extracted from the databases. 17 studies met all inclusion criteria; Colombia (1) Thailand (2), Philippines (2) Kenya (4) and Ghana (8).11 studies were case control studies, 2 mixed methods, 2 qualitative and 2 systematic reviews. UHC index and indicators were higher in UHC successful countries compared to the EAC countries. Most papers in Ghana discussed a significant progress towards UHC through political stewardship, quality of care, significant expansion of population coverage and financial risk protection with their National Health Insurance though equity, sustainability and enrolment were some of the challenges. Successes of Thailand and Philippines were as a result of political commitment and goodwill, subsidies, increasing funding, adoption of general tax-financed for UHC, access to PHC, quality through accreditation system and earmarked revenue source. In Kenya, progress was made by introduction of civil servants’ schemes, subsidies and expansion of benefit packages while struggling with purchasing reforms, equity, efficiency and sustainability.