Strategies for financing social health insurance schemes for providing universal health care: a comparative analysis of five countries

Figures & data

Table 1. Country profiles of the five selected countries in the study

	Ghana	Kenya	Ethiopia	Tanzania	Rwanda
Total population (million)	30 (2019)	52 (2019)	112 (2019)	58 (2019)	12.6 (2019)
GDP per capita (current US$)	2,202 (2019)	1,816.5 (2019)	857.5 (2019)	1122.1 (2019)	801.7 (2019)
Gross Domestic Product Growth	6.5 (2019)	5.4 (2019)	8.3 (2019)	5.8 (2019)	9.4 (2019)
GNI per capita, Atlas method (Million US$)	0.67 (2019)	0.91 (2019)	0.95 (2019)	0.60 (2019)	0.10 (2019)
Inflation (%)	7.2 (2019)	4.7 (2019)	15.8 (2019)	3.5 (2019)	3.4 (2019)
Life Expectancy at Birth	64 (2018)	66 (2018)	66 (2018)	65 (2018)	69 (2018)
Infant Mortality (deaths per 1,000 live births)^a	34 (2019)	32 (2019)	37 (2019)	36 (2019)	26 (2019)
Under 5 Mortality Rate (deaths per 1,000 live births)^6	46 (2019)	43 (2019)	51 (2019)	50 (2019)	34 (2019)
Maternal Mortality Rate (Per 100,000) [UNICEF Database, 2017]	308	342	401	524	248
Out-of-pocket expenditure as % of THE in 2017	40	24	34.4	24	6.25

Source: http://data.worldbank.org/indicator/SH.XPD.OOPC.TO.ZS.

^ahttp://dhsprogram.com/Where-We-Work/Country-List.cfm.

Table

Box 1: Tanzania’s fragmented health insurance system Tanzania’s continued reliance on donor financing and low uptake of national health insurance reveals challenges in the country’s drive towards UHC. A major constraint is the large number of insurance schemes that serve different groups within the country listed below: National Health Insurance Fund (NHIF) Community Health Fund (CHF) Tiba Kwa Kadi (TIKA) Social Health Insurance Benefit (SHIB) Private insurance schemes Micro-insurance schemesThe formal sector is served by the NHIF, SHIB and private insurance companies. The informal sector relies on community based schemes such as the CHF, TIKA and micro-insurance schemes run by private sector firms. However, these schemes with the exception of the NHIF, are voluntary, have low penetration and limited financial and risk-pooling. Private micro-insurance schemes are few, and concentrated in small pockets of the country. There are efforts to build Public Private Partnerships (PPPs) to improve the CHF. For example, since 2011, PharmAccess has been working with the Kilimanjaro Native Cooperative Union (KNCU- made up of 68 primary societies) and the NHIF to establish and implement a health plan for the cooperative members and their dependents in the Kilimanjaro region. This is known as the ‘improved CHF’ (iCHF) and is supported with 50% of matching grant from the central Tanzania government like the other CHF schemes. However, the iCHF utilises the infrastructure of NHIF with technical expertise provided by PharmAccess.Efforts by the Tanzanian government to cross subsidize and widen the insurance pool has faced many oppositions in recent years. Recently, the NHIF, has been expanded to cover the self-employed and also allows voluntary membership outside the public sector. The NHIF has also been mandated by the Ministry of Health and Social Welfare (MoHSW) of Tanzania to support and manage the Community Health Fund (CHF) implementation in all districts of the Tanzania Mainland. This is to improve the operational functions of the CHF at the council level. The government has set up a ministerial task force comprising members from the MoHSW, NHIF, academic institutions and other relevant institutions to draft a policy for UHC. This policy will be the government’s blue print to improve health insurance coverage to all regions in the country.

Data availability statement

Not applicable.