Amu Hubert, Seidu Abdul-Aziz, Agbaglo Ebenezer, Dowou Robert Kokou, Ameyaw Edward Kwabena, Ahinkorah Bright Opoku, Kissah-Korsah Kwaku
Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
PLoS One. 2021 Mar 19;16(3):e0248411. doi: 10.1371/journal.pone.0248411. eCollection 2021.
In the pursuit of achieving the Sustainable Development Goal targets of universal health coverage and reducing maternal mortality, many countries in sub-Saharan Africa have implemented health insurance policies over the last two decades. Given that there is a paucity of empirical literature at the sub-regional level, we examined the prevalence and factors associated with health insurance coverage among women in in sub-Saharan Africa.
We analysed cross-sectional data of 307,611 reproductive-aged women from the most recent demographic and health surveys of 24 sub-Saharan African countries. Bivariable and multivariable analyses were performed using chi-square test of independence and multi-level logistic regression respectively. Results are presented as adjusted Odds Ratios (aOR) for the multilevel logistic regression analysis. Statistical significance was set at p<0.05.
The overall coverage of health insurance was 8.5%, with cross-country variations. The lowest coverage was recorded in Chad (0.9%) and the highest in Ghana (62.4%). Individual-level factors significantly associated with health insurance coverage included age, place of residence, level of formal education, frequency of reading newspaper/magazine and watching television. Wealth status and place of residence were the contextual factors significantly associated with health insurance coverage. Women with no formal education were 78% less likely to be covered by health insurance (aOR = 0.22, 95% CI = 0.21-0.24), compared with those who had higher education. Urban women, however, had higher odds of being covered by health insurance, compared with those in the rural areas [aOR = 1.20, 95%CI = 1.15-1.25].
We found an overall relatively low prevalence of health insurance coverage among women of reproductive age in sub-Saharan Africa. As sub-Saharan African countries work toward achieving the Sustainable Development Goal targets of universal health coverage and lowering maternal mortality to less than 70 deaths per 100,000 live births, it is important that countries with low coverage of health insurance among women of reproductive age integrate measures such as free maternal healthcare into their respective development plans. Interventions aimed at expanding health insurance coverage should be directed at younger women of reproductive age, rural women, and women who do not read newspapers/magazines or watch television.
为实现全民健康覆盖和降低孕产妇死亡率的可持续发展目标，撒哈拉以南非洲的许多国家在过去二十年里实施了医疗保险政策。鉴于次区域层面的实证文献匮乏，我们研究了撒哈拉以南非洲女性医疗保险覆盖的患病率及相关因素。
我们分析了来自撒哈拉以南非洲24个国家最近一次人口与健康调查的307,611名育龄妇女的横断面数据。分别使用独立性卡方检验和多水平逻辑回归进行双变量和多变量分析。多水平逻辑回归分析的结果以调整后的比值比（aOR）表示。设定p<0.05为具有统计学意义。
医疗保险的总体覆盖率为8.5%，存在国家间差异。覆盖率最低的是乍得（0.9%），最高的是加纳（62.4%）。与医疗保险覆盖显著相关的个体层面因素包括年龄、居住地点、正规教育水平、阅读报纸/杂志和看电视的频率。财富状况和居住地点是与医疗保险覆盖显著相关的背景因素。与受过高等教育的女性相比，未接受正规教育的女性获得医疗保险覆盖的可能性低78%（aOR = 0.22，95%CI = 0.21 - 0.24）。然而，与农村地区的女性相比，城市女性获得医疗保险覆盖的几率更高[aOR = 1.20，95%CI = 1.15 - 1.25]。
我们发现撒哈拉以南非洲育龄妇女的医疗保险总体覆盖率相对较低。随着撒哈拉以南非洲国家努力实现全民健康覆盖的可持续发展目标，并将孕产妇死亡率降至每10万活产少于70例死亡，育龄妇女医疗保险覆盖率低的国家将免费孕产妇保健等措施纳入各自的发展计划非常重要。旨在扩大医疗保险覆盖范围的干预措施应针对育龄年轻女性、农村女性以及不阅读报纸/杂志或不看电视的女性。
