Odonkor Sydney N N T, Koranteng Ferdinand, Appiah-Danquah Martin, Dini Lorena
Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
PLOS Glob Public Health. 2023 Aug 9;3(8):e0001286. doi: 10.1371/journal.pgph.0001286. eCollection 2023.
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.
为推动全民健康覆盖（UHC），西非的几个国家已采用国家健康保险（NHI）计划为卫生服务提供资金。然而，保护参保人群免受灾难性卫生支出（CHE）以及因卫生支出导致贫困的影响仍然是一项挑战。本研究旨在描述西非参加NHI计划的家庭中财务风险保护的程度，并总结潜在的经验教训。我们按照PRISMA指南进行了系统综述。我们在以下数据库中搜索了2005年至2022年期间以英文发表的观察性研究：PubMed/Medline、科学网、护理学与健康领域数据库（CINAHL）、Embase和谷歌学术。我们使用乔安娜·布里格斯研究所（JBI）的批判性评价清单评估研究质量。两名独立评审员评估研究是否纳入、提取数据并进行质量评估。我们将研究结果呈现为定性数据的主题综合和定量数据的无元分析综合（SWiM）。我们在国际前瞻性系统评价注册库（PROSPERO）上发表了研究方案，编号为CRD42022338574。九篇文章符合纳入标准，包括2011年至2021年期间在加纳发表的八项横断面研究（n = 8）和在尼日利亚发表的一项回顾性队列研究（n = 1）。虽然三分之二的研究报告了NHI参保在不同阈值下对CHE有积极（保护）作用，但几乎所有研究（n = 8）都报告了一定比例的参保家庭仍遭遇CHE，三分之一的研究报告超过50%的家庭发生CHE。尽管与未参保家庭相比，参保家庭似乎在防范CHE和贫困方面得到了更好的保护，但当前NHI设计中的差距导致了参保人群的财务负担。为加强参保家庭的财务风险保护并推动全民健康覆盖，西非各国政府应考虑加大对NHI研究的投入，实施全国性强制性NHI计划，并建立跨国次区域合作，以共同设计基于团结、公平和公平财务贡献的可持续的因地制宜的NHI系统。
