Afriyie Doris Osei, Muhongerwa Diane Karenzi, Nabyonga-Orem Juliet, Chukwujekwu Ogochukwu
World Health Organization Regional Office for Africa, Congo Brazzaville, Congo.
World Health Organization, Country Office Namibia, Namibia.
J Glob Health. 2025 Aug 8;15:04233. doi: 10.7189/jogh.15.04233.
BACKGROUND: Countries in the World Health Organization (WHO) African region are lagging behind in the global push toward universal health coverage (UHC), a core component of the 2030 Agenda for Sustainable Development. As the target year steadily approaches, it is crucial to assess countries' current and planned health financing reforms to understand their path towards UHC. We examine both current and planned health financing reforms in the WHO African region and assess their implications for UHC. METHODS: We sent a survey to all 47 Member States of the WHO African Region in August 2024 about their current and planned health financing reforms in the three health financing functions of revenue raising, pooling, and purchasing, as well as public finance management. We used responses from 43 countries, of which 18 countries had a current endorsed national health financing strategy to assess the implications of their reforms based on current literature on using health financing to progress towards UHC goals. RESULTS: Of the 43 countries in the WHO African Region that responded to our survey, 33 (77%) have current or planned health financing reforms across the various health financing functions. A major focus of these reforms is on establishing contributory health insurance schemes, despite their limited potential to address the region's challenges. Additionally, countries are prioritising expanding performance-based financing and provider payment mechanisms. These purchasing strategies could improve service coverage and quality of care if implemented within robust public finance management structures. CONCLUSIONS: Countries in the WHO African Region are adopting and planning various health financing reforms to achieve UHC. To ensure success, they will require support in effectively implementing evidence-based reforms in the areas of purchasing and reducing fragmentation from various coverage schemes.
背景:世界卫生组织(WHO)非洲区域的国家在全球推动全民健康覆盖(UHC)方面落后,全民健康覆盖是《2030年可持续发展议程》的核心组成部分。随着目标年份稳步临近,评估各国当前和计划中的卫生筹资改革以了解其实现全民健康覆盖的路径至关重要。我们研究了WHO非洲区域当前和计划中的卫生筹资改革,并评估其对全民健康覆盖的影响。 方法:2024年8月,我们向WHO非洲区域的所有47个成员国发送了一项关于其在筹资、风险共担和采购这三项卫生筹资职能以及公共财政管理方面当前和计划中的卫生筹资改革的调查。我们使用了43个国家的回复,其中18个国家有当前认可的国家卫生筹资战略,以根据当前关于利用卫生筹资推动实现全民健康覆盖目标的文献评估其改革的影响。 结果:在回复我们调查的WHO非洲区域的43个国家中,33个(77%)在各项卫生筹资职能方面有当前或计划中的卫生筹资改革。这些改革的一个主要重点是建立缴费型健康保险计划,尽管其应对该区域挑战的潜力有限。此外,各国将扩大基于绩效的筹资和提供者支付机制作为优先事项。如果在强大的公共财政管理结构内实施,这些采购战略可以提高服务覆盖范围和医疗质量。 结论:WHO非洲区域的国家正在采用并计划进行各种卫生筹资改革以实现全民健康覆盖。为确保成功,它们将需要在有效实施采购领域基于证据的改革以及减少各种覆盖计划的碎片化方面获得支持。
Glob Health Res Policy. 2021-3-1
Int J Health Policy Manag. 2023
Cochrane Database Syst Rev. 2017-9-11
Int J Health Policy Manag. 2025
Health Res Policy Syst. 2025-7-16
Health Policy Plan. 2025-1-11
PLOS Glob Public Health. 2024-8-28
PLOS Glob Public Health. 2023-5-8
Health Policy Plan. 2022-10-12
Bull World Health Organ. 2022-5-1