Evidence map›Paper›PMID 33641673›Full record

SynthesisGlobal health research and policy2021

Health financing for universal health coverage in Sub-Saharan Africa: a systematic review.

Susan C Ifeagwu, Justin C Yang, Rosalind Parkes-Ratanshi, Carol Brayne

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Global health research and policy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 9 pooled it
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Susan C IfeagwuDepartment of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK. sci24@medschl.cam.ac.uk.ORCID 0000-0002-7915-2765
Justin C YangDepartment of Epidemiology and Applied Clinical Research, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
Rosalind Parkes-RatanshiDepartment of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK.
Carol BrayneDepartment of Public Health and Primary Care, Cambridge Public Health, University of Cambridge, Cambridge, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundUniversal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings.

methodsA systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 to 30 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. Studies describing health financing approaches for UHC in SSA were included. Evidence was synthesised in form of a table and thematic analysis.

resultsOf all records, 39 papers were selected for inclusion. Among the included studies, most studies were conducted in Kenya (n = 7), followed by SSA as a whole (n = 6) and Nigeria (n = 5). More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC. The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments. Another common financing mechanism was donor funding, which was reported by most of the studies. The average quality score of all studies was 81.6%, indicating a high appraisal score. The interrater reliability Cohen's kappa score, κ=0.43 (p = 0.002), which showed a moderate level of agreement.

conclusionsAppropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC. It is evident from the review that innovative health financing strategies in SSA are needed. Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA. Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.

Indexed as

Healthcare FinancingAfrica South of the SaharaDelivery of Health CareUniversal Health InsuranceHealth financingSub-Saharan AfricaSystematic reviewUniversal health coverage

Identifiers

PMID33641673
PMCPMC7916997

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.