Health financing and systems in African small and island states: Unique challenges and opportunities in achieving universal health coverage.

While Africa has made substantial health progress, small and island states face distinct vulnerabilities and threats, demanding focused attention. Employing WHO building blocks, this study explores the health systems and financing status of small and island states in Africa, emphasizing their unique challenges in achieving universal health coverage. We undertake a comparative analysis of health systems and financing between African small and island states and larger counterparts within the region. Despite their unique challenges, African small and island states appear to perform comparatively well both in terms of health financing and for a number of key health system inputs. These findings suggest that the hypothesized structural impediments facing small and island states may be less severe than anticipated, or that good policies may have effectively mitigated these challenges within the health sector. However, many small and island states remain understudied, and further health research must be undertaken to better understand the nuances of health systems in these countries.