ReviewInternational journal for equity in health2025
Institutional design features of health insurance subsidy programmes in Africa: a narrative review.
Review in International journal for equity in health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTo advance Universal Health Coverage (UHC), many countries have introduced Health Insurance Subsidy Programs (HISPs) to extend financial protection to poor and vulnerable populations by covering their insurance premiums. This study examined the institutional design of HISPs in Africa and their contribution to UHC goals, including equity, financial protection, and service coverage.
methodsWe undertook a literature search on Google, Google Scholar, PubMed, Web of Science, Scopus and EconLit to identify published and grey literature on African countries with HISPs. HISPs were defined as government-driven health insurance programs that extend health insurance coverage to vulnerable groups by fully or partially subsidizing their insurance premiums. Screening and selection of relevant articles were done using Covidence. A total of 98 articles were reviewed, detailing the institutional design features of 25 HISPs in 18 African countries. Institutional design features of the HISPs were analysed using a framework adopted from Vilcu and Mathauer (2016).
findingsOur review identified 25 Health Insurance Subsidy Programs (HISPs) across 18 African countries. Institutional design features that promoted financial risk protection of vulnerable groups included full premium subsidisation, government financing, and the provision of comprehensive benefits packages. However, several design elements undermined effectiveness - most notably, the use of indirect targeting methods prone to high inclusion and exclusion errors, fragmented risk pools, and voluntary membership structures that reduced enrolment among healthy individuals. Implementation of partial subsidies, as observed in Burkina Faso’s Assurance Maladie à Base Communautaire (AMBC), increased the risk of adverse selection, while restrictive definitions of indigence, as in Ghana, limited program reach.
conclusionHISPs are a common mechanism for extending financial protection and health service access to vulnerable populations in Africa. However, their impact on UHC goals depends heavily on how they are designed and implemented. Achieving equity and financial protection will require aligning targeting mechanisms with local contexts, mandating enrolment where feasible, and ensuring predictable public financing.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.