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This paper describes the health financing policies used today by African countries to expand health coverage. It identifies key health financing policies used by African countries and measures the existence of regional patterns in the use of these policies. The paper does not attempt to identify best practices, nor does it try to measure the effective coverage of the policies or their impact. Rather, it aims to add value to the existing literature by providing a systematic portrayal of the health financing policies that are in place across the region. The study concludes with a discussion about the implications of its findings for planning next steps to advance universal health. The rest of the paper is organized as follows. Section 2 describes the conceptual framework and methodology used in the study. Section 3 describes the different paths chosen by African countries to expand health coverage. Sections 4 and 5 describe the two key instruments used in that journey: the universal basic package of health services and the subpopulation health coverage programs. Section 6 reviews in detail some of the technical instruments required for the successful implementation of these policies. Section 7 uses the findings of the paper to discuss the cost estimations of implementing a broader benefit package to advance universal health coverage. The paper concludes with a summary of the findings and their implications.

Health and Poverty --- Health Care Services Industry --- Health Economics and Finance --- Health Insurance --- Health Policy and Management --- Health Service Management and Delivery --- Health, Nutrition and Population --- Industry

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Health care reform

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The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a 'mashup' index that captures both aspects of UHC: that everyone-irrespective of their ability-to-pay-gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35-57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data-by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.

Communities & human settlements --- Equity --- Financial protection --- Health economics & finance --- Health law --- Health monitoring & evaluation --- Health systems development & reform --- Health, nutrition and population --- Housing & human habitats --- Law and development --- Service coverage --- Universal health coverage