Susan Ifeagwu
Determinants of health in a population are related to numerous factors beyond health services. Ability to benefit from these services is essential in order to foster sustainable development. Universal health coverage (UHC), embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals and communities having access to any health services they need, of sufficient quality to be effective, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). The aim of this systematic review is to examine health financing approaches for UHC in SSA. A systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 14 August 2019. Of the screened records, 39 papers were included. The results indicate that a majority of healthcare revenue in SSA is from direct out-of-pocket payments (OOPs). Another common health financing mechanism was donor funding. The average quality score of all studies, 80.4%, was high. It is evident from the review that existing health financing strategies in SSA are inadequate and innovative solutions are needed. There is a need for evidence-based holistic, coordinated and multi-sectoral strategies tailored to country contexts to provide sustainable solutions.