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Healthcare Financing in Sub-Saharan Africa

Sub-Saharan Africa, perhaps to a greater extent than any other region in the world, still faces a grim scenario with respect to the health of its people. While the continent has seen improvements in health outcomes, including child mortality, morbidity remains high, and many countries missed on the Millennium Development Goals targets in this area. Poor population health status is mirrored by crises in health financing and human resources for health. Most of the notable successes in the health area have been made possible in large part through development support. An example is the 2014 Ebola outbreak in West Africa. This suggests that reductions in development aid in general, and health related aid in particular, could potentially jeopardise the gains made thus far. To mitigate such risk, there is a need for Africa to increasingly self-finance its development agenda, and financing of health care is no exception.


African Economic Research Consortium (AERC) launched a new collaborative research project on Health care financing in sub-Saharan Africa in a workshop held on June 1-2, 2017 in Johannesburg, South Africa. The framework phase of the project is expected to run for one year from the inception meeting, and the final review workshop is planned to take place back-to-back with the June 2018 biannual research workshop. The phase will be followed by country case studies. Details on the project teams commissioned to produce framework papers are as follows:

1.    “The Changing Pattern of Financing Healthcare in sub-Saharan Africa: Implications for Health Outcomes” By Femi Ayadi, University of Houston- Clear Lake, USA and Akanni Lawanson, University of Ibadan, Nigeria

2.    “Health Care Financing and Health Care Demand in Africa: A Framework for Analysis” By Germano Mwabu, University of Nairobi, Kenya

3.    “The role of the Legal Framework and Regulations for Private Healthcare Service Purchasing under Public Funded Systems in Low- and Middle-income Countries” By Ayako Honda, Amarech Obse and Nicola Foster, University of Cape Town, South Africa

4.    “An Analysis of Domestic and Donor Financing for Maternal and Child Health in sub-Saharan Africa” By Chris Atim, Results for Development Institute, and Jacob Novignon  and Eric Arthur, African Health Economics and Policy Association

5.    “Evaluation of Health Financing Reforms in sub-Saharan Africa” By Manuela De Allegri, University of Heidelberg; Stephanie Degroote, University of Montreal; and Valery Ridde, University of Montreal, Canada

6.    “Evaluating Health Financing Equity: The Need to Account for Quality of Care” By Augustine Asante, University of New South Wales, Australia

7.    “Effect of User-fees Abolition on Health Financing Sustainability” By Martine Audibert and Jacky Mathonnat, CERDI/University of Auvergne, France

8.    “The Impact of Health Financing on Income Inequality: a Framework for Assessing Drivers of Income Inequality” by John E. Ataguba, University of Cape Town, South Africa; Hyacinth Ichoku, University of Nigeria; and James Akazili, Navrongo Health Research Centre, Ghana

9.    “Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Selected sub-Saharan Africa countries” By Sarah Ssewanyana and Ibrahim Kasirye, Economic Policy Research Centre, Makerere University, Uganda


10.  “Performance Based Financing for Healthcare Service Delivery in Crisis Settings: Lessons on Adaptation to Humanitarian and Early Recovery Contexts” by Sophie Witter and Maria Bertone, Institute for Global Health and Development, Queen Margaret University, UK; and Egbert Sondorp, Jurrien Toonen and Eelco Jacobs, Royal Tropical Institute (KIT), Amsterdam, the Netherlands


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