Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation
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EDITORIAL
Health Financing in Sub‑Saharan Africa: From Analytical Frameworks to Empirical Evaluation Augustine Asante1 · Wilson S. K. Wasike2 · John E. Ataguba3 Accepted: 19 October 2020 © The Author(s) 2020
1 Introduction Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [1]. Often the financing arrangements are influenced by the historical, social, political and economic development of the country [2, 3]. In general, health financing covers three basic functions of revenue collection, risk pooling and purchasing of health services [4, 5]. Revenue collection deals with raising of funds from different sources (taxes, social security/insurance systems, fees, grants, loans, etc.) to finance the health system [4]. Risk pooling involves combining and managing revenue in such a way that individuals in a pool share collective health risk and, in so doing, protect members of the pool from payment of applicable health expenditures. Purchasing is the transfer of pooled funds to health service providers to provide health services to the population [4, 6]. Regardless of income level, all countries face challenges in financing healthcare. However, these challenges are more acute in lowand middle-income countries (LMICs), where the need for healthcare is greatest and resources are most scarce [7]. Global health spending has grown significantly in the last few decades, with total spending rising from $US3.5 trillion * Augustine Asante [email protected] 1
School of Population Health, University of New South Wales (UNSW) Sydney, Room 238, Level 2 Samuels Building, Sydney, NSW 2052, Australia
2
African Economic Research Consortium (AERC), Nairobi, Kenya
3
Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa
in 1995 to $US8.0 trillion in 2016 [8]. This represents about 4% annual growth over the past two decades. Significant disparities exist, with per capita health spending in LMICs lagging far behind that of high-income countries (HICs). For example, health spending per capita in low-income countries (LICs) averaged about $US110 in 2015 compared with $US5551 in HICs [8]. The disparities between countries are more profound for government health spending than for other spending sources. On average, less than 30% of total health expenditure in LICs comes from government sources compared with nearly 80% in HICs [9]. Government health spending in countries such as Myanmar, Nepal and Haiti accounted for less than 20% of total health expenditure in 2015 [8]. As a consequence of low government health spending, many LMICs rely heavily on out-of-pocket (OOP) payments, which prevent millions of people from accessing health services and push millions i
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