Health insurance in Sub-Saharan Africa: Implementation, challenges and prospects

Rotterdam Global Health Initiative network meetings
Friday 12 Apr 2024, 14:30 - 16:30
Spoken Language
Aula A and zoom
International Institute of Social Studies
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Please contact Dr Zemzem Shigute Shuka for the zoom link

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Join us on 12 April for three insightful presentations which highlight the unique experiences and approaches to health insurance implementation in Ethiopia, Ghana and Rwanda.

On 12 April 2024, the International Institute of Social Studies will host this network meeting examining a number of health insurance strategies in Sub-Saharan Africa.

From the innovative strategies employed to address implementation hurdles to the promising prospects for universal health coverage, our speakers will provide valuable perspectives and lessons learnt from their research in these three countries.

The discussant is Dr Kwasi Boahene, Director of Health Systems at PharmAccess



Emmanuel Nshakira-Rukundo - RWI Leibniz Institute for Economic Research, Essen

This research presents the first empirical analysis of how a large-scale health insurance programme impacted on labour supply in a low-income country, and how this altered in response to major changes in the insurance premia. 

The programme was first implemented by the Government of Rwanda on a nationwide basis in 2004, and made major changes to the health insurance premium policy in 2011. This increased insurance premiums for individuals classified as non-poor by 200% while providing poor households with waivers. 

The research estimated the effect of health insurance enrolment and the health insurance premium changes on labour supply. They found that health insurance decreases labour supply in non-agricultural and wage activities. Premium waivers reduce labour supply, highlighting the income effect. However, premium increases also reduce labour supply. 

The results highlight the necessity to reassess drawbacks of popular community-based targeting methods in social programmes.


Chrstoph Strupat - German Institute of Development and Sustainability

His presentation uses the roll-out of the national health insurance in Ghana to assess the cushioning effect of coverage on the financial consequences of health shocks and resulting changes in coping behaviours.

His results show a strong reduction in medical expenditures, preventing households from cutting non-food consumption and causing a decrease in the volume of received remittances as well as labor supply of healthy adult household members. 

He also found evidence that the insurance scheme reduced the likelihood that households experiencing a health shock pulled their children out of school in order to put them to work. Avoidance of such costly coping mechanisms is potentially an important part of the social value of formal health insurance.


Zemzem Shigute Shuka - International Institute of Social Studies

This presentation delves deep into the current landscape of health insurance coverage in Ethiopia, focusing on the implementation, challenges and potentials of the Community-Based Health Insurance (CBHI) and the yet-to-be-implemented Social Health Insurance (SHI). 

CBHI, driven by community participation, strives to enhance healthcare access to the informal sector, while SHI targets formal sector employees, although its implementation remains pending for several years. 

Challenges such as awareness of the scheme and its service coverage, provision of quality healthcare service and administrative complexities hinder CBHI's efficacy. Meanwhile, the anticipation of SHI raises questions about its prospective impact and the obstacles it may face upon implementation. 

Despite these hurdles, both insurance models hold promise in improving healthcare accessibility and financial protection. Concerted efforts are essential to overcome challenges and realize the vision of universal health coverage in Ethiopia.

RGHI Health insurance in Sub-Saharan Africa event poster - 12 April 2024

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