A Systematic Review of Healthcare Financing Models and Their Impact on Universal Health Coverage Progress in Sub-Saharan Africa

Review Article

Abstract

Sub-Saharan Africa faces significant challenges in achieving Universal Health Coverage (UHC), with persistent gaps in healthcare access and financial protection. The region bears 24% of the global disease burden despite having only 11% of the world's population, highlighting the critical need for effective healthcare financing strategies. A structured literature search was conducted across PubMed, Scopus, and Dimensions databases, supplemented by grey literature from WHO IRIS and World Bank repositories. Publications from 2000 to 2025 were included based on predefined criteria. The final analysis involved 15 studies that evaluated various healthcare financing models in Sub-Saharan African countries. Tax-based systems and National Health Insurance Authority schemes demonstrated superior outcomes in financial protection and service accessibility. Out-of-pocket payments, accounting for 35.8% of total health expenditure, were associated with increased catastrophic health spending and reduced healthcare utilization. Multi-payer systems showed mixed results, with success contingent upon effective regulation and risk pooling. Innovative financing mechanisms, including sin taxes, generated over $500 million in additional health funding between 2015-2020 across 14 countries. Evidence supports the superiority of publicly funded financing models for achieving UHC in Sub-Saharan Africa. Success depends on robust governance, effective pooling mechanisms, and context-specific adaptations. Reducing reliance on out-of-pocket payments while strengthening domestic resource mobilization presents the most viable path toward sustainable UHC in the region.