What do we know about financial protection in health in Africa? A systematic review

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Abstract Background Financial protection is one of the main indicators to assess progress towards Universal Health Coverage. Efforts have been made globally to monitor financial protection. However, progress in the African Region is limited. Methods A systematic review was conducted to assess financial protection in health in Africa. The search of five databases was conducted between March and May 2019. Studies were included if they conducted empirical analyses on one or two dimensions of financial protection—catastrophic and impoverishing health expenditures, at the national or subnational levels. The review included peer-review articles, grey literature and reports. Data extraction included study characteristics, the dimension of financial protection, including methods and data sources, and the type of analysis (incidence, equity analysis, determinants, trends over time) of financial protection. Results Fifty-one studies met the inclusion criteria of the review with at least one study in 41 out of the 47 countries in the WHO African Region. The analyses of the included studies showed that catastrophic and impoverishing health spending occurs in all the countries in the region, albeit at different levels. Various national household surveys were used as data sources. Also, the studies used different methods to assess financial protection. The incidence ranged from 0.29% in Zambia in 2010 to 16.4% in Nigeria in 2009 at a 10% threshold. Due to the wide range of data sources and methods, comparison of findings within and across countries was difficult. Furthermore, the majority of the studies focused on in-depth analysis of catastrophic health spending than impoverishing. Trends over time of both catastrophic and impoverishing health expenditures were even limited in single-country analysis. Conclusion This review provides evidence that generally, financial protection is being monitored at the national level in the African Region, and the incidence of financial protection has increased generally in the Region. Further research on financial protection should explore methods to harmonize the estimation of OOP from different surveys In addition, analyses should go beyond measuring the incidence of financial protection and also focus on equity analysis, looking at the drivers and trends of both dimensions of financial protection.

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