Responding to the challenges of social health insurance in African countries

With most sub-Saharan African countries facing problems of raising revenues for financing the delivery of an essential package of health services, there has been growing interest in social health insurance (SHI) as shown by efforts in Ghana, Kenya, Lesotho, Nigeria, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. While these health financing constraints are linked to broader public affairs of slow, or even negative macroeconomic growth, civil strife and political instability, there is little consensus on what should be the appropriate institutional arrangements and policies to mobilise resources for effective provision of essential health services. Given an observed inclination towards SHI, this paper provides some answers to the challenge of making it work in African countries. The paper discusses a number of policy choices and trade-offs that health planners may consider when implementing SHI to generate financing for the provision of essential health care benefits.