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. 2023 May 2;13(1):25.
doi: 10.1186/s13561-023-00433-y.

Assessing the efficiency of health systems in achieving the universal health coverage goal: evidence from Sub-Saharan Africa

Kwadwo Arhin  1 , Eric Fosu Oteng-Abayie  2 , Jacob Novignon  2
Affiliations

Assessing the efficiency of health systems in achieving the universal health coverage goal: evidence from Sub-Saharan Africa

Kwadwo Arhin et al. Health Econ Rev. .

Abstract

Objective: Universal health coverage (UHC) is a major pathway to save many people from catastrophic and impoverishing healthcare spending and address the inequality in health and healthcare. The objective of this paper is to assess the efficiency with which health systems in sub-Saharan Africa (SSA) are utilizing healthcare resources to progress towards achieving the UHC goal by 2030.

Methods: The study followed the guidelines proposed by the World Health Organization (WHO) and World Bank joint UHC monitoring framework and the computational operationalization approach proposed by Wagstaff et al. (2015) to estimate the UHC index for each of the 30 selected SSA countries. The bootstrapping output-oriented data envelopment analysis (DEA) was used to estimate the bias-corrected technical efficiency scores and examine the environmental factors that influence health system efficiency.

Results: The estimated UHC levels ranged from a minimum of 52% to a maximum of 81% [Formula: see text] with a median coverage of 66%. The average bias-corrected efficiency score was 0.81 [Formula: see text]. The study found that education, governance quality, public health spending, external health funding, and prepayment arrangements that pool funds for health had a positive significant effect on health system efficiency in improving UHC, while out-of-pocket payment had a negative impact.

Conclusion: The results show that health systems in SSA can potentially enhance UHC levels by at least 19% with existing healthcare resources if best practices are adopted. Policymakers should aim at improving education, good governance, and healthcare financing architecture to reduce out-of-pocket payments and over-reliance on donor funding for healthcare to achieve UHC.

Keywords: Financial risk protection; Health service coverage; Health system efficiency; Sub-Saharan Africa; Universal health coverage.

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Conflict of interest statement

None of the authors of this paper has any competing interests. We, therefore, declare no competing interests.

Figures

Fig. 1
Fig. 1
Universal Health Coverage (UHC)
Fig. 2
Fig. 2
Boxplots of health service and financial protection indicators
Fig. 3
Fig. 3
Choropleth map showing spatial incidence of UHC in SSA
Fig. 4
Fig. 4
Universal Health Coverage (UHC) and total health expenditure per capita in SSA
Fig. 5
Fig. 5
Bar graphs of efficiency scores across different categories and kernel density estimate
Fig. 6
Fig. 6
Error bars for sensitivity analysis of efficiency scores
See this image and copyright information in PMC

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