Building Stronger National Health Insurance In Africa

Key Takeaways

• National Health Insurance is a cornerstone of universal health coverage, yet insurance coverage in Africa remains low at 9 percent.
• Countries across the continent face shared challenges in implementing National Health Insurance in Africa, particularly enrolling informal sector workers and ensuring fiscal sustainability.
• Recent reforms in Kenya, Nigeria, and Ghana show progress but have not fully resolved operational and financing bottlenecks.
• Fragmented national approaches to National Health Insurance lead to duplicated effort and inefficient use of scarce technical and financial resources.
• Global evidence shows that structured peer learning accelerates reform more effectively than consultant-driven approaches.
• Consolidated risk pooling, unified purchasing, and digital systems are proven tools for strengthening National Health Insurance schemes.
• A continent-wide community of practice would support joint problem-solving, reduce reliance on external consultants, and enhance political resilience.
• Shared benchmarks and pooled knowledge can increase bargaining power with providers and suppliers, generating cost savings.
• Advancing National Health Insurance in Africa will depend on collective learning and coordinated reform rather than isolated national initiatives.

Executive Summary

This report examines the growing role of National Health Insurance in Africa and makes the case for establishing a continent-wide community of practice to accelerate progress toward universal health coverage. Across the continent, National Health Insurance schemes are increasingly recognized as critical instruments for reducing out-of-pocket spending, protecting vulnerable populations, and mobilizing domestic resources for health. Despite this momentum, coverage remains limited. As of 2021, only 9 percent of Africans were enrolled in any form of health insurance, highlighting a significant gap between policy ambition and implementation.

The report reviews reforms in Kenya, Nigeria, and Ghana to illustrate both advances and persistent constraints. Kenya’s Social Health Insurance reforms emphasize digital enrollment and primary health care financing, but affordability for informal workers remains a challenge. Nigeria’s reformed National Health Insurance Authority introduced equity mechanisms for vulnerable groups, yet coverage remains below 5 percent. Ghana’s National Health Insurance Scheme has achieved broader reach through earmarked taxes but faces fiscal pressure from rising utilization and claims arrears. While these systems differ in maturity and scale, they confront similar operational, fiscal, and governance challenges.

Drawing on global experience, the report demonstrates that peer learning and structured collaboration outperform isolated reform efforts. It concludes that an African-led community of practice focused on National Health Insurance in Africa would strengthen institutional capacity, improve efficiency, and support sustained expansion of coverage across countries.