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African leaders across the continent have made bold commitments to attain Universal Health Coverage (UHC). One way to show this commitment has been through exploring National Health Insurance Schemes (NHIS). In this study, the authors examine African country experiences in implementing NHIS, and draw some lessons about whether and how contributory NHIS may or may not be a viable path toward UHC in sub-Saharan Africa. The authors report that for NHI to be an effective tool for attaining UHC, first, there is need to set explicit objectives and an understanding of why NHI can meet the objectives in the country’s particular context; second, it must include key pro-equity design elements; and finally NHI needs to be supported by widespread political commitment and ongoing learning and adaptation. For many governments, achieving this kind of enabling environment for NHI may be particularly challenging for various political, economic, or social reasons. In these contexts, health sector leaders may consider looking inward to their existing health financing systems for ways to improve and be more effective.
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