Equitable health financing where costs are shared within a population based on everyone’s contributory capacity is critical for Universal Health Coverage (UHC). Several African countries have introduced Universal Health Insurance (UHI) programmes with the aim of extending health insurance to groups that are usually excluded, namely informal workers. This article studies the institutional characteristics of National Health Insurance Schemes (NHIS) in various African countries and assesses their contribution to the achievement of UHC goals. The authors focused on African countries with a NHIS programme for at least four years and identified 16 countries in a period ranging from 2015-2017. The findings shows that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution- based financing and the need to strengthen tax-based financing.
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