Data published by WHO coming from National Health Accounts (NHA) 2015 show that the lowest rates of out-of-pocket payments in relation to Current Health Expenditure (CHE) are found in Southern African countries: Botswana, Mozambique, South Africa, Namibia, Lesotho, Swaziland and Malawi. While Africa has an OOP mean of 40%, and some countries as Nigeria reach 72%, Southern African countries remain below 12%.
It is hard to know what happens in these countries. Botswana has a mainly public health system, running 98% of health facilities, and with private provision catering for the high-income groups. Mozambique has a National Health Service with low but increasing payments and several challenges in public finance management and efficiency of this collection and service delivery. Preliminary data of National Health Accounts in 2017 show a relevant increase in OOP.
South Africa has been inspired by the British NHS and after 1994 a public investment effort has been done, whjile removing user fees in 2001.
It will be interesting to closely monitor the evolution of this unique pattern of low out-of-pocket payments in the Southern Africa region.
