A framework policy analysis of national health insurance policymaking in sub-Saharan Africa

Abstract National health insurance (NHI) is a financing mechanism established by national government with the goal of covering all or almost its citizens. A number low- and middle-income countries have NHIs as part strategy to progress towards universal coverage. The establishment an NHI presents potentially significant shift in sector governance, but little available literature regarding how policymaking authority governance shared between ministries (MOHs). To answer this question, we conducted descriptive, qualitative comparative analysis policies, including legislation, guidelines webpages, from four sub-Saharan African that are process establishing scheme 2019 (Ghana, Kenya, Zambia South Africa). We developed novel conceptual framework comprising 16 policy domains deductive review relevant policies. then extracted indexed elements according facilitate analysis. found substantial variation across types policies decision-making around those MOHs retained at least some power over through regulations appointment board members. However, were often delegated key areas mechanisms, provider payments, member benefit schemes, accreditation relationships private schemes. results illustrate many aspects regulatory oversight will need be defined NHIs. approaches these presented manuscript may helpful for other evaluating differing MOHs.