How extensive is NHI coverage in emerging markets?

As governments in South Africa and Uganda are preparing to put national health insurance (NHI) bills to parliaments, HBI looks at schemes already in place and the extent of coverage based on the latest available data.

The interactive graph below shows the percentage of the population covered by government organised health insurance schemes, with consolidated figures from both formal sector and informal sector schemes where these are in place. It does not include people covered by private medical insurance, which remains high in India.

Many emerging market countries have implemented – or started to implement – NHI schemes over the past decade, HBI has looked here at Kenya, Ghana, Rwanda, Nigeria, Burkina Faso, Tanzania, Ethiopia and India as these markets are where NHI is the longest or furthest developed.

Based on the markets that HBI has looked at, coverage is highest in Rwanda at 90% and the lowest in Nigeria at 4%, where the only persons who have really paid into the scheme are those working in the higher levels of government. Under the country’s NHI act which set up an opt-in scheme, those working in Federal Government agencies pay 1.75% and their employer pays 3.25% while those working in other government agencies or in the organised private sector pay 10% and their employer 5%.

Of course, far-reaching NHIS coverage isn’t automatically beneficial to the private sector. Not all schemes support private sector provision and where it does the payouts are generally relatively low.

Just 20-25% of the accredited health facilities in Kenya’s NHIS scheme are for-profit and the figure is even lower in Ghana, at 12%. Policymakers in South Africa have been speaking loudly about how the private sector must be able to deliver healthcare under its proposed law but detail is scarce on how this will work.

The funding pots also remain small. Kenya paid out $18.44 per beneficiary in 2018 and Ghana $24.25 (2017, latest data available), proving that there’s a lot of work to do to make any investment from the private sector worthwhile.

We would welcome your thoughts on this story. Email your views to Rachel Lewis or call 0207 183 3779.