Healthcare Financing and Equity in Access Among Vulnerable Populations in Africa: A Review
1
Medicine, Federal Medical Centre, Abeokuta, Nigeria, Abeokuta, Nigeria
2
Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
3
Community Medicine and Primary Care, Federal Medical Centre, Abeokuta, Nigeria, Abeokuta, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A1385
ABSTRACT
BACKGROUND:
Africa has a large population with attendant health needs. Universal Health Coverage is a framework to help meet these health needs, ensuring everyone has equitable access without financial hardship. However, Out-of-pocket payment is still the major mode of health payments, which may disproportionately affect vulnerable populations.
METHODS:
This systematic review followed PRISMA guidelines and included original studies conducted in Africa between 2014 and 2025 that examined healthcare financing and equity in access to care. Literature searches were conducted in PubMed, Embase, Web of Science, Google Scholar, and African Journals Online. Titles, abstracts, and full texts were independently screened by two authors using predefined inclusion and exclusion criteria, with disagreements resolved through consensus. Findings from selected studies were synthesized narratively. Extracted data included study characteristics, vulnerable populations, healthcare financing mechanisms, outcome measures, and equity-related outcomes.
RESULTS:
Seventeen studies published between 2014 and 2024 across nine African countries were included, mostly single-country (n=15) and cross-sectional (n=11) in design. Study quality was generally high (JBI score 75–88%). Most examined National Health Insurance, out-of-pocket, or hybrid financing. rural residents, elderly individuals, pregnant women, children, persons with disabilities, people with depression, tuberculosis patients, migrants, and socioeconomically disadvantaged groups (poor vs rich households, female- vs male-headed households, and poor urban dwellers).
DISCUSSION:
This review showed persistent inequities in healthcare access among vulnerable populations in Africa. Women, poorer households, rural residents, the elderly, pregnant women, and individuals with chronic illnesses face reduced insurance coverage due to socioeconomic, geographic, and structural barriers, resulting in continued exposure to catastrophic health expenditure and limited progress toward universal health coverage.
CONCLUSIONS:
Widespread disparities in healthcare financing continue to restrict access for vulnerable populations in Africa. Expanding inclusive, equitable insurance schemes and addressing socioeconomic and geographic barriers are crucial to reduce financial hardship and improve access to essential health services.
Africa has a large population with attendant health needs. Universal Health Coverage is a framework to help meet these health needs, ensuring everyone has equitable access without financial hardship. However, Out-of-pocket payment is still the major mode of health payments, which may disproportionately affect vulnerable populations.
METHODS:
This systematic review followed PRISMA guidelines and included original studies conducted in Africa between 2014 and 2025 that examined healthcare financing and equity in access to care. Literature searches were conducted in PubMed, Embase, Web of Science, Google Scholar, and African Journals Online. Titles, abstracts, and full texts were independently screened by two authors using predefined inclusion and exclusion criteria, with disagreements resolved through consensus. Findings from selected studies were synthesized narratively. Extracted data included study characteristics, vulnerable populations, healthcare financing mechanisms, outcome measures, and equity-related outcomes.
RESULTS:
Seventeen studies published between 2014 and 2024 across nine African countries were included, mostly single-country (n=15) and cross-sectional (n=11) in design. Study quality was generally high (JBI score 75–88%). Most examined National Health Insurance, out-of-pocket, or hybrid financing. rural residents, elderly individuals, pregnant women, children, persons with disabilities, people with depression, tuberculosis patients, migrants, and socioeconomically disadvantaged groups (poor vs rich households, female- vs male-headed households, and poor urban dwellers).
DISCUSSION:
This review showed persistent inequities in healthcare access among vulnerable populations in Africa. Women, poorer households, rural residents, the elderly, pregnant women, and individuals with chronic illnesses face reduced insurance coverage due to socioeconomic, geographic, and structural barriers, resulting in continued exposure to catastrophic health expenditure and limited progress toward universal health coverage.
CONCLUSIONS:
Widespread disparities in healthcare financing continue to restrict access for vulnerable populations in Africa. Expanding inclusive, equitable insurance schemes and addressing socioeconomic and geographic barriers are crucial to reduce financial hardship and improve access to essential health services.
| eISSN: | 2654-1459 |
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