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The goal of universal health coverage (UHC) is to ensure that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. This brief discusses trends in financial hardship due to out-of-pocket health spending in the WHO African Region.
Financial hardship is monitored within the Sustainable Development Goals (SDGs) framework based on catastrophic and impoverishing outof-pocket (OOP) health spending indicators. The incidence of catastrophic health spending (SDG indicator 3.8.2) is measured as the proportion of the population with OOP health spending exceeding 10% and 25% of total household expenditure or income (budget). The total population with impoverishing health spending includes people impoverished (pushed below the poverty line) and further impoverished (already below the poverty line but pushed even further below) due to OOP health spending. In this brief, we use the absolute poverty line of US$ 2.15 a day per person in 2017 purchasing power parity (PPP) that defines extreme poverty. OOP health spending can occur in relation to any type of health product or service, any kind of care by any provider type, any illness or health condition, and any type of setting. It includes both formal and informal expenses directly related to the cost of seeking care.
In countries of the WHO African Region, OOP payments are a significant source of funding for health. In 2019, OOP payments accounted for over 25% of current health spending in 31 countries. Moreover, in 11 countries, OOP payments exceeded 50% of current health spending, and in three countries, the share exceeded 70%. Within the WHO African Region, these payments were higher, particularly in low- and lower-middle-income countries. Only four countries’ OOP spending represented less than 10% of their total health spending (Figure 1).