Countdown to 2030: overview of current and planned health financing reforms for universal health coverage in the WHO African Region.

Background: Countries in the World Health Organization (WHO) African region are lagging behind in the global push toward universal health coverage (UHC), a core component of the 2030 Agenda for Sustainable Development. As the target year steadily approaches, it is crucial to assess countries' current and planned health financing reforms to understand their path towards UHC. We examine both current and planned health financing reforms in the WHO African region and assess their implications for UHC.

Methods: We sent a survey to all 47 Member States of the WHO African Region in August 2024 about their current and planned health financing reforms in the three health financing functions of revenue raising, pooling, and purchasing, as well as public finance management. We used responses from 43 countries, of which 18 countries had a current endorsed national health financing strategy to assess the implications of their reforms based on current literature on using health financing to progress towards UHC goals.

Results: Of the 43 countries in the WHO African Region that responded to our survey, 33 (77%) have current or planned health financing reforms across the various health financing functions. A major focus of these reforms is on establishing contributory health insurance schemes, despite their limited potential to address the region's challenges. Additionally, countries are prioritising expanding performance-based financing and provider payment mechanisms. These purchasing strategies could improve service coverage and quality of care if implemented within robust public finance management structures.

Conclusions: Countries in the WHO African Region are adopting and planning various health financing reforms to achieve UHC. To ensure success, they will require support in effectively implementing evidence-based reforms in the areas of purchasing and reducing fragmentation from various coverage schemes.