Exploring new ways to extend equity, access to health care in Africa

For more than a decade, IDRC’s Governance for Equity in Health Systems program has supported researchers and health reformers in their efforts to strengthen health systems and find health financing solutions that reflect local needs and priorities in low- and middle-income countries. 

One such example is the support GEHS has provided to SHIELD (Strategies for Health Insurance for Equity in Less Developed Countries). This research partnership analyzed health financing inequities in Ghana, South Africa, and Tanzania (2006-2011). These three countries rely partly on voluntary insurance and are adopting elements of mandatory insurance, or dedicated tax funding, into their health systems. Using financing and benefit incidence analysis methods, SHIELD researchers’ found that low-income countries should look more closely at various forms of indirect taxation as mechanisms to finance health system.

SHIELD research stated that financial barriers to service access must be addressed if universal coverage is to become a reality. Research results emphasized the need to integrate financing mechanisms to promote universal health coverage with strong income and risk cross-subsidies.

GEHS also supported SHIELD researchers disseminate their findings and results through peer-reviewed journal articles. Findings were published in the WHO bulletin, a special issue of the Health Policy and Planning Journal, as well as The Lancet article, "Equity in financing and use of health care in Ghana, South Africa, and Tanzania."

Learn more about GEHS's support for universal health coverage

According to SHIELD research leader and GNHE co-leader Di McIntyre, in low-income countries, “basic survival escapes the VAT net.”

Professor McIntyre is the South African Research Chair in ‘Health and Wealth’ and a Professor in the School of Public Health and Family Medicine at the University of Cape Town, South Africa.