Willingness to Pay for Health Insurance in Sub-Saharan Africa: A Systematic Review Protocol

Introduction

In sub-Saharan Africa, most people pay for healthcare directly out-of-pocket (OOP). This makes it harder for countries in the region to achieve Universal Health Coverage (UHC), as many people can’t afford care, resulting in poor health, and some people being pushed deeper into poverty due to the high cost of care. To reduce this burden and move closer to UHC, many African countries have introduced health insurance to raise funds for healthcare and reduce direct OOP spending. To make the health insurance more effective, it’s important to understand how willing people are to pay for health insurance, how much can be raised relative to GDP, and what factors influence their willingness to pay (WTP). This information can help shape health financing policies in the region.

Methods and Analysis

A systematic search will be conducted using PubMed, Google Scholar, Science Direct, relevant references from selected studies and grey literature that would be identified from the databases searched. The search will cover all available studies that focus on WTP for health insurance in sub-Saharan Africa from inception to 31 ^st May 2025. Key outcomes will include the percentage of people willing to pay, amount to be raised relative to GDP per capita, and the factors that frequently influence WTP. Each study will be carefully reviewed using the STROBE (strengthening the reporting of observational studies in Epidemiology) tool for quality, and the results will be combined and analysed using quantitative methods.

Ethics and Dissemination

Since this is a systematic review that does not involve recruiting or studying people directly, ethics approval is not required. The findings will be disseminated through conferences, symposia, and published in a peer-reviewed journal. They will also be shared with policymakers and the general public interested in health financing.

PROSPERO registration number

CRD420251027763

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Follows a structured and transparent systematic review methodology.

• Uses STROBE tool for critical appraisal of included studies.

• Includes standardization of amounts to be raised across countries using GDP per capita.

• Employs vote-counting to identify influencing factors.

• Limited to studies conducted in Sub-Saharan African countries published in English