The Gendered Impacts of Out-Of-Pocket Payments for Healthcare on Women in Sub-Saharan Africa-a Narrative Review Dolapo Ruth Adu, Muhammad Saddiq

Background Healthcare financing is central to achieving Universal Health Coverage (UHC). In Sub-Saharan Africa (SSA), limited public funding and high disease burdens have resulted in heavy reliance on out-of-pocket (OOP) payments. Although the negative effects of OOP spending on vulnerable populations are well documented, the specific gendered impacts on women remain insufficiently explored. Women generally have higher healthcare needs but face persistent economic and social constraints, increasing their vulnerability within OOP-dependent systems. This review examines how OOP payments affect women’s access to healthcare, service utilisation, and health outcomes in SSA. Method A thematic narrative review of literature published between 2013 and 2023 was conducted using seven electronic databases. A systematic search strategy was applied, and eligible studies were critically appraised using the CASP checklist. Results Out of 1,370 identified publications, 19 studies met the inclusion criteria. Three major themes emerged: access to healthcare services, utilisation of healthcare services, and health outcomes. The findings show that OOP payments significantly restrict women’s access to essential healthcare, often leading to delayed care, use of lower-quality services, or complete forgone treatment. Women frequently adopt harmful coping strategies and make health-related compromises due to financial pressures. Conclusion The review highlights the urgent need for gender-responsive health financing reforms. Addressing these disparities is essential for developing equitable healthcare systems that improve women’s health and advance UHC in SSA.