Couverture financière en santé de la population à Madagascar et cas des pays de l’Afrique Subsaharienne

The atypical feature of the healthcare market involves the analysis of the behavior of different health stakeholders where healthcare costs payable by the patient punishes the poor and prevent them from accessing vital care. This systematic review aimed to synthesize all the literature published between 2022 and 2025 which illustrated the level of health financial protection coverage in Sub-Saharan Africa, including Madagascar. Methods: Electronic and manual searching of articles was done using keywords to identify articles on Google Scholar and Pubmed by using an Excel file. All qualitative, quantitative and mixed studies were considered. A synthesis was carried out to highlight financial protection and financial access to healthcare following PRISMA guidelines. Out of 251 articles, 35 met the inclusion criteria. In the analysis of the determinants of healthcare use, age, area of ​​residence, economic well-being and level of education are the most represented characteristics to explain the disparities between the two groups. People covered by a financial protection scheme have a higher probability of seeking care than those who do not. In sub-Saharan Africa, direct payments still represent more than 40% of total health spending. The study highlights the inequity in access to health care which remains a challenge to extend health coverage to the entire population.