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Factors influencing the adoption of Universal Health Coverage in Africa: Insights from a realist synthesis

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  • Langat, Evaline
  • Gesesew, Hailay Abrha
  • Mwanri, Lillian
  • Ward, Paul R.

Abstract

Achieving Universal Health Coverage (UHC) is a critical goal for improving health equity and access in Africa. Knowledge gap exists on the underlying factors that drive UHC performance in the African context. Our study sought to explore the complex landscape of UHC adoption in Africa, examining the factors that influence its implementation and the strategies that could accelerate progress towards this vital goal.

Suggested Citation

  • Langat, Evaline & Gesesew, Hailay Abrha & Mwanri, Lillian & Ward, Paul R., 2025. "Factors influencing the adoption of Universal Health Coverage in Africa: Insights from a realist synthesis," Social Science & Medicine, Elsevier, vol. 387(C).
    • Handle: RePEc:eee:socmed:v:387:y:2025:i:c:s0277953625010408
    DOI: 10.1016/j.socscimed.2025.118709
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    References listed on IDEAS

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    1. Carolien Aantjes & Timothy Quinlan & Joske Bunders, 2016. "Towards universal health coverage in Zambia: impediments and opportunities," Development in Practice, Taylor & Francis Journals, vol. 26(3), pages 298-307, April.
    2. Abelson, Julia & Miller, Fiona A. & Giacomini, Mita, 2009. "What does it mean to trust a health system?: A qualitative study of Canadian health care values," Health Policy, Elsevier, vol. 91(1), pages 63-70, June.
    3. Lavers, Tom, 2021. "Aiming for Universal Health Coverage through insurance in Ethiopia: State infrastructural power and the challenge of enrolment," Social Science & Medicine, Elsevier, vol. 282(C).
    4. Maximillian Kolbe Domapielle & Joshua Sumankuuro & Frederick Der Bebelleh, 2022. "Revisiting the debate on health financing in Low and Middle‐income countries: An integrative review of selected models," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(6), pages 3061-3074, November.
    5. Chunling Lu & Brian Chin & Jiwon Lee Lewandowski & Paulin Basinga & Lisa R Hirschhorn & Kenneth Hill & Megan Murray & Agnes Binagwaho, 2012. "Towards Universal Health Coverage: An Evaluation of Rwanda Mutuelles in Its First Eight Years," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-16, June.
    6. Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    7. Mohamed Kouni Chahed & Chokri Arfa, 2014. "Monitoring and Evaluating Progress towards Universal Health Coverage in Tunisia," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-2, September.
    8. Evaline Chepchirchir Langat & Paul Ward & Hailay Gesesew & Lillian Mwanri, 2025. "Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review," IJERPH, MDPI, vol. 22(1), pages 1-20, January.
    9. van der Schee, Evelien & Braun, Bernard & Calnan, Michael & Schnee, Melanie & Groenewegen, Peter P., 2007. "Public trust in health care: A comparison of Germany, The Netherlands, and England and Wales," Health Policy, Elsevier, vol. 81(1), pages 56-67, April.
    10. Sharif A. Ismail, 2018. "The rocky road to universal health coverage in Egypt: A political economy of health insurance reform from 2005–15," International Social Security Review, John Wiley & Sons, vol. 71(2), pages 79-101, April.
    11. Prossy Kiddu Namyalo & Boniface Mutatina & Sarah Byakika & Aliyi Walimbwa & Rose Kato & Robert K Basaza, 2023. "The feasibility analysis of integrating community-based health insurance schemes into the national health insurance scheme in Uganda," PLOS ONE, Public Library of Science, vol. 18(4), pages 1-24, April.
    12. Elisabeth Paul & Youssoupha Ndiaye & Farba Lamine Sall & Fabienne Fecher & Denis Porignon, 2020. "An assessment of the core capacities of the Senegalese health system to deliver Universal Health Coverage," ULB Institutional Repository 2013/312244, ULB -- Universite Libre de Bruxelles.
    13. Gilson, Lucy, 2003. "Trust and the development of health care as a social institution," Social Science & Medicine, Elsevier, vol. 56(7), pages 1453-1468, April.
    14. Fentaw Teshome Dagnaw & Melkalem Mamuye Azanaw & Aytenew Adamu & Tinsaea Ashagrie & Abdelah Alifnur Mohammed & Hiwot Yisak Dawid & Mulu Tiruneh & Biruk Demissie & Getaneh Atikilt Yemata & Getachew Yid, 2022. "Community-based health insurance, healthcare service utilization and associated factors in South Gondar Zone Northwest, Ethiopia, 2021: A comparative cross-sectional study," PLOS ONE, Public Library of Science, vol. 17(7), pages 1-11, July.
    15. Bedasa Taye Merga & Bikila Balis & Habtamu Bekele & Gelana Fekadu, 2022. "Health insurance coverage in Ethiopia: financial protection in the Era of sustainable development goals (SDGs)," Health Economics Review, Springer, vol. 12(1), pages 1-7, December.
    16. Gajate-Garrido, Gissele & Owusua, Rebecca, 2013. "The national health insurance scheme in Ghana: Implementation challenges and proposed solutions:," IFPRI discussion papers 1309, International Food Policy Research Institute (IFPRI).
    17. Mohseni, Mohabbat & Lindstrom, Martin, 2007. "Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study," Social Science & Medicine, Elsevier, vol. 64(7), pages 1373-1383, April.
    18. Mercy G Mugo, 2023. "The impact of health insurance enrollment on health outcomes in Kenya," Health Economics Review, Springer, vol. 13(1), pages 1-19, December.
    19. Straten, G. F. M. & Friele, R. D. & Groenewegen, P. P., 2002. "Public trust in Dutch health care," Social Science & Medicine, Elsevier, vol. 55(2), pages 227-234, July.
    20. Dexnell Peters & Farid F. Youssef, 2016. "Public trust in the healthcare system in a developing country," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(2), pages 227-241, April.
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