Health financing policy reforms for universal health coverage in eastern, central and southern Africa (ECSA)-health community region

Providing access to health care services and goods to all citizens has long been a cornerstone of modern health financing systems in many countries. In sub-Saharan Africa (SSA), this became evident soon after independence in the 1960s: in order to redress the significant levels of inequality and deprivation during the colonial era, most countries introduced free public health care services, as a way of increasing access to (and utilisation of) modern health services and, hence, achieving the equity goal. However, with the passage of time, countries in SSA have been faced with an increased disease burden and growing demand for quality health care services, amidst limited economic resources, low economic growth, a large informal sector with unregulated labour markets, and high population growth rates. In order to respond to this crisis, in the 1980s and 1990s, many governments with the influence/support of international organisations undertook health sector reforms, with regard to health financing, which saw the reversal of the policy of the provision of free public health care services. User fees for health services at the point of use in public health facilities were introduced in almost all countries in SSA—only a few countries, such as Malawi and Mauritius, resisted the temptation of introducing user fees for public health services at all levels nationally.