Assessing the efficiency of health systems in achieving the universal health coverage goal : evidence from Sub-Saharan Africa

Objective Universal health coverage (UHC) is a major pathway to save many people from catastrophic and impover‑ ishing healthcare spending and address the inequality in health and healthcare. The objective of this paper is to assess the efciency with which health systems in sub-Saharan Africa (SSA) are utilizing healthcare resources to progress towards achieving the UHC goal by 2030. Methods The study followed the guidelines proposed by the World Health Organization (WHO) and World Bank joint UHC monitoring framework and the computational operationalization approach proposed by Wagstaf et al. (2015) to estimate the UHC index for each of the 30 selected SSA countries. The bootstrapping output-oriented data envelop‑ ment analysis (DEA) was used to estimate the bias-corrected technical efciency scores and examine the environ‑ mental factors that infuence health system efciency. Results The estimated UHC levels ranged from a minimum of 52% to a maximum of 81% (SD = 8.6%) with a median coverage of 66%. The average bias-corrected efciency score was 0.81 (95%CI : 0.77 − 0.85). The study found that education, governance quality, public health spending, external health funding, and prepayment arrangements that pool funds for health had a positive signifcant efect on health system efciency in improving UHC, while out-ofpocket payment had a negative impact. Conclusion The results show that health systems in SSA can potentially enhance UHC levels by at least 19% with existing healthcare resources if best practices are adopted. Policymakers should aim at improving education, good governance, and healthcare fnancing architecture to reduce out-of-pocket payments and over-reliance on donor funding for healthcare to achieve UHC.