Estimating the distributional incidence of healthcare spending on curative health services in Sub-Saharan Africa: Benefit Incidence Analysis in Burkina Faso, Malawi and Zambia

Sub-Saharan African countries have been experiencing a persistently high level of inequality in access to healthcare services. Following the global call to eliminate health inequalities worldwide, different investments in health policies towards Universal Health Coverage (UHC) have been made in many Sub-Saharan African countries. However, evidence on the distributional incidence of health spending on these recent UHC-specific reforms is still limited. This paper aimed to close this gap in knowledge by conducting a quasi-longitudinal benefit incidence analysis to assess equality of both public and overall health spending on curative health services across socioeconomic groups in three Sub-Saharan African countries: Burkina Faso, Malawi and Zambia. The study relied on healthcare utilization data derived from different nation-level household surveys (including Living Condition and Monitoring Survey, Performance based Financing Survey, and Zambia Household Health and Expenditure Survey) and health expenditure data derived from National Health Accounts. The findings demonstrated increasing equality in the distributional incidence of health spending over time, but also considerable persistent heterogeneity across provinces/regions/district. Less health financing inequality was observed in Malawi than in the other two country. These findings suggest that the implementation of UHC-specific reforms was effective in increasing equality in the distributional incidence of health spending, meaning that more financial resources reached the poorest segments of society, but was not yet sufficient to remove differences across provinces/regions/districts. Further research is needed to investigate sources of heterogeneity within countries and identify strategies to overcome it.