Expanding Social Health Insurance Coverage for the Informal Sector in Zambia: Lessons and Insights from LMICs.

Area of Science:

• Health Policy and Systems Research
• Public Health
• Health Economics

Background:

• Universal Health Coverage (UHC) is a key goal for low- and middle-income countries (LMICs).
• Social Health Insurance (SHI) is a strategy used by LMICs to achieve UHC.
• Expanding SHI to informal sector households is crucial for increasing coverage.

Purpose of the Study:

• To review strategies and interventions for enrolling and retaining informal sector households in SHI schemes in LMICs.
• To identify barriers and effective approaches for informal sector inclusion in SHI.

Main Methods:

• Scoping review of strategies and interventions in LMICs.
• Analysis of common barriers and potential solutions for SHI enrollment and retention.

Main Results:

• Common barriers include irregular incomes, low awareness, administrative hurdles, and trust issues.
• Effective strategies involve flexible contributions, simplified registration, awareness campaigns, community structures, and balanced benefit packages.
• Innovative approaches like tiered premiums, mobile payments, and microfinance partnerships can address barriers.
• Enrollment expansion often necessitates public subsidies and incurs administrative costs, with modest net revenue gains.

Conclusions:

• Context-specific, innovative strategies are vital for informal sector inclusion in SHI.
• Achieving equitable access through SHI requires acknowledging fiscal constraints and potential need for public funding.
• Lessons learned can inform national schemes, like Zambia's NHIS, to improve informal sector coverage.