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  1. Home
  3. Expanding Social Health Insurance Coverage For The Informal Sector In Zambia: Lessons And Insights From Lmics.
  1. Home
  3. Expanding Social Health Insurance Coverage For The Informal Sector In Zambia: Lessons And Insights From Lmics.

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

Oliver Kaonga1,2, Jackson Otieno1, Mark Malema3

  • 1African Institute for Development Policy (AFIDEP), Nairobi, Kenya.

Health Systems and Reform
|January 9, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Social Health Insurance (SHI) in low- and middle-income countries (LMICs) can expand coverage for informal workers through flexible contributions and community outreach. However, achieving Universal Health Coverage (UHC) requires public subsidies and addressing administrative costs.

Keywords:
Informal sectorZambiasocial health insuranceuniversal health coverage

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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.