Health aid to sub-Saharan Africa fell a record 25% in 2025, and is projected to retreat penetration further, leaving fewer resources to reach the three-quarters of households without health insurance. Most pay health costs out-of-pocket – unaware of the options, unconvinced of the value of insurance or priced out by high premiums. Around a quarter of African nations have made health insurance mandatory, many within the past two decades. And penetration is modestly growing. But overall uptake remains low– at 13% in Nigeria, for example. Kenya moved in August 2025 to draw private insurers into its public scheme as claims administrators and complementary carriers. Elsewhere, however, high operating costs and hard-to-price informal-sector risk can limit private-sector participation. How can regulators reshape incentives, reduce market frictions, and crowd in private-sector capacity?
Key points:
- How should boundaries and incentives be calibrated for private insurers to supplement public universal health schemes?
- Supporting and financing coverage for poor and vulnerable groups: What is needed to grow risk pools and build risk-equalisation or equity funds?
- How far can regulation address the main barrier- premiums that most cannot afford?