Pitfalls of universal health coverage systems : evidence from West Africa

The importance of establishing universal health coverage policies for facilitating health care access and utilisation in developing countries is recognised in the literature. However, previous studies focus primarily on the fiscal challenges associated with the implementation of universal health coverage schemes, particularly in sub-Saharan Africa. In the wake of the inclusion of universal health coverage as one of the key targets of the United Nation's Sustainable Development Goal 3, many African countries are preparing to implement some form of national health insurance system. We seek to contribute to the literature by discussing the experiences of Ghana's National Health Insurance Scheme and, more briefly, the health insurance initiatives of Senegal and Burkina Faso. Our purpose is to show that implementation of universal health coverage is challenging, but possible, if associated blind spots are managed.