Health insurance coverage and timely antenatal care attendance in sub-Saharan Africa

Aboagye, Richard Gyan, Okyere, Joshua, Ahinkorah, Bright Opoku, Seidu, Abdul-Aziz, Zegeye, Betregiorgis, Amu, Hubert, and Yaya, Sanni (2022) Health insurance coverage and timely antenatal care attendance in sub-Saharan Africa. BMC Health Services Research, 22. 181.

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Introduction: Out-of-pocket payments for healthcare remain a significant health financing challenge in sub-Saharan Africa (SSA), preventing women from using maternal health services. There is a paucity of empirical literature on the influence of health insurance coverage on the timeliness of antenatal care (ANC) attendance in low- and middle-income countries. In this study, we examined the association between health insurance coverage and timely ANC attendance among pregnant women in SSA.

Methods: Secondary data from Demographic and Health Surveys conducted between 2015 and 2020 in sixteen (16) sub-Saharan African countries with 113,918 women aged 15-49 years were included in the analysis. The outcome variable was the timing of antenatal care (ANC). A multilevel binary logistic regression analysis was carried out to determine the association between health insurance coverage and timely ANC.

Results: The overall coverage of health insurance and timely antenatal attendance among pregnant women in SSA were 4.4% and 39.0% respectively. At the country level, the highest coverage of health insurance was found in Burundi (24.3%) and the lowest was in Benin (0.9%). For timely ANC attendance, the highest prevalence was in Liberia (72.4%) and the lowest was in Nigeria (24.2%). The results in the model showed that women who were covered by health insurance were more likely to have timely ANC attendance compared to those who were not covered by health insurance (aOR = 1.21, 95% CI = 1.11-1.31).

Conclusion: Our findings show that that being covered under health insurance is associated with higher likelihood of seeking timely ANC attendance. To accelerate progress towards achievement of the Sustainable Development Goal targets by the year 2030, we recommend that governments and health insurance authorities across the sub-Saharan African countries actively implement health insurance policies as well as roll out health educational programmes that facilitate and ensure increased coverage of health insurance.

Item ID: 74451
Item Type: Article (Research - C1)
ISSN: 1472-6963
Keywords: National Health Insurance, Pregnant women, Sub-Saharan Africa, Timely ANC
Copyright Information: © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Date Deposited: 20 Oct 2022 00:39
FoR Codes: 42 HEALTH SCIENCES > 4204 Midwifery > 420402 Models of care and place of birth @ 30%
42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 70%
SEO Codes: 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200509 Women's and maternal health @ 100%
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