Three Essays on Health Financing in Sub-Saharan Africa

Health Shocks, Health Insurance Uptake, and Financial Risk Protection

by Adeyemi Theophilus Okunogbe

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In Sub-Saharan Africa (SSA), out-of-pocket health spending constitutes a significant proportion of household expenditures, thereby exposing households to a high risk of impoverishment and potential worsening of already poor health outcomes. This dissertation is a series of three essays on health financing in SSA using quantitative and comparative case study methods.

Table of Contents

  • Chapter One


  • Chapter Two

    Health Shocks, Health Insurance, Household Welfare & Informal Coping Mechanisms: Evidence from Nigeria (Paper 1)

  • Chapter Three

    Insurance Uptake Intention, Actual Insurance Uptake, Social Capital and other determinants in the context of a community-based health insurance program in Nigeria (Paper 2)

  • Chapter Four

    A Cross-National Analysis of Factors Influencing Financial Risk Protection for Universal Health Coverage in Sub-Saharan Africa (Paper 3)

  • Chapter Five

    Final Conclusions

  • Appendix A

    Supplementary Materials for Chapter 1 (Introduction)

  • Appendix B

    Supplementary Materials for Chapter 2 (Health Shocks)

  • Appendix C

    Supplementary Materials for Chapter 4 (Financial Risk Protection)

Research conducted by

This document was submitted as a dissertation in November 2018 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Peter Hussey (Chair), Edward Okeke, and Diana Bowser (Brandeis University).

This report is part of the RAND Corporation Dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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