Helping Sierra Leone create a universal healthcare scheme • City, University of London

The researchers:

Research status:Completed

This is impact: Healthcare policy making in Sierra Leone 2 minutes

In summary

The Ebola crisis of 2014-15 caused around 4,000 deaths and enormous socioeconomic disruption in Sierra Leone. In the aftermath, it became clear there was an overwhelming need for a universal healthcare insurance system. The country had one of the highest rates of out-of-pocket expenditure in the world.

Professor Jofre-Bonet has made a significant impact on healthcare policymaking in Sierra Leone. Her research, including a large-scale survey, underpinned the design of the health insurance scheme rolled out in 2018. The findings also advised the government on specifics of the scheme, including how much people are willing to pay.

What did we explore and how?

After the Ebola crisis, the Sierra Leone government made healthcare a priority. Without insurance, people were relying on pay-as-you-go care. When they ran out of money, they could no longer access healthcare.

Using different economic research methods, Professor Jofre-Bonet explored Willingness to Pay (WTP) for health insurance among individuals working in the informal sector. This includes people who work in areas such as cattle rearing, fishing, mining and quarrying.

A pivotal part of her research was a large, purpose-designed survey. She looked at different subgroups in the population and examined different socio-economic factors. The study involved 10,000 people and was translated into different dialects and then transcribed.

I hope to do a follow up in the future and see how it’s helping and whether it will work in other countries. I’m very grateful to have had the chance to do this research as it has had an impact on the lives of so many.

– Professor Jofre-Bonet

Benefits and influence of this research

From the survey results, Professor Jofre-Bonet calculated the amount people would pay and how often. Her analysis showed that a premium could be set at around 20,000 SLL (3.54 USD) per month. A single premium set too high would jeopardise certain groups taking part in the scheme.

89% people said they’d pay for health insurance to avoid expensive pay-as-you-go healthcare

The findings were key for the Sierra Leone government. Professor Jofre-Bonet presented her report to the Minister of Labour and Social Security and his team, development partners (World Health Organization and World Bank), the private sector and other government representatives.

She also held private talks about the implications of her research and the feasibility of the health insurance scheme with:

The Minister of Labour and Social Security
The Director General of the National Social Security and Insurance Trust
The Minister of Health and Sanitation
A representative of the World Health Organisation
An Overseas Development Institute fellow

The research helped the government make an informed decision to go ahead with the health insurance scheme. People working in the informal sector were paying large amounts for their healthcare. Now they have access to an insurance scheme for primary care.

Not only did this research make a difference to lives in Sierra Leone, the survey challenged pre-conceptions on feasible premium fees for healthcare coverage.