Universal health coverage and national health insurance reform: Evaluating the impact on reproductive and maternal health services in Zambia

Low-income countries continue to develop ways to achieve universal health coverage (UHC).

UHC is defined as a situation where all people have access to the health services they need, when and where they need them, without financial hardship .

In order to reduce the risk for people suffering financial hardship as a result of ill health, health financing systems need to fulfill the two functions of pre-payment and pooling of funds.

Zambia has recently launched a national health insurance scheme (NHIS) to enhance service provision and reduce catastrophic health payments.

The inconclusive evidence of impact of social health insurance reforms as a means to improve financial protection, improving access to health care and increase health care utilization, in particular for the poor, illustrates the need to carefully evaluate large scale insurance reforms to ensure that desired effects are reached.The aim of this research project is to evaluate the impact of the NHIS and the process of implementation.

The project will adopt a quasi-experimental research design and use a nationally representative household survey to evaluate the impact of the reform initiative on financial protection for reproductive and maternal health (RMH) service users and on the equitable utilization of RMH care.

A process evaluation of implementing the NHIS will contribute to an understanding of the levels of enrollment, service utilization and financial protection.