From Aid to Impact: The Cost-Effectiveness of Global Health Aid in Sub-Saharan Africa and the Evolving Role of Microinsurance.

Background

Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested.

Objectives

The study aims to evaluate the cost-effectiveness of DAH in Sub-Saharan Africa from 1995 to 2018, as well as to explore differences in efficiency across diseases and country contexts.

Methods

Data were drawn from the Institute for Health Metrics and Evaluation and applied Generalized Cost-Effectiveness Analysis in conjunction with the Gross Domestic Product-based thresholds. Averted Disability-Adjusted Life Years were analyzed across countries and diseases, and countries were categorized by the Human Development Index (HDI) level to assess differential DAH performance.

Results

DAH cost-effectiveness showed similar patterns across HDI groups, with roughly equal proportions of cost-effective and dominated outcomes in both low- and middle-HDI countries. Thirteen countries were identified as very cost-effective, nine as cost-effective, and two as non-cost-effective. Twenty-one countries were dominated, reflecting persistent inefficiencies in aid impact that transcends the various levels of development.

Conclusions

Tailoring DAH allocation to specific disease burdens and development levels enhances its impact. The study underscores the need for targeted investment and a strategic shift toward integrated health system strengthening. Additionally, microinsurance is highlighted as a key mechanism for improving healthcare access and financial protection in low-income settings.