The effect of community based health insurance on impoverishing health expenditure associated with non-communicable disease services in Africa: A scoping review protocol

Purpose This project aims to systematically map and synthesize existing evidence on the role of community-based health insurance (CBHI) in reducing the financial burden of non-communicable disease (NCD) services across African countries. NCDs such as hypertension, diabetes, and cervical cancers are rising rapidly in Africa, often requiring long-term and costly care. For many households, these expenses can lead to catastrophic or impoverishing health expenditures, pushing families further into poverty. Community-based health insurance schemes have been introduced in several African countries as a mechanism to improve financial protection and access to healthcare, particularly for low-income and rural populations who are often excluded from formal insurance systems. However, the extent to which CBHI mitigates impoverishing health expenditure specifically for NCD services remains unclear. This scoping review seeks to fill that gap by providing a structured overview of the available literature. Objectives 1. To identify and map existing studies that examine the relationship between CBHI and financial protection against NCD-related health expenditures in Africa. 2. To assess the evidence on whether CBHI reduces catastrophic or impoverishing health spending among households affected by NCDs. 3. To highlight gaps in the literature and propose directions for future research and policy development. 4. To provide insights that can inform policymakers, health system planners, and development partners on the potential of CBHI as a strategy for achieving universal health coverage (UHC) in Africa. Methods • Design: scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guideline, enhanced by the Joanna Briggs Institute guidelines. • Data sources: Peer-reviewed articles, reports, and grey literature will be searched across databases such as PubMed, Scopus, Web of Science, CINAHL, Embase, and regional repositories. • Eligibility criteria: studies conducted in African countries that report on CBHI and its impact on financial protection, specifically in the context of NCD services. •Data extraction and analysis: key information will be charted, including study design, country, type of CBHI scheme, NCD services covered, and outcomes related to catastrophic or impoverishing health expenditure. Results will be synthesized thematically and presented in tables and figures. Expected outcomes • A comprehensive map of the current evidence base on CBHI and NCD-related financial protection in Africa. • Identification of strengths and limitations in existing studies, including methodological gaps. • Insights into the effectiveness of CBHI in reducing impoverishing health expenditure, with implications for scaling up or redesigning such schemes. • Policy-relevant recommendations to strengthen CBHI schemes as part of broader strategies toward UHC and financial risk protection. Significance This review will contribute to the global health financing discourse by clarifying the role of CBHI in addressing the dual challenge of rising NCDs and persistent poverty in Africa. By highlighting evidence and gaps, the study will support informed decision-making for governments, donors, and civil society organizations working to improve equitable access to healthcare and reduce the economic burden of disease.