Divergent Trajectories of Universal Health Coverage in Ghana, Kenya, Nigeria, and Tanzania: A Policy Appraisal (2022-2024)

This study evaluates the progress toward Universal Health Coverage (UHC) in Ghana, Kenya, Nigeria, and Tanzania using Demographic and Health Survey (DHS) data from 2022-2024.While the global goal is to achieve UHC by 2030, sub-Saharan Africa faces significant structural barriers, including vast informal economies and chronic underfunding of public health infrastructure.Results reveal a concerning divergence in national trajectories: Ghana experienced a significant decline in functional coverage from 62.4% to 5.7% due to the structural failure of its voluntary enrollment model, delayed provider reimbursements, and a subsequent deterioration of public trust.Conversely, Kenya's shift toward mandatory enrollment for the formal sector increased overall population coverage to 34%, although a persistent pro-rich bias remains evident.Meanwhile, Nigeria and Tanzania continue to register low, single-digit functional coverage despite recent ambitious legislative reforms, heavily hindered by extreme poverty and system fragmentation.Multivariate logistic regression confirms that educational attainment and household wealth remain the primary, universal determinants of health insurance status across all four nations.The study concludes that sustainable UHC requires an immediate shift from voluntary, fragmented schemes to unified mandatory systems, supported by robust, automated poverty subsidies and synchronized investments in supply-side health infrastructure.