Willingness to Pay for Health Insurance in Sub-Saharan Africa: A Systematic Review Protocol

IntroductionIn sub-Saharan Africa, most people pay for healthcare directly out-of-pocket (OOP). This makes it harder for countries in the region to achieve Universal Health Coverage (UHC), as many people cant afford care, resulting in poor health, and some people being pushed deeper into poverty due to the high cost of care. To reduce this burden and move closer to UHC, many African countries have introduced health insurance to raise funds for healthcare and reduce direct OOP spending. To make the health insurance more effective, its important to understand how willing people are to pay for health insurance, how much can be raised relative to GDP, and what factors influence their willingness to pay (WTP). This information can help shape health financing policies in the region. Methods and AnalysisA systematic search will be conducted using PubMed, Google Scholar, Science Direct, relevant references from selected studies and grey literature that would be identified from the databases searched. The search will cover all available studies that focus on WTP for health insurance in sub-Saharan Africa from inception to 31st May 2025. Key outcomes will include the percentage of people willing to pay, amount to be raised relative to GDP per capita, and the factors that frequently influence WTP. Each study will be carefully reviewed using the STROBE (strengthening the reporting of observational studies in Epidemiology) tool for quality, and the results will be combined and analysed using quantitative methods. Ethics and DisseminationSince this is a systematic review that does not involve recruiting or studying people directly, ethics approval is not required. The findings will be disseminated through conferences, symposia, and published in a peer-reviewed journal. They will also be shared with policymakers and the general public interested in health financing. PROSPERO registration numberCRD420251027763 STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIFollows a structured and transparent systematic review methodology. C_LIO_LIUses STROBE tool for critical appraisal of included studies. C_LIO_LIIncludes standardization of amounts to be raised across countries using GDP per capita. C_LIO_LIEmploys vote-counting to identify influencing factors. C_LIO_LILimited to studies conducted in Sub-Saharan African countries published in English C_LI