Background:
To facilitate the drive towards Universal Health Coverage (UHC) several countries in West Africa have over the years adopted the National Health Insurance (NHI) to finance their health services. However, most of these countries continue to face challenges safeguarding insured populations against catastrophic health expenditure (CHE) and impoverishment due to health spending. The aim of this review is to describe the extent of financial risk protection among NHI enrolled households in West Africa from published literature.

Methods:
A systematic review of articles published in English between 2005 and 2022 was conducted. Articles were searched using keywords related to NHI and financial risk protection in all West African countries on PubMed/Medline, Web of Science and CINAHL, Embase and Google Scholar. Two independent reviewers assessed the articles for inclusion, extracted data and conducted quality assessment. A narrative synthesis consisting of thematic synthesis for qualitative data and Synthesis Without Meta-analysis (SWiM) for quantitative data was done.

Results:
Of the 1,279 articles initially identified, nine were eligible for inclusion. These were cross-sectional studies (n=8) and retrospective cohort study (n=1) published between 2011 and 2021 in Ghana (n=8) and Nigeria (n=1). Two-thirds of the included studies reported enrollment into the NHI had a protective effect on CHE at different thresholds whereas one study reported a protective effect of NHI on impoverishment due to health spending. However, almost all of the included articles (n=8) reported that a proportion of insured households encountered CHE with one-third of included articles reporting more than 50% of insured households incurring CHE.

Conclusion:
To protect insured households from the financial burden due to health spending in West Africa, governments should consider investing more in NHI research, implementing nationwide compulsory NHI programmes and establishing a multinational West African collaboration to design a sustainable context-specific NHI system based on solidarity and equity.