Exploration of financial risk protection and access to care are fundamental tools with which to explore health systems performance. Empirical evidence shows that there are systematic linkages between financial risk protection and utilisation, and hence, effective access to health services. The commonplace problems of shortages of funding and difficulties in the efficient allocation of funds found in Africa also cannot be overlooked. Together, these compound the difficulties in accessing care and foster inadequate financial risk protection for users. Health financing reforms not only need to address shortages and inefficiencies in funding, but also, improve utilisation and financial risk protection.

Rwanda, Uganda and Zambia have recently gone through significant health financing reforms in recent years: Rwanda has rapidly expanded insurance coverage; Uganda has tried to adjust user fees to order to optimize resource generation and access to care; and Zambia's reform has eliminated user fees and aiming to introduce social health insurance. There are many similar aspects of the reforms in the three countries, such as a desire to reduce difficulties accessing care due to high out-of-pocket payments. However, the paradigms of the reform are quite distinct, in addition to, of course, the particularities of the reforms.

In this session, we will highlight the reforms in the three countries and analyze the wider implications for health systems. We will then compare the reforms' effects on financial risk protection and access to care as a measure of their success.