**Author details**

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

some countries in SSA [35] .A comparative study of five African countries (Ghana, Tanzania, Kenya, Rwanda and Ethiopia) sought to help fill this gap by looking at how a national health system insurance schemes can cover the poor or not, as the case may be. Selected countries had were national insurance schemes with the intent of providing health insurance for all their inhabitants. Ghana, Kenya and Tanzania had similar health insurance programmes [36–40]. Ghana's National Health Insurance Scheme (NHIS), covers every citizen by law. Tanzania and Kenya had separate insurance schemes for the public and private sectors. Rwanda and Ethiopia operated a Community-Based Health Insurance (CBHI), but Rwanda's CBHI was the only one with wide coverage of the poor. Hence, setting down insurance policies or programmes does not guarantee reaching the poor. Many have questioned whether African countries have been too eager to adopt Western-style policies that are not necessarily appropriate to their context-specific fiscal laws. The selected countries are characterized by large informal sectors, making it difficult for the rolling out of health insurance scheme models that depend on this group. After almost 12 years of introducing national health insurance in Ghana, less than 40% of the population were covered by the health system insurance scheme. In spite of provisions made to cover the poor, health system insurance programmes have faced challenges in enrolling this group. Defining who the poor are is a task that policymakers have grappled with. Many terms have been used to identify the poor—ultrapoor, very poor, indigent and vulnerable. Coining these terms and explaining what they mean and who qualifies to be categorized as such has become not only burdensome but

The way forward to establishing a sustainable cost-effective and context specific health system insurance scheme in SSA should take into consideration the following. Firstly, the fact that the educational and socioeconomic status of a family play key roles in the decision of whether to enroll in health insurance should take into consideration that community-based health insurance provides some financial protection by reducing out-of-pocket spending [42]. Secondly, data analysis from micro-level household indicates that community financing improves access by rural and private sector workers to needed heath care and provides them with some financial protection against the cost of illness. Thirdly, analysis from macro-level cross-country gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and

In view of the vicious circle of poverty, lifestyle and cardiovascular disease in Africa, we propose some solutions to break this cycle. Women of childbearing age need to be well nourished, empowered and educated. They are "the most proximal levers" on which we can act to ensure optimal foetal and infant nutrition to break the vicious circle of poverty; malnutrition, underdevelopment and non-communicable disease. Obstacles hampering primary and secondary prevention of CVDs in SSA such as insufficient health care systems and infrastructure, scarcity of cardiologists, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems in most African countries need to be urgently addressed by the various governments and ministries of health of

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costly—and political [41].

responsiveness indicators [43].

different African countries.

**7. Conclusion**

Franck Ngowa Nzali<sup>1</sup> , Mazou Ngou Temgoua<sup>1</sup> , Joel Noutakdie Tochie2,3\* and Simeon Pierre Choukem3,4

1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

2 Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

3 Health and Human Development (2HD) Research Network, Douala, Cameroon

4 Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon

\*Address all correspondence to: joeltochie@gmail.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
