Health insurance across 54 African countries: where is it mandatory?
Employee health insurance rules vary widely across Africa.
Some countries, like Nigeria, Rwanda, and Kenya, make it mandatory. They offer clear rules on how employers and employees share the cost.
Others, such as South Africa and Angola, leave it optional, relying instead on public healthcare or general social security contributions.
Many fall somewhere in between, requiring contributions to national schemes that cover some sickness or medical benefits…without mandating full private health insurance.
For employers operating across the continent, knowing which rules apply where is key to staying compliant and setting the right expectations for staff benefits.
In this article, our experts share a country-by-country breakdown.
| Country | |
| Algeria | Employee health insurance in Algeria is mandatory through the national social security system (CNAS), funded by statutory contributions from both employers and employees.
Employers pay a mandatory health and long-term care contribution of 11.5%, while employees contribute 1.5% of their salary. |
| Angola | Private employee health insurance is not mandatory under Angolan labour law. |
| Benin | Employee health insurance is mandatory in Benin for both public and private sector workers.
Public or private insurers cover at least 80% of the insurance premium for the basic healthcare package.
The remaining amount, which is payable by employees, is deducted at source by the insurer responsible for paying the total premium. |
| Botswana | Employee health insurance is not mandatory for private employers in Botswana. |
| Burkina Faso | Private employer-sponsored health insurance is not a mandatory benefit under standard labour codes in Burkina Faso, though a national universal health scheme is currently being rolled out in stages. |
| Burundi | Employee health coverage is mandatory in Burundi through statutory social security and medical contributions. For instance, employers contribute 3% of monthly covered payroll as social insurance. |
| Cabo Verde | Employee health insurance and social security coverage are mandatory in Cabo Verde. Both employers and employees contribute to the social security fund with regards to sickness and maternity, for a total of 8% of the total salary, split equally at 4% for both parties. |
| Cameroon | Employee health insurance is not fully mandatory as a standalone private benefit for all employers in Cameroon, though formal sector employers must contribute to the state social security system.For Old-age, Disability and Survivors’ Pensions, the total contribution is 8.4%, split equally into 4.2% between the employer and employee. It is applicable for employees in the formal sector. |
| Central African Republic | Private supplementary employee health insurance is not strictly mandated by law as a standalone employer-provided benefit in the Central African Republic.
Coverage under social insurance extends to: · Private-sector employees · Certain public-sector employees (including those working for the national public service and local authorities) · Students in professional schools Employer liability coverage applies to employed persons, including certain public-sector employees, but excludes self-employed persons, magistrates and civil servants, and military and security forces personnel.
In terms of funding, insured persons make no contributions under either scheme, and self-employed persons are not applicable to either. Employers fund social insurance in the same way as under family allowances, while under employer liability, they bear the total cost. |
| Chad | Private employers in Chad are not traditionally mandated to provide standalone private medical insurance, but they must register employees with the national social security system. |
| Comoros | Employers are required to provide basic health care to employees, and employees may be entitled to social security benefits for work-related illnesses or injuries. |
| Democratic Republic of the Congo | Providing medical coverage or healthcare support for employees in the formal sector is mandatory under the labour laws of the Democratic Republic of the Congo (DRC).
Employees in the formal sector are enrolled according to the DRC labour law (Loi organique No 17/002) which states that, an employee and his/her family members are entitled to be supported for healthcare by his/her employers. |
| Republic of the Congo | In the Republic of the Congo (Congo-Brazzaville), standalone private medical health insurance is not strictly mandatory for employers to provide by direct labour law. However, employers must contribute to public social security and a national solidarity tax for universal coverage. |
| Côte d'Ivoire | Employee health insurance is mandatory in Ivory Coast (Côte d'Ivoire) under the country's Universal Health Coverage scheme (known as CMU or Couverture Maladie Universelle). |
| Djibouti | Employee health insurance is mandatory in Djibouti under the country's social security and universal health insurance laws.
Djibouti provides sickness and medical coverage through a mix of systems: · A universal scheme covering all residents · Social insurance covering salaried workers, household and manual workers, dockworkers, the self-employed, students, and low-income pensioners · Employer liability covering employed persons (excluding the self-employed), with the government funding a separate social assistance scheme for needy residents.
Insured employees contribute 2% and self-employed persons 7% of covered earnings towards social insurance medical benefits, employers add 5% of payroll.
Employers alone bear the full cost of employer liability sickness benefits, while the government funds the universal and social assistance schemes outright. |
| Egypt | Under the Universal Health Insurance Law in Egypt, everyone covered must pay contributions based on set brackets, regardless of whether they're also covered by other social insurance laws.
For their part, employers pay a monthly contribution of 4% of each employee's insured salary. |
| Equatorial Guinea | Equatorial Guinea is mandatory through the national social security system, but private health coverage is largely optional. |
| Eritrea | Employee health insurance is generally not a universal mandatory statutory requirement for all private employers in Eritrea, though basic work-related accident coverage or specific public contributions may apply. |
| Eswatini | Private employee health insurance is not mandatory by law in Eswatini.
However, sickness and maternity benefits are governed by an employer-liability system dating from a 1980 labour law, providing cash sickness and maternity benefits only.
Coverage extends to employed persons, with the self-employed excluded.
Employers bear the total cost, while insured persons and the government contribute nothing.
To qualify for the cash sickness benefit, a worker must have at least 3 months of continuous employment with the same employer and must provide a medical certificate. |
| Ethiopia | Mandatory public health insurance is rolling out for formal sector workers, while private employer-provided health insurance remains optional.
The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. |
| Gabon | Employee health insurance is mandatory in Gabon.
The National Health Insurance Fund (CNAMGS) is the main provider of health insurance in Gabon, offering coverage to both public and private sector employees, as well as their dependents. |
| Gambia | Employee health insurance is mandatory in The Gambia under the National Health Insurance Act, 2021. |
| Ghana | Employers in Ghana are not legally required to provide private health insurance for their workers, though participation in the public national system is tied to mandatory payroll deductions. |
| Guinea | Employee health insurance is mandatory in Guinea through the national social security framework managed by the Caisse Nationale de Sécurité Sociale (CNSS). |
| Guinea-Bissau | Standalone private employee health insurance is not mandatory by law in Guinea-Bissau.
However, sickness benefits in Guinea-Bissau do fall under a social insurance system.
Coverage extends to private-sector employees. There is no minimum qualifying period for either the cash sickness benefit or medical benefits, though a medical certificate is required, and the sickness benefit pays 100% of the insured's earnings for up to 960 days. |
| Kenya | Employee health insurance is mandatory in Kenya.Employers and employees must contribute to the statutory national health scheme. The older National Hospital Insurance Fund (NHIF) was replaced by the Social Health Authority (SHA), which manages the Social Health Insurance Fund (SHIF). |
| Lesotho | Employee health insurance is generally not legally mandatory as a standalone private benefit that employers must purchase for workers in Lesotho, but employers are required to provide statutory protections like paid sick leave and workers' compensation for workplace injuries. |
| Liberia | Private employers in Liberia are not currently mandated by law to provide general health insurance for local employees, but a compulsory national scheme is moving through the legislative process. |
| Libya | Private standalone employee health insurance is generally not universally mandated for private-sector employers in Libya, but employers must contribute to the national Social Security Fund which covers basic statutory benefits like sickness, accident, and work-related medical leave. |
| Madagascar | Employee health insurance and basic medical contributions are mandatory in Madagascar. Employees in Madagascar are entitled to health insurance through social security benefits delivered by the National Social Security Fund (CNaPS). Both employers and employees contribute to this system.
However, the scope of coverage can vary depending on the individual's employment and the employer's contributions. |
| Malawi | Employee health insurance is not mandatory for employers in Malawi. Instead of health insurance, employers must contribute to the statutory National Pension Scheme (NPS), where employers pay at least 10% and employees contribute a minimum of 5% of pensionable earnings. |
| Mali | Employee health insurance is mandatory in Mali for formal sector workers through the national compulsory scheme known as AMO (Assurance Maladie Obligatoire). |
| Mauritania | Employee health insurance is mandatory in Mauritania only through statutory contributions to the National Health Insurance Fund, known as CNAM (Caisse Nationale d'Assurance Maladie).
Employers and permanent employees must make regular payments to fund this healthcare coverage:
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| Mauritius | Employee health insurance is not mandatory by law in Mauritius, as the country provides a free public healthcare system for citizens and residents. |
| Morocco | Employee health insurance is mandatory in Morocco through the Assurance Maladie Obligatoire (AMO). It is the compulsory basic medical coverage required by law for all formal sector workers.
Private sector employees are registered through the National Social Security Fund (CNSS) by their employers.
Mandatory contributions are split between the employer and employee. Employees contribute a set percentage (around 2.26%) of their gross salary, while employers contribute as part of broader social security levies. |
| Mozambique | Private employee health insurance is not legally mandatory for employers in Mozambique.
Employers must contribute 4% of an employee's monthly earnings to the mandatory national social security system managed by the National Institute of Social Security (INSS), while employees contribute 3%. This covers general social insurance benefits like pensions and basic sickness support rather than private medical care.
Though private health insurance is not required by law, many companies still offer it as an extra perk to cover private medical care. |
| Namibia | Employee health insurance is not mandatory for private-sector employers in Namibia. However, employers do contribute to healthcare financing through corporate health insurance schemes, ensuring that employees receive adequate medical coverage. |
| Niger | Employers are not required by law to provide private group medical or health insurance plans in Niger. However, some offer it as a competitive perk.
It is also worth noting that in 2021, the Nigerien government announced a plan known as the national strategy for universal health coverage for 2021-2030.
They plan to establish a contributory mandatory health insurance scheme for public and private employees, retirees, and self-employed individuals. |
| Nigeria | Employee health insurance is mandatory in Nigeria for employers with 5 or more staff.
Under the National Health Insurance Authority (NHIA) Act of 2022, health insurance became compulsory for all employers and employees in both the public and private sectors. |
| Rwanda | Employee health insurance is mandatory in Rwanda for all residents and workers. Public and private employers must contribute to a recognised health insurance scheme for their workers and provide proof of coverage.
Medical Scheme Costs: Contributions typically total 15% of the employee's basic salary. Shared Split: The cost is split evenly, with 7.5% paid by the employer and 7.5% paid by the employee. |
| Sao Tome and Principe | Private employee health insurance is not strictly mandatory as a standalone private benefit in São Tomé and Príncipe, but employers must contribute to the national social security system which covers basic medical and sickness benefits. |
| Senegal | Employee health insurance is mandatory for formal sector and private company employees in Senegal.
Employers must enrol all permanent and salaried workers into an Institut de Prévoyance Maladie (IPM), which is a corporate or inter-company health insurance fund. |
| Seychelles | Employee health insurance is generally not legally mandatory for local citizens or domestic employees in Seychelles. |
| Sierra Leone | Employee health insurance is generally not legally mandatory as a general statutory employer obligation under Sierra Leone's core labour laws. |
| Somalia | Employee health insurance is not mandatory by law in Somalia. |
| South Africa | Employee health insurance or medical aid is not mandatory by law for employers to provide in South Africa.
Private medical insurance or medical aid is optional unless it is specifically written into an employment contract or agreed upon through a collective bargaining council agreement. But it can be offered as a competitive perk. |
| South Sudan | Employee health insurance is not universally mandatory as a standalone statutory benefit for private employers in South Sudan, though general social security and pension remittances are compulsory. |
| Sudan | Employee health insurance in Sudan is mandatory for the formal sector, requiring employers to contribute to the national system, though it remains voluntary for small companies and the informal sector. |
| Tanzania | Employee health insurance is mandatory in Tanzania under the Universal Health Insurance Act.
Employers must ensure all workers have health insurance. Employers must finance the chosen coverage costs for their workforce. |
| Togo | Employee health insurance is mandatory in Togo under the country's universal health coverage framework. |
| Tunisia | Employee health insurance is mandatory in Tunisia through the national public system managed by the CNAM (Caisse Nationale d'Assurance Maladie). |
| Uganda | Private employee health insurance is not currently mandatory for employers in Uganda. Though it may be, as plans are on the way. |
| Zambia | Employee health insurance is mandatory in Zambia under the National Health Insurance Management Authority (NHIMA) scheme. |
| Zimbabwe | Private employee health insurance is not mandatory by law for employers in Zimbabwe, though companies must provide other statutory benefits like sick leave and social security. |
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Frequently Asked Questions
Is employee health insurance mandatory everywhere in Africa?
No. Requirements differ significantly by country.
Some nations, such as Nigeria, Rwanda, Kenya, and Morocco, mandate health insurance for employees, while others, including South Africa, Angola, and Namibia, leave it optional and rely on public healthcare or general social security contributions instead.
What is the difference between mandatory health insurance and mandatory social security contributions?
Mandatory health insurance specifically requires cover for medical treatment, while social security contributions often fund a broader set of benefits, such as pensions, sickness pay, or maternity leave, which may include only limited medical support rather than comprehensive health cover.
Who usually pays for employee health insurance where it is mandatory?
In most countries with mandatory schemes, the cost is shared between employer and employee, with the employer typically covering a larger share.
In Rwanda, for example, the split is even, whereas in Djibouti and Mauritania, employers contribute a higher percentage than employees.
Do employers need to provide private health insurance even where it is not legally required?
No, but many employers choose to offer it as a competitive benefit to attract and retain staff, particularly in countries such as Mozambique, Niger, and South Africa, where it is not a statutory obligation.
How can employers keep track of these varying requirements across multiple countries?
Given how frequently regulations change and how much they vary by jurisdiction, employers expanding into multiple African markets often work with an Employer of Record or HR partner with local expertise to ensure compliance in each country.
Disclaimer: The information contained in this article is for general information purposes only. While we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability with respect to this article or the information, products, services, or related graphics contained therein for any purpose.
