Universal Health Coverage, Health Insurance, and Breast Cancer Screening in North Africa: A Scoping Review

Introduction: Breast cancer (BC) is the most common malignancy among women in North Africa, yet screening uptake remains limited due to socio-cultural, financial, and systemic barriers. Universal Health Coverage (UHC) and health insurance reforms across Algeria, Egypt, Libya, Morocco, Sudan, and Tunisia offer opportunities to strengthen preventive services, but evidence on their impact is fragmented. Methods: A scoping review was conducted following PRISMA SCR guidelines. Peer-reviewed articles, policy reports, and grey literature published between 2015 and 2026 were systematically searched and screened for relevance to breast cancer screening (BCS), UHC, and health insurance reforms. Data were charted to identify barriers, reform strategies, and comparative trends. Results: Integration of BCS into UHC frameworks remains uneven. Tunisia and Algeria show stronger institutional commitments, though rural-urban disparities persist. Morocco's RAMED and CNSS schemes expanded financial protection, but screening uptake is limited by knowledge gaps and infrastructural inequities. Egypt's reforms provide a platform for embedding screening benefits, yet fragmented schemes constrain impact. Libya and Sudan face the greatest challenges, as conflict and instability undermine insurance systems and preventive services. Common barriers include high out-of-pocket costs, weak referral systems, and limited registries. Conclusion: Policies have raised awareness and expanded coverage, but have not consistently translated into equitable screening uptake. Strengthening UHC reforms to prioritise preventive services, expand insurance benefits, and address socio-cultural barriers is essential to improve early detection and survival outcomes for women in North Africa.