Community based health Insurance (CBHI) members of the Ndiagne commune, Louga region, Senegal, show their member cards. An Abt Associates-led project has been helping Senegal develop a strategic plan toward universal health care, including CBHI schemes. Community-based health insurance (CBHI) schemes in Senegal have received very limited government support in the past, but that is changing. CBHI is an alternative financing mechanism through which members pool premium payments into a collective fund, which is managed by the members, and covers basic health care costs at local health centers. These schemes are referred to as mutuelles in French. CBHI emerged during the 1980s, building on community initiatives and support from external partners and non-government organizations. While their potential to contribute to the extension of health insurance in the informal and rural sectors has been recognized, until recently Senegal didn’t have a policy framework that could leverage the social potential of CBHI programs in the country. However, a new government that took power in 2012 has made universal health coverage one of its most important health sector priorities.
Abt Associates, through its USAID-funded Health System Strengthening project (HSS), has been providing technical assistance to Senegal’s Ministry of Health (MOH) for the development of a strategic plan towards universal health care. The plan is a partnership between the state, local government, and CBHI schemes to extend health insurance in the informal and rural sectors. The project also has helped the MOH demonstrate how this partnership could be expanded and has helped develop technical tools and systems to strengthen CBHI programs’ management capabilities.
Mme. Dieng, Chief Nurse of the health post in Bagadadji, Senegal, discusses the improvements seen in her health center since the implementation of a community-based health insurance (CBHI) scheme in the surrounding rural community. “Accessing health care is about more than staying healthy – it’s about keeping students in school and adults in the workforce. It is about security,” said Francois Diop, HSS chief of party. In February 2014 five regional CHBI schemes received their first state support – approximately $350,000 USD in all. The funding represents a 50 percent match of household contributions to CHBI programs for fiscal 2013. The payments were instituted to support the extension of CBHI benefit packages while maintaining contributions at levels which are affordable for households in informal and rural sectors. Sixty-three CBHI programs are benefiting from this subsidy. Other regional unions expect to receive their first transfers the following weeks.