Senegal: How Did the HSS Project Help Expand Access to Health Services?
For more than 25 years, Abt Associates has been a global thought leader and implementer of health system strengthening programs. In Senegal, Abt has led health system strengthening programs for more than 20 years. These programs have supported Senegal’s goals of universal health coverage and have contributed to great strides in better serving the Senegalese people.
Recently, another chapter in Abt’s work in Senegal closed with the end of the Senegal Health Systems Strengthening (HSS) Project, which ran from 2011-2016. However, a new chapter begins as Abt builds on its accomplishments and begins leadership of two new programs: the USAID-funded Senegal Health Systems Strengthening Plus (HSS+) project and the Government Technical Assistance Project (GoTAP).
“Under Senegal HSS, Abt helped local officials expand community health insurance coverage to many more people, helped improve financial management of health care, and helped design and implement incentives to provide the best quality care possible,” said Lisa Nichols, a principal associate for International Health at Abt. “The next big goal is to assist the government of Senegal implement their ‘Plan Emergent’ which commits to providing universal health coverage to 75 percent of the population by 2017.”
Expanding Community-Based Health Insurance
Senegal has greatly increased its health spending in the last decade, from 90 billion CFA francs in 2008 to 136 billion CFA in 2015. The health budget had been 36 billion CFA in 1998. Along the same time, the Infant mortality rate declined by 61 percent between 1997 and 2014, lowering mortality to 54 deaths per 1,000 live births, one of the lowest rates in West Africa.
But maternal mortality remains high, as does child mortality in the periphery of Senegal. Over 80 percent of Senegalese people working in the informal sectors – such as farmers, poor and vulnerable groups – lacked access to health coverage at the beginning of Senegal HSS in 2011.
The government of Senegal recognized the need to decentralize control over and increase access to health care services. Senegal HSS helped the government develop the 2013-17 Universal Health Coverage Strategic Development Plan, a key tenet of which is regionalizing health care financing and extending health coverage in the informal sector through mutual health organizations, or mutuelles.
Mutuelles are voluntary organizations that provide health insurance services to their members. Often they are owned, designed, and managed by the communities they serve. They offer member households access a package of services for an enrollment fee, regular premiums, and co-pays, while contracting with health care providers for the services they provide. The government of Senegal subsidizes these arrangements.
More Senegalese Access Health Coverage
Since the decentralization effort began, 106 new mutuelles have been established and 69 existing ones have been restructured in 14 demonstration departments. Coverage of people employed in the informal and rural sectors increased from 6.6 percent in 2013 to 12.4 percent in 2014, according to estimates of Senegal’s Universal Health Coverage Agency.
“We spread the word about the benefits of mutuelles whenever there is a group assembled. We go door-to-door, to the mosques, the markets, the sports events,” said Aminata Diop, deputy president, Mutuelle of Popenguine. “Once new members realize the benefits, they tell their friends.”
Incentives and Training Drive Improved Health Provider Performance
Results-based financing (RBF) of health services is another key initiative assisted by Senegal HSS. Under RBF, health officials in six pilot regions in eastern Senegal have been given more control over the types of health services offered plus planning and budgeting for these services. (Senegal has 14 regions.)
In exchange, health providers and health facilities are paid based on achieving milestones, such as the percentage of children who are fully immunized. The number of such children increased from 60 percent in 2012 to more than 90 percent in 2014 in the first three pilot regions.
Senegal HSS in 2014 also supported the extensive training of health staff and community health workers in the six regions in priority health services, including: maternal and child health, family planning, nutrition, malaria, and HIV and AIDS. In addition, additional funding under RBF helped health workers to conduct more than 3,700 outreach activities in the six regions, with a focus on these priority services.
“The number of patients has increased because – with the benefits of direct financing – staff are well-trained and provide better quality of care,” said Fatma Sarr, District Medical Officer for the Mbour District in eastern Senegal.
Read more about Abt’s work in Senegal:
Senegal HSS: Implementing Universal Health Coverage
Abt Associates Supports Countries Working to Achieve Universal Health Coverage
Abt Assists Senegal in Expansion of Community-Based Health Insurance
Read more about Abt's work in health systems strengthening.