A few years ago, the vast majority of people in Senegal didn’t have formal health coverage. On average, they paid more than one-third of medical expenses out of pocket. And the availability and distribution of health care services varied dramatically from district to district.
Since 2011, the Senegal Health Systems Strengthening (Senegal HSS) project, led by Abt Associates, has been changing this by helping the government of Senegal implement a universal health coverage program – one that addresses health coverage gaps, financing, and quality.
The goal: Extend basic health insurance coverage to 75 percent of the Senegalese people by 2017.
“We are providing assistance in the development and implementation of a national UHC strategic plan to reach this goal,” said Francois Diop, Senegal HSS Chief of Party for Abt Associates.
Laying the Groundwork for Better Coverage
Senegal launched its universal health coverage program on Sept. 20, 2013 in a ceremony presided over by Senegal President Macky Sall and attended by partners in the effort, including USAID. Sall pledged during his April 3, 2012 inaugural address to launch a universal health coverage program.
“This we were able to do in less than a year because we were already prepared,” Diop said. “We had been working in this area and Abt also had many experiences (in expanding health coverage) in other countries, like Rwanda and Ethiopia.”
Senegal already had some formal health coverage, but only for civil servants and employees of private enterprises and their families. Together they represent 20 percent of the population.
Senegal HSS is providing technical and policy assistance in 10 of Senegal’s 14 regions to implement several new types of coverage, including plans for workers in informal and rural sectors and retirees and the elderly. In addition, the program offers free coverage for pregnant women, newborns, and young children.
Once fully implemented, these plans are expected to reduce the financial burden of getting health services. Of all health spending in Senegal in 2008, 35 percent was paid for by patients out-of-pocket.
Incentives Help Drive Improvements
Front-line health workers are very important, Diop said. “All of the performance of the health system depends on the motivation of these health workers.”
Therefore, the program provides performance-based incentives to health facilities and front-line health workers to improve their child, maternal, and health services, and quality improvement. These Performance-based incentives:
- Measure the quality and quantity of services;
- Are used in seven target health districts;
- Pay health centers and posts for meeting each goal; and
- Include 14 goals for maternal, newborn, and child health and six for disease control.
Diop said some of the poorest regions of Senegal delivered some of the best results under performance-based incentives.