Senegal is firmly committed to the objective of universal health coverage (UHC). Various initiatives have been launched over the past decade to protect the Senegalese population against health hazards, but these initiatives are so far fragmented. UHC cannot be achieved without health system strengthening (HSS). Here we assess the core capacities of the Senegalese health systems to deliver UHC, and identify requirements for HSS in order to implement and facilitate progress towards UHC. Based on a critical review of existing data and documents, complemented by the authors' experience in supporting UHC policy making and implementation, we evaluate the main foundational and institutional bottlenecks relative to the six health system building blocks, together with an analysis of the demand-side of the health system, which facilitate or hamper progress towards UHC. Despite the fact that many institutions are now in place to deliver UHC, important weaknesses limit progress along the two dimensions of UHC. Substantial disparities characterize resource allocation in the health sector, and health risk protection schemes are highly fragmented. This spreads down to the rest of the health system including service delivery and consequently, impacts on health outcomes. These constraints are acknowledged by the authorities, solutions have been proposed, but these necessitate strong political will. Moreover, progress towards UHC is constrained by the difficulty to act on social determinants of health and a lack of fiscal space. ; info:eu-repo/semantics/published
Senegal is firmly committed to the objective of universal health coverage (UHC). Various initiatives have been launched over the past decade to protect the Senegalese population against health hazards, but these initiatives are so far fragmented. UHC cannot be achieved without health system strengthening (HSS). Here we assess the core capacities of the Senegalese health systems to deliver UHC, and identify requirements for HSS in order to implement and facilitate progress towards UHC. Based on a critical review of existing data and documents, complemented by the authors' experience in supporting UHC policy making and implementation, we evaluate the main foundational and institutional bottlenecks relative to the six health system building blocks, together with an analysis of the demand-side of the health system, which facilitate or hamper progress towards UHC. Despite the fact that many institutions are now in place to deliver UHC, important weaknesses limit progress along the two dimensions of UHC. Substantial disparities characterize resource allocation in the health sector, and health risk protection schemes are highly fragmented. This spreads down to the rest of the health system including service delivery and consequently, impacts on health outcomes. These constraints are acknowledged by the authorities, solutions have been proposed, but these necessitate strong political will. Moreover, progress towards UHC is constrained by the difficulty to act on social determinants of health and a lack of fiscal space. ; Peer reviewed
Introduction: The Government of Senegal is firmly committed towards universal health coverage (UHC). Various initiatives have been launched over the last decade to extend the coverage of risk protection to the entire population. The objective of UHC is mainly pursued through (i) a desire to expand coverage in services in poor areas and (ii) improvement of financial access through the Universal Health Insurance Policy (called CMU). However, the proportion of the population actually covered is still low, and access to health services and funding of national public health priorities are limited by inadequate allocation of resources. The concept of UHC is closely linked to health system strengthening (HSS). The latter comprises the means, while UHC is a way of framing the policy objectives.1 Aim: This study aims to assess the main gaps and henceforth necessary requirements in terms of HSS so as to facilitate progress towards UHC in Senegal. Methods: Based on a critical review of existing data and documents, completed by authors' experience in supporting UHC policymaking and implementation in Senegal, we apply the World Health Organization's health system conceptual framework based on 6 building blocks, plus an analysis of populations. Results: A number of bottlenecks hampering progress towards UHC were identified in terms of leadership and governance – especially, fragmentation of insurance schemes and institutions in charge of managing CMU; financing – insufficient governmental expenditure for health, large share of out-of-pocket expenditure, inefficient and inequitable spending; inequitable allocation of health workforce; supply chain management issues with respect to equipment and medical products; low quality and timeliness of financial statements; important disparities and poor quality of health services; low consideration of the social determinants of health, including access barriers. Conclusion: Despite the fact that many institutions are now in place in Senegal to deliver UHC, challenges related to health systems need to be addressed more systematically if progress has to be made with regard to the two dimensions of UHC, namely financial protection and quality services. Reference: 1. Kutzin J., Sparkes S.P. Health systems strengthening, universal health coverage, health security and resilience. Bull World Health Organ 2016; 94(2): 2.
Introduction: The Government of Senegal is firmly committed towards universal health coverage (UHC). Various initiatives have been launched over the last decade to extend the coverage of risk protection to the entire population. The objective of UHC is mainly pursued through (i) a desire to expand coverage in services in poor areas and (ii) improvement of financial access through the Universal Health Insurance Policy (called CMU). However, the proportion of the population actually covered is still low, and access to health services and funding of national public health priorities are limited by inadequate allocation of resources. The concept of UHC is closely linked to health system strengthening (HSS). The latter comprises the means, while UHC is a way of framing the policy objectives.1Aim: This study aims to assess the main gaps and henceforth necessary requirements in terms of HSS so as to facilitate progress towards UHC in Senegal.Methods: Based on a critical review of existing data and documents, completed by authors' experience in supporting UHC policymaking and implementation in Senegal, we apply the World Health Organization's health system conceptual framework based on 6 building blocks, plus an analysis of populations.Results: A number of bottlenecks hampering progress towards UHC were identified in terms of leadership and governance – especially, fragmentation of insurance schemes and institutions in charge of managing CMU; financing – insufficient governmental expenditure for health, large share of out-of-pocket expenditure, inefficient and inequitable spending; inequitable allocation of health workforce; supply chain management issues with respect to equipment and medical products; low quality and timeliness of financial statements; important disparities and poor quality of health services; low consideration of the social determinants of health, including access barriers.Conclusion: Despite the fact that many institutions are now in place in Senegal to deliver UHC, challenges related to health ...
The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors' own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of ...
The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors' own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of transparency and accountability. Our analytical framework enables us to identify rooms for improvement with regard to country-led negotiation processes relating to UHC. ; Les nombreux acteurs impliqués dans l'élaboration des politiques de couverture santé universelle (CSU) sont susceptibles d'avoir des intérêts divergents sur les dimensions à privilégier, d'où l'importance de garantir un dialogue politique efficace et transparent. Ce papier de recherche a pour but d'examiner si les processus de dialogue politique sur la CSU fonctionnent ou non bien au Bénin et au Sénégal. Sur la base d'une revue de la littérature, nous avons identifié un certain nombre de caractéristiques garantissant la qualité des processus de dialogue politique, que nous avons intégrées dans une grille d'analyse. Les critères de qualité identifiés ont été classés selon quatre dimensions : la participation des parties prenantes, le processus de dialogue/négociation, la qualité de l'analyse de la situation et les critères de décision, et les résultats du processus de négociation. Sur la base des données recueillies par le biais d'une revue documentaire, d'entretiens, d'une enquête électronique et de l'expérience des auteurs, nous avons appliqué cette grille d'analyse aux cas du Bénin et du Sénégal. Dans ces deux pays, les processus de dialogue politique sont largement imparfaits en ce qui concerne bon nombre des critères de qualité identifiés. Les décisions ont été prises sous un leadership politique fort, assurant la coordination et l'appropriation par le gouvernement, et l'accent a été mis sur l'élargissement de la protection contre les risques financiers. Pourtant, les deux pays affichent de piètres performances dans un certain nombre de domaines, notamment en ce qui concerne les conflits d'intérêts, la transparence et la redevabilité. Aucun d'entre eux n'a réellement institutionnalisé un processus de dialogue politique en vue de la CSU, et les processus d'élaboration des politiques de CSU ont en fait contourné les mécanismes de coordination existants dans le secteur de la santé. Les deux pays obtiennent de bons résultats en ce qui concerne la qualité de l'analyse de la situation. Une petite coalition gouvernementale (dans le cas du Bénin) ou plus large (dans le cas du Sénégal) a réussi à imposer ses vues, compte tenu de la participation insuffisante des parties prenantes. Les réseaux politiques ont été particulièrement influents au Sénégal. Dans l'ensemble, il existe des lacunes importantes qui réduisent la qualité des processus de dialogue politique sur la CSU, ce qui explique les faiblesses de leurs résultats en termes de transparence et de redevabilité. Notre cadre analytique nous permet d'identifier les possibilités d'amélioration des processus de négociation menés par les pays en matière de CSU.
