Reforms for financial protection schemes towards universal health coverage, Senegal

Abstract

Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country.

An assessment of the core capacities of the Senegalese health system to deliver Universal Health Coverage

“…In practice, four regimes coexist – compulsory health insurance, medical assistance, community-based health insurance (CBHI) and commercial health insurance (see below) – but they are managed by various organisations without effective coordination to date. Yet, the CMU policy is constantly evolving so as to respond to the emerging challenges, especially to better integrate the various schemes (e.g., transfer of medical assistance schemes to State-subsidised CBHI affiliation) [ 16 ].…”

“…Each municipality has at least one mutual health insurance company, and each department has a union of mutual health insurance companies. By the end of 2016, no less than 676 mutual health insurance companies were in place throughout the country [ 16 ]. In addition, supplementary health insurance schemes have been created by civil servants to enable them to benefit from guarantees broader than those provided by the budget allocation scheme [ 2 ].…”

“…As mentioned above, efforts are being made to better integrate the various schemes, especially the CBHIs [ 16 ].…”

The emergence of the national medical assistance scheme for the poorest in Mali

“…In fact, this region of Africa, including Mali, has seen a very large number of experiments concerning user fees for healthcare within a context of decentralisation (Ridde, 2015), but very few regarding healthcare access for the poorest. It was only in 2019 that Senegal organised a pilot project in one district for the integration of its free healthcare policies within its national health insurance system (Daff et al, 2019). Conversely, when the situation in South-East Asia is examined, it is clear how many of these pilot projects have been instrumental in the emergence of social protection policies in favour of the most deprived (Asante et al, 2019).…”

The emergence of the national medical assistance scheme for the poorest in Mali

“…In fact, this region of Africa, including Mali, has seen a very large number of experiments concerning user fees for healthcare within a context of decentralisation [29], but very few regarding healthcare access for the poorest. It was only in 2019 that Senegal organised a pilot project in one district for the integration of its free healthcare policies within its national health insurance system [53]. Conversely, when the situation in South-East Asia is examined, it is clear how many of these pilot projects have been instrumental in the emergence of social protection policies in favour of the most deprived [54].…”