For Universal Health Coverage to happen, health systems need to be strengthened: The case of Senegal

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.