Building strong and effective institutions to achieve UHC in Western Africa

Building strong health systems and progressing towards universal health coverage (UHC) have been shown to be more urgent than ever in the Covid-19 pandemic era. This session intends to discuss various aspects of institutional strengthening that need to be considered by public authorities when pursuing the objective of UHC. This is based on case studies from three Western African countries: Benin, Nigeria and Senegal. Various perspectives are approached, relying on different disciplines. The introduction embraces the perspective of health policies and systems and discusses the challenges of ensuring policy coherence and building strong and effective institutions to achieve UHC. The next three sessions approach a specific issue per case country. First, a research on the performance of hospitals in Senegal, developed using the DELPHI-AHP approach, is presented. A multidimensional performance steering tool was developed, which is more in line with the introduction of results-based management. Second, the question of whether UHC policies are sufficient to eliminate barriers to maternal health service utilisation in Nigeria is explored. The results show that locus of control and behavioural traits are significantly associated with skilled delivery care utilisation – so that achieving UHC in a developing country like Nigeria also requires interventions targeted at eliminating inherent psychological and behavioural traits beyond financial barriers to utilisation of health care services. Third, the question of whether the UHC policy has been designed in a way that meets stakeholders’ expectations in Benin is discussed. Results show that the formulation of the UHC scheme did not undergo a broad phase of social consultation to collect the aspirations of the different stakeholders. It drew on the technical and political experiences of public officials, and it has not been widely communicated to beneficiary populations and local mutual health organisations. The health workers in charge of their application are neither sufficiently informed nor sufficiently motivated to implement it. Finally, two lawyers present the challenges associated with translating UHC objectives into the legal framework in Senegal and Benin. Altogether, these pieces of research highlight a number of key challenges that need to be addressed to build strong and appropriate institutions to support UHC, which are quite similar among Western African countries.