Reforms for financial protection schemes towards universal health coverage, Senegal

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

Assessment of the iron-folic acid supplement (IFAS) supply chain to improve distribution at community level in Dakar and Fatick regions, Senegal.

Objectives: Ensuring adequate and timely availability of iron folic acid supplements at delivery points is a challenge for success of IFAS interventions. In Dakar and Fatick regions, the supply chain of IFAS was assessed to identify constraints and bottlenecks and to recommend solutions. Methods: Structured interviews with 84 health workers from 36 health facilities were carried out to determine the supply chain constraints in Dakar and Fatick regions. Transcriptions were analyzed using content analysis. Results: Health workers reported IFA stock-outs in 50% of included health districts. Although the needed quantities were reportedly available at regional drugs stores, the limited frequency of overall health commodity orders, applied by health districts to reduce costs, resulted in delayed IFA procurement when stocks were low. These delays were the primary cause of stock-outs reported by health workers. Conclusions: Adequate and consistent supply of IFA supplements could be ensured through allowing larger orders of IFA during regular commodity orders, reducing or subsidizing the cost of IFAS or shipment costs.

Prevalence of Anemia and Its Risk Factors among Pregnant Women in Dakar and Fatick Regions, Senegal.

Objectives: Iron Folic acid supplementation (IFAS) during pregnancy has been implemented in Senegal for many years. However, prevalence of anemia is still high among pregnant women. To provide data for program improvement, we conducted a study to assess the prevalence of anemia and associated risk factors in Dakar and Fatick regions. Methods: The study was a cross-sectional, descriptive survey of 483 randomly selected pregnant women in Dakar and Fatick regions. Hemoglobin level was determined by HemoCue photometer, and questionnaires were used to collect data on socio-economic characteristics, knowledge, attitudes, and practices. Data were cleaned, coded and analyzed with Epi Info. Financial barriers were defined as: family decision makers who restrict expenditures, limited financial resources. Results: Results showed that the prevalence of anemia (Hb <11g/dL) among pregnant women was 66.4% and 71.4% in Dakar and Fatick regions, respectively. Pregnant women had lower risks of being anemic when they had an income-generating activity (OR=1.63, CI (1.1 - 2.5)), had been supplemented for at least 90 days (OR=2.26, CI (1.2 - 4.3)), and had no financial barrier to access IFAS (OR=0.40, CI (0.1 - 0.9]. 50% of the pregnant women wrongly associated side effects to IFA consumption and consequently initiated IFAS after the 2nd trimester. Conclusions: Anemia is a severe public health problem among pregnant women in these two regions. Interventions designed to address anemia should improve accessibility to IFAS through promotion of early initiation of IFAS during pregnancy and distribution of free IFAS.