[Analysis of free health care for the elderly in the context of the "Plan Sésame" in Senegal]. / Analyse du fonctionnement du plan de prise en charge gratuite des soins chez les personnes âgées "Plan Sesame" au Senegal.

INTRODUCTION: Access to health care remains a major problem in Senegal, particularly among vulnerable groups such as the elderly. In 2006, the Senegalese government introduced a national plan for the provision of free health care known as "Plan Sésame" to improve access to care. The purpose of this study was to examine the current state of the "Plan Sésame" in national hospitals four years after its implementation (2006-2009). METHODS: A qualitative study using individual interviews was conducted between 15 March and 14 May 2010 among five target populations: hospital directors, health care providers, managers of the "Plan Sésame" in hospital admission services, management accountants, and beneficiaries. Content analysis was used. RESULTS: Between 2006 and 2008, hospital attendance rates increased every year. However, attendance rates began to decrease in 2009, except in the main hospital. The state has been left with a growing debt because of issues surrounding the reimbursement of expenses related to the "Plan Sésame'. As a result, national hospitals have been forced to restrict certain services included in the "Plan Sésame" and even to withdraw free health care for the elderly. These difficulties are likely to undermine the sustainability of the "Plan Sésame" CONCLUSION: The health authorities need to audit the "Plan Sésame:, to comply with standard procedures through regular monitoring and to redefine conditions of access.

[Geriatrics and gerontology in Senegal]. / Gériatrie et gérontologie au Sénégal.

Senegal is dealing positively with its demographic transition. On September 1st 2006, the Senegalese government introduced the "Plan Sesame", a national free health care program for elderly people aged 60 years and over. The University of Dakar academic authorities support the Sesame plan through an innovative training program in geriatrics and gerontology. Such programs aim to address the challenge of ageing in a developing country.

[Perceptions and use of Universal Health Coverage (Plan Sésame) among the elderly in Dakar (Senegal), impacts on health expenditure related to diabetes and hypertension]. / Perceptions et utilisation de la Couverture Maladie Universelle (Plan Sésame) par les personnes âgées à Dakar (Sénégal), impacts sur les dépenses de santé liées au diabète et à l'hypertension.

Introduction/rationale: In 2006, the Senegalese government set up a health coverage programme for people aged 60 and over - the Plan Sésame - to provide free medical care in all the country's public health facilities. This scheme has been integrated into the Universal Health Coverage (CMU) promoted from 2013. The objective of the study was to describe and analyse the knowledge and representations of professionals and users about health coverage and the Plan Sésame, the use of the scheme by the elderly, to evaluate the amount of medical expenses incurred during a routine medical consultation for the monitoring of their illness (hypertension and diabetes), and to calculate the out-of-pocket expenses related to the consultation. Material and methods: Study conducted between July 2020 and October 2021 in two public health facilities in Dakar. Mixed approach: 1/ qualitative study by semi-directive interviews, informal interviews, observations and field diary with 35 people selected according to a reasoned choice procedure with the aim of diversifying gender, age, social status, therapeutic itineraries for 23 people (including 12 women, ages between 60 and 85 years), and professional activities for 12 health actors; 2/ quantitative cross-sectional study by questionnaire of 225 people (including 141 women) aged 60 and over; we calculated the total cost of the consultation and associated prescriptions (complementary examinations and medicines) as well as the remaining medical expenses (out-of-pocket) and the cost of transporting patients. This is a descriptive exploratory study of a non-representative sample of the elderly population in Senegal. Results: The health professionals interviewed supported the principle of health coverage, but most of them had limited and sometimes imprecise knowledge of the existing schemes and the methods of access or the services covered. Their point of view about the consequences of the Plan Sésame on their practice reveals some contradictions: some complain about the increase in workload, the criticism is extended to all the free schemes which would have a negative impact on daily practice because of the increase in the number of consultations which would be linked to abuse by patients.The interviews highlight the heterogeneity of the knowledge of elderly people about the health coverage intended for them, even though the Plan Sésame has been in place for over ten years. The interviews clearly show that the use of the health coverage system by the elderly depends closely on the information they have and their ability to use it, both for women and men. There is a close link between the level of social integration of people and their use of health coverage: the most socially integrated people are those who know how to use CMU services best. The use of health coverage by the elderly appears to vary according to the individual.Although Plan Sésame is defined as part of a national strategy, its implementation varies according to the health structures and the periods; in the two study sites, the range of services covered by Plan Sésame is very limited, so the coverage provided by Plan Sésame is only partial: between 30 and 50% of the medical costs; the remaining cost of a consultation for elderly patients with hypertension and/or diabetes varies between 24,000 and 28,000 CFA francs.These amounts must be put into perspective with the resources available to people. Statistical studies published in 2021 report that in Senegal the average daily expenditure is 1,390 CFA francs/person/day; and that almost 38% of the population lives on 913 CFA francs/person/ day, which is the poverty line calculated in 2019. Thus, the average out-of-pocket expenses for a follow-up consultation for hypertension, diabetes or a combination of the two diseases represent 15 to 30 days of daily expenditure. While the vast majority of elderly people in Senegal do not have a retirement pension, health expenses are therefore borne by their relatives. Within households, medical expenditure for the elderly competes with basic needs, particularly food, which usually take up more than half of household resources. This indispensable family support places the elderly in a situation of total dependence. Conclusions: In 2021, Plan Sésame does not yet allow for completely free care for the elderly. However, its application, even partial, has resulted in a real reduction in health care costs for the elderly. Its use remains limited due to inconsistent application by most health structures. Its impact is insufficient in view of the amounts that users have to pay in a context of social and economic vulnerability. These observations reinforce the need to work on reducing the price of medical services and strengthening the UHC, in order to improve the equity and performance of the system, and to make it fully functional in all health structures.

[Vaccination in the elderly in sub-Saharan Africa: Relevance and scheduling model]. / Vaccination chez la personne âgée en Afrique subsaharienne : pertinence et modèle de calendrier.

According to the World Health Organisation (WHO), recent decades have seen a major increase in the number of elderly people in Africa. Persistent infectious diseases are responsible for high morbidity and mortality in this immuno-senescent population, making vaccination an effective preventive measure. In developed countries, vaccination programs are in place and regularly updated. In sub-Saharan Africa, however, vaccination is still reserved for children, and access for seniors remains limited by a number of factors. The aim of this study was to use a systematic review to demonstrate the relevance of vaccination in this field, and to propose an appropriate vaccination schedule. Ultimately, vaccines against influenza, pneumococcus (23-valent), herpes zoster, diphtheria, pertussis and tetanus should be systematically recommended. Others may be discussed, depending on the fragility of the patient's condition.

Analysis of public policies in favor of the elderly people in Senegal: state of legal protection.

Senegal will be spared by phenomenon of population ageing, which will surely have socioeconomic and cultural consequences that will not be easy to tackle, as all sectors will be affected. In regard to legal protection, there are not any special legal acts for the elderly as is the case for children and women. They are treated just as responsible adults whose legal status is the same as everyone else. As far as the framework of legal protection of elderly people is concerned, Senegal has ratified all international and regional means and mecanisms for the protection of the rights of the elderly. In addition, the authorities have adopted policies and programs that favor taking charge of old people's interests. At the present, Senegal possesses a legal framework for the protection of its elderly people. So the matter is about creating new rights, because even the existing rights are not known to their beneficiaries. What is important is to ensure that the elderly fully enjoy their rights in the same way as the other members of society. It is wise, therefore, to put in place plan for information, public awareness and communication concerning the legal regulating framework. Thus, Senegal could be regarded as a pioneer in terms of the protection the elderly, and these leading programs can represent models for the countries of the region, whose social, sanitary and economic contexts are similar.

[Estimate of the prevalence of cognitive impairment in an elderly population of the health center of Senegalese national retirement institution]. / Estimation de la prévalence du déficit cognitif dans une population de personnes âgées sénégalaises du Centre médico-social et universitaire de l'Institution de prévoyance retraite du Sénégal.

OBJECTIVE: To assess the prevalence of cognitive impairment in a Senegalese elderly population, of the Sociohealth and university center of Senegalese national retirement institution, Dakar, Senegal. METHODOLOGY: A cross sectional study was conducted in 872 Senegalese elderly population aged 55 years and over utilizing the Sociohealth and university center of IPRES, Dakar, Senegal for health care. Sociodemographic, lifestyles, physical activity, medical history, familial history of dementia data were collected with a structured questionnaire completed with a clinical exam and neuropsychological testing. Cognitive impairment was defined as a score of 28 or less with the test of Senegal. RESULTS: Ninety four subjects (10.8%; 95% CI 8,7-12,9) had cognitive impairment. Mean age was 67.2 years (±7.5 years), 63% were men, 79% were married, and half of them knew how to read and write. Hypertension, arthritis and gastro-intestinal diseases were the main health conditions reported. Prevalence of cognitive impairment varied with age and education. CONCLUSION: Prevalence of cognitive decline in the Sociohealth and university center of IPRES, Dakar, Senegal, is higher and varied with age and education.