FINANCIAL PROTECTION AND IMPROVED ACCESS TO HEALTH CARE: PEER-TO-PEER LEARNING WORKSHOP

FINDING SOLUTIONS TO COMMON CHALLENGES FEBRUARY 15-19, 2016

ACCRA, GHANA

Republic of Senegal One People - One Goal - One Faith

Ministry of Health and Social Action

Universal Health Coverage (UHC) in Senegal:Implementation Status and Outlook

February 2016

Context

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Financial access to health services is a major concern for most people in Senegal.

Before 2012, more than 80% of the people in Senegal had no health coverage.

Coverage Plans in Senegal

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R1 • Non-contributory plan for government employees (budget

allocations) • Mandatory plan for private sector employees (IPM)

R2 • Voluntary plan through mutual health insurance companies • Voluntary plan through private insurance

R3 • Medical care plan through no-cost initiatives for the indigent and

persons at risk

Political commitment at the highest level

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“Beyond a new resolve to improve health facilities, I intend to launch a program of universal health coverage and a serious debate on the government’s health policy, in concert with the actors concerned.” (excerpt from the speech to the nation on April 3, 2012)

Goal of the UHC Program

To improve financial accessibility to quality health

care for the people of Senegal, particularly those in the

informal sector and rural areas

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Goal of the UHC Program

To extend basic health coverage to 75% of the population by 2017.

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Strategic Planning Areas

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Expansion of basic universal health coverage

through mutual health insurance companies

Strengthening of existing no-cost initiatives

Implementation of new no-cost care initiative for

children under 5 years of age.

Reform of Health Coverage Institutions by implementing decree 2012 - 832 of August

7, 2012

Priority area: Promotion and expansion of

mutual health insurance companies

Approach and major innovations in the promotion of mutual health insurance

companies

Approach: “In each municipality, at least one mutual health

insurance company.” Major innovations: Contribution of 7,000 Francs per person per year, 50% subsidized

for persons who are able to contribute, i.e. a contribution of 3,500 Francs per person per year;

Free care for indigent persons through a 100% subsidy of the

contribution and the copayment.

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Package of care offered (health center

and unit)

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Paquets de Bénéfices de Base Type (Postes et Centres de Santé)

Prestations prises en charge par la mutuelle de santé

Taux de prise en charge

par la mutuelle de santé

Soins ambulatoires

• Consultation curative générale 80%

• Consultation dentaire 80%

• Pansement, piqûres, transfusions 80%

• Vaccinations 100%

• Petite chirurgie ambulatoire 80%

• Soins dentaires 80%

• Echographie 80%

• Analyses médicales/Laboratoire 80%

• Médicaments de spécialité ou de marque 50%

• Médicaments génériques 80%

Transport

• Ambulance 80%

Hospitalisation

• Forfait de séjour 80%

• Analyses médicales/Laboratoire 80%

• Médicaments de spécialité ou de marque 50%

• Médicaments génériques 80%

• Consommables médicaux 80%

Maternité

• Consultation prénatale 80%

• Consultation post-natale 80%

• Planning familial 80%

• Accouchement simple 80%

• Hospitalisation 80%

• Echographie 80%

• Analyses médicales/Laboratoire 80%

• Médicaments de spécialité ou de marque 50% • Médicaments génériques 80%

Package of care offered (hospital)

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Paquet de Bénéfices Complémentaire (Hôpitaux) Référence Obligatoire pour Bénéficier de la Couverture

Prestations prises en charge par la mutuelle de santé

Taux de prise en charge par la mutuelle de santé

Soins ambulatoires • Consultation curative générale 80% • Consultation dentaire 80% • Consultation ophtalmologie 80% • Consultation autres spécialités 80% • Pansement, piqûres, transfusions 80% • Petite chirurgie ambulatoire 80% • Soins dentaires 80% • Radiographie/Scanner/Echographie 80% • Analyses médicales/Laboratoire 80% • Médicaments de spécialité ou de marque 50% • Médicaments génériques 80%

Transport • Ambulance 80%

Hospitalisation • Forfait de séjour 80% • Radiographie/Scanner/Echographie 80% • Analyses médicales/Laboratoire 80% • Médicaments de spécialité ou de marque 50% • Médicaments génériques 80% • Consommables médicaux 80% • Chirurgie 80%

Maternité • Consultation gynécologie 80% • Accouchement avec complications 80% • Césarienne 100% • Hospitalisation 80% • Radiographie/Echographie 80% • Analyses médicales/Laboratoire 80% • Médicaments de spécialité ou de marque 50% • Médicaments génériques 80%

The UHC in Senegal. Where do we stand?

Strategic Achievements

Creating the UHC Agency

Setting up the National Interministerial UHC Steering Committee

Preparing a plan for information and communication about the UHC

Preparing a strategic plan for 2013-2017

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Missions and powers of the UHC Agency

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Develop communication strategies to better promote

the universal health coverage program.

Promote the financing of the Universal Health Coverage

policy in cooperation with the actors concerned.

Participate in defining and implementing the policies for expanding health coverage for indigent persons and groups

at risk.

Promote mutual health insurance companies and

other social mutual companies as part of expanding health

coverage to the informal sector and rural areas.

Achievements before creation of the Agency Strategic

Areas Results

Promotion of community-based health

insurance (mutual health

insurance companies and district health

insurance units)

Pilot regions

106 new mutual health insurance companies were set up in one year in the 14 districts; about twenty mutual health insurance companies are in the process of restructuring; 28,293 new members; In total: 369 functional mutual health insurance companies.

Large-scale health insurance model Koungheul Regional Health Insurance Unit: 4,704 beneficiaries Foundiougne (Sokone) Regional Health Insurance Unit: 5,335 beneficiaries

Enrolment of beneficiaries of the Family Security Grant Program 97,883 beneficiaries already enrolled in mutual insurance companies h h ld b ll d i l h ill h

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Strategic Areas Results The initiative of free care for children under five (05) years of age

More than 2 million cases were covered under the initiative in 2015.

Free caesareans and other no-cost initiatives

12,066 women received free caesareans from January to December 2014. More than 215,000 elderly received free care Dialysis is free at all public health facilities, and sessions at private facilities are subsidized.

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Change in National Coverage Rate

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Indicator 2013 2014

% of population that had a coverage system

Less than 20%

32% (estimate)

Outlook for the UHC Agency

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Advance from the pilot phase of development of mutual health insurance

companies in the 14 districts to the phase of coverage of the country’s 45

districts;

Set up regional offices of the UHC Agency;

Exhaustive inventory of health coverage in Senegal;

Expand the package of care offered under the initiative of free care for

children under 5 years of age;

Free coverage of the 2,400,000 beneficiaries of the 2016 Program of Family

Security Grants through mutual health insurance companies.

Major Challenges

Availability of quality care offerings;

Sustainable financing of the UHC;

Identifying and targeting beneficiaries;

Strengthening the legal and regulatory framework;

Improving communication about the UHC.

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THANK YOU FOR YOUR KIND ATTENTION