ENDOGENOUS HEALTH FINANCING MECHANISMS UNANIMOUSLY ACCEPTED IN LOUGA AND SAINT-LOUIS

In Louga, a region located in the Northwestern part of Senegal with a population of 950,102 inhabitants, only a small percentage of the population is covered against the risk of disease. Beyond poverty, this can be explained by an unawareness of available health coverage procedures, such as UHC (Universal Health Coverage). At the same time, in Saint-Louis, with a population of 983,032 inhabitants; rates have been reported to be somewhat better, but are still relatively low. To address this situation, CICODEV Africa, within the framework of its Health program funded by Hewlett Foundation and OSIWA, has embarked on a series of visits in those regions of Senegal in early December of 2019. The purpose of these regional visits were to gather information regarding the focal points and their working environments; meet with local authorities and actors involved in health (and that work closely with CICODEV’s focal points); assist focal points in implementing outreach activities to popularize endogenous mechanisms to help fund the health sector; and to spread information on the UHC policy.

Communities in Saint-Louis received MEFs as a familiar and traditional method; both efficient and adequate, that should be officialized through governmental recognition and a large community enrollment into health mutuals. The regional visits began in Saint-Louis with CICODEV’s focal point, Nafissatou Diop. A briefing session was held in order to present the new orientations of CICODEV’s programs (those that are in progress and/or to come); and to obtain the agenda for the morning’s visits to authorities and local actors that the focal point organized. The team visited the Deputy Prefect, the Secretary General of the Departmental Council, the 2^nd Deputy Mayor of Saint Louis, the Regional Service Manager of Community development of Social and Territorial equity and her collaborator, the Chief of departmental services.

Prior, Mrs. Diop, organized an outreach activity in the form of a community conversation. These activities are organized to sensitize communities on endogenous health funding mechanisms and enrollment into health mutuals. The morning visits also served as another occasion to extend a personal invitation to each authority and local actor that was visited. Present, were also members from the community Relays, Directors of Village Savings and Credit Associations (AVECs) and their federation (FAVEC), Presidents of Neighborhood Councils and of the Municipal Youth Council. Many issues concerning health mutual enrollment were identified during this session. According to several local actors and certain authorities, health mutual members believe that there is a lack of transparency in regards to how health mutuals use the funds that members pay; this leads potential mutual members to distrust health mutuals – making them hesitant to contribute.

There were some solutions brought to the table as well. Such as those from certain youth, who committed to investing in social networks to help popularize endogenous health funding mechanisms and the UHC policy. MEFs have been proposed as solutions to make healthcare sustainable but also accessible and affordable for all. President of Community Relays and community godmothers/sponsors (Bajenu Gox) Aicha Coulibaly. Saint-Louis. December 2019 From the side of local authorities, health workers, actors as well as communities, MEFs were received as a familiar and traditional method, both efficient and adequate, that should be officialized through governmental recognition and a large community enrollment into health mutuals. According to national reports, more than 50% of health expenditures are borne by households. Hence the importance of being concerned with the ways in which communities take care of their health needs. Saint-Louis has 48 health mutuals but the enrollment rate is not high. The conversation ended with commitments by the communities to help change that. Kebemer’s population and mutual members encouraged to respect the annual subscription fees even if benefits aren’t immediate. In Louga, in the department of Kebemer to be exact, the Focal points, Aissatou Dieng (Kebemer’s focal point) and Modou Dieng (Diokoul’s focal point) facilitated the visits to the Deputy Prefect, the Prefect, the Mayor of Kebemer, the Deputy Chief Doctor, etc. CICODEV’s Health team at Kebemer’s Health center with focal points, Aissatou Dieng and Modou Dieng; and Chief Doctor’s Assistant, Dr. Kodou Ndiaye. Kebemer. December 2019 Later that day, they organized a community conversation that took place in the Diamaguene district of Kebemer. The conversation in Kebemer was very progressive. Many participants said that many communities in the region were unaware of the benefits offered by the UHC policy as well as health mutuals. The regional and departmental President of the community godmothers (Bajenu Gox) Mareme Sy, encouraged health mutual members to respect the annual subscription fees even if they have not yet received benefits. Indeed, certain individuals often enrolled in a health mutual, but after a while, if they did not benefit from it (due to not falling sick), they eventually stop making payments. The first visits are devoted to the regions of Saint-Louis and Louga. Guided by the approach described above, the CICODEV Africa Health program will lead the team to different regions of Senegal where the Focal Points are located as well as to the regions where the new Focal points will be recruited in. CICODEV has already established UHC (Universal Health Coverage) observatories in 9 regions of the country and plans to cover the 14 regions of Senegal by 2020.

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