Factors that foster and challenge the sustainability of departmental health insurance units in Senegal

Abstract

In an effort to establish universal health coverage (UHC), Senegal set up two departmental health insurance units (UDAM) to scale‐up health insurance to rural communities. Part of this innovation meant that health insurance was no longer managed by volunteers, but by professionals. Several years after the conclusion of the project in 2017 that supported their initial development, both UDAMs still operate successfully. This mixed methods research aims to understand the factors that have contributed to the sustainability of both UDAMs, as well as discuss the remaining challenges. The factors deemed favourable to sustainability are actions undertaken to ensure financial stability and organizational risk taking. However, the mobilization of the population, relationships with health professionals and the role of the State have been more difficult to organize. Challenges concern the payment of subsidies and the supply of medicines by the State and partnership with the health care system, the maintenance of contributions, the digitalization of administration, as well as fraud and abuse.

The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal

“…As we have seen, it is not about thinking that resilience promotes the status quo but rather innovation and transformation. Thus, our research suggests that the UDAM was resilient because it was able to ‘succeed under varying conditions’14: first, when its international technical and financial partner ceased support in 2017 (as a planned intervention),29 and then in 2020 and 2021 at the time of the COVID-19 pandemic and its restrictive measures in Senegal (as an adverse event) 22…”

“…Indeed, the human and social leadership skills of UDAM managers and the dynamism of their team have been identified as important factors in their sustainability in a recent study. 29 Indeed, they have been in the leadership since 2014, when a development cooperation project started to create UDAM and ended in 2017. 27 Since the start of the project, they have demonstrated innovation and have managed to develop their insurance offerings and membership to become a model for the country and the region.…”

“…This research, together with our knowledge of the field and our recent analysis of the factors favourable to the sustainability of UDAMs, suggests that our hypothesis of the role of leadership is well grounded. Indeed, the human and social leadership skills of UDAM managers and the dynamism of their team have been identified as important factors in their sustainability in a recent study 29. Indeed, they have been in the leadership since 2014, when a development cooperation project started to create UDAM and ended in 2017 27.…”

“…At the time of the COVID-19 pandemic in Senegal in early 2020, these UDAMs cover more than 50% of their target population, 22 while the latest national survey of 2019 shows that communal CBHI covers only 4.5% of the country’s population. 28 Despite the termination in 2017 of the funding that supported their implementation, 29 the UDAM is a success for UHC in the Sahel in terms of coverage. However, while the State has decreed restrictive measures to combat the pandemic and protect the health system, 30 how did these two UDAMs cope with this situation?…”

Innovations in mutuality: challenges and learnings for the Universal Health Insurance Plan in Mali

“…Senegal has transformed from communal CBHI to departmental CBHI. This transformation has proven to be effective in increasing coverage 17. In Rwanda, local CBHI moved to a national network in 2006 with a complete operation change.…”