Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal

Wood, Anna

doi:10.1016/j.socscimed.2022.115491

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…Social health insurance is funded via income-based contributions that require tax-based revenue, though its application may vary depending on countries (72, 73, 84). In developing countries, people voluntarily pay for health insurance as a prepayment so that they are exempted from paying medical costs, like initiatives of community-based health insurance scheme in Ethiopia (85) and Senegal (86). In some instance, insurance schemes have been implemented for specific groups of the population, such as National Disability Insurance Scheme in Australia (87).…”

Section: Resultsmentioning

confidence: 99%

“…Partnership: This is about with-in-a-nation and cross-nations partnerships. Partnership between government employers and consumer within a nation to strengthens infrastructure capacity and raise funds for UHC and provide better and comprehensive care towards UHC (86,110,111). As a cross nations partnership, the partnership project between Thailand and Japan (112) and China-Africa health development initiatives (113) towards UHC can be examples.…”

Section: How Does Universal Health Coverage Work?mentioning

confidence: 99%

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Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Endalamaw,

Mengistu,

Khatri

et al. 2024

Preprint

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Background: Universal health coverage (UHC) is a critical target in many health system strategies to achieve the ‘good health and wellbeing’. Evidence on the meaning and scope of UHC and the strategies required to achieve it are needed, as variations in its understanding and implementation have risen. We synthesised evidence on the meaning, components, significance, and strategies of UHC. Methods: A review of evidence was conducted based on realist synthesis. We searched PubMed, EMBASE, Scopus, and Web of Science for published materials and websites for grey literature. We have followed some steps: define the scope of the review and develop initial programme theory, search for evidence, data extraction, and synthesis of evidence. Results: Universal coverage, universal health, universal healthcare, universal access, and insurance coverage are used interchangeably with UHC. It is a legal notion that embodies a human rights-based and collaborative approach to ensure fair and comprehensive health care services. Universal health coverage is relevant for three macro reasons: first, it prevents and reduces the impact of diseases; second, it addresses inequality and promotes equity; and third, it is key for global health security. Various mechanisms involved to implement UHC, such as health insurance, social health protection, digital financing systems, value-based care, private sectors, civil societies, partnership, primary health care, and reciprocal health care systems. Conclusions: Universal health coverage is a multifaceted concept that can be expressed by various terms in different contexts. Universal health coverage is a political and ethical imperative that aims to promote health equity and protect human dignity across different levels of society. It is essential in preventing diseases and serving a crucial role in global health security. Practically, UHC is not truly universal, as it does not include all services under its scheme and varies across countries. This requires consistent advocacy, strategic and operational research as well as political will to ensure UHC.

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Section: Resultsmentioning

confidence: 99%

Section: How Does Universal Health Coverage Work?mentioning

confidence: 99%

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Endalamaw,

Mengistu,

Khatri

et al. 2024

Preprint

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“…One of the findings of my research has been that health mutuelles often struggle to operate through the large-scale enrolment of the population and government match-funding. Low enrolment rates, together with too-little-too-late government subsidies, have meant that most mutuelles are forced to look elsewhere for resources (Wood 2023). Large cheques such as the one presented at the Grand Theatre for the MSNAC help get mutuelles off to a good start or tide them over while they wait on government subsidies to materialise.…”

Section: * * *mentioning

confidence: 99%

Invoking Senghor: Universal Healthcare Coverage and the Place of Culture in Senegal

Wood

2024

MAT

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Senegal introduced Couverture Maladie Universelle (CMU), its version of universal health coverage (UHC), in 2013, basing it on the establishment of mutual health insurance. Mutual health organisations (mutuelles de santé) manage the pooling of funds, including member enrolment fees and government subsidies; in an effort to extend the reach of UHC, the Senegalese cultural sector created a mutuelle of its own. As part of ethnographic fieldwork focused on CMU, I attended a ceremony at the Grand Théâtre National de Dakar on the occasion of this mutuelle receiving a large cheque from the government. In this Field Note I examine the centring of Senegalese culture during this event to reflect on the national project of development itself. The event’s celebration of the arts sector coupled with its emphasis on mutualism and solidarity invoked Senegal’s post-colonial developmentalist visions and aspirations that were motivated by négritude and African socialism under its first president, Léopold Sédar Senghor. Engaging with renewed calls for African values and morality to be put at the centre of development, I argue that ambitious endeavours like CMU present such an attempt and help buoy it, but that, in the context of continued healthcare underfunding, one-off gifts like that presented during the ceremony are unsustainable.

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“…These priorities are framed as primary ways to improve health and reduce poverty, putting the country “on the road to development by 2035” (Presidency of Senegal, 2021). Leveraging the strengths of its communities, Senegal has adopted community‐based health insurance—a financing scheme based on the pooling of voluntary contributions to offset health care costs—as its primary pathway to universal coverage (Wood, 2023). In Senegal, community‐based health insurance is intended to be partially subsidized by the Senegalese state to alleviate some of the burdens that accompany voluntary enrollment.…”

Section: Background: Community‐based Health Care In Senegalmentioning

confidence: 99%

“…This is particularly true for many African nations under the discipline of structural adjustment (Marten & Sullivan, 2020; Pfeiffer & Chapman, 2010), which underpins much of the pervasive “Afropessimism” that circulates in scholarly and media discourse (Ferguson, 2006, p. 10). Yet, at the same time, people across the Global South have often found ways to improvise despite these policies (Wood, 2023) and, in some cases, develop robust community responses to state shortfalls, often through activating and maintaining alternative social and economic networks like HTAs (Foley & Babou, 2011). In the Senegal River Valley, those networks are often rooted in a kind of community solidarity that spans the globe.…”

Section: Conclusion: Suffering For the Common Goodmentioning

confidence: 99%

Sanctified suffering and the common good: Translocal health care provisioning in smalltown Senegal

Burgen,

Marten

2024

Economic Anthropology

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Senegal has long relied on local communities to expand health services and improve health outcomes for citizens and is internationally lauded for its effectiveness in promoting good health and facilitating local trust. Here we examine how community health care emerges in Keur Toma, a rural Wolof town in the Senegal River Valley that relies on a global network of labor migrants to fuel its remittance‐based economy. Largely through its hometown association and the migrant men abroad who fund it, Keur Toma has built and sustained the local health infrastructure and staffing essential to achieving health care accessibility, providing consistent investment and critical stop‐gap funding when government assistance falters. Following Robbins's call for investigating “an anthropology of the good,” we highlight the deeply rooted sense of care and obligation to kin and community that fosters the translocal ties that make Keur Toma's health care possible in the state's absence. We highlight what Ngom calls “sanctified suffering”—which valorizes personal fortitude and the ability to endure hardships for family and community, shaped by traditions of solidarity, mutual aid, and Islamic morality—and its role in migrants' hometown commitments to building stronger communities.

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Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal

Cited by 5 publications

References 38 publications

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Invoking Senghor: Universal Healthcare Coverage and the Place of Culture in Senegal

Sanctified suffering and the common good: Translocal health care provisioning in smalltown Senegal

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Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal

Cited by 5 publications

References 38 publications

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

​​Invoking Senghor​: Universal Healthcare Coverage and the Place of Culture in Senegal

Sanctified suffering and the common good: Translocal health care provisioning in smalltown Senegal

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Invoking Senghor: Universal Healthcare Coverage and the Place of Culture in Senegal