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

摘要

In its desire to extend health care coverage, Senegal has, in recent years, embarked on several health financing strategies [1,2], at the risk of some fragmentation [3]. The strategic plan for the development of universal health coverage (UHC) 2013-2017 aims to achieve the objective of cover- ing at least 75% of the population at risk of illness by 2021. After introduc- ing community-based health insurance [4,5] and the various user fees ex- emption intervention for certain categories of people (people aged 60 and over, children under 5, the poor) or certain services (caesarean sections, HIV treatment, dialysis) [6-9], Senegal has tested two models for extending health risk coverage. The first relates to the decentralization of health insurance (DECAM) with the cre- ation of community-based health insurance at the communal level. At the end of 2019, a national assess- ment estimates that 80% of community-based health insurance policies have fewer than 500 beneficiaries [10]. The second is large-scale professionalized health insurance with, for the moment, two departmental health insurance units (UDAM) in Koungheul and Foundiougne [11]. From 2013 to 2017, the formula- tion and implementation of these two UDAMs have been organized by the Ministry of Health and Social Action with Belgian Technical Cooperation (currently Enabel), through its Care Supply and Demand Sup- port Project (PAODES).