Analysis of Senegal's Health Financing System: Implications for Health Financing Reform and Universal Health Coverage Público

Sylla, Soukeyna (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/hd76s0677?locale=pt-BR
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Abstract

Senegal officially launched its Universal Health Coverage (UHC) Program in 2013. Prior reforms aimed at extending coverage to unreached sectors of the population have primarily targeted seniors above the age of 60 and pregnant women for caesarian care. This thesis analyzes National Health Accounts and population-level data to assess the extent to which coverage extension strategies have had an impact on population health coverage and household out-of-pocket spending over time. Results suggest that even after the introduction of coverage extension schemes in 2005 and 2006, there has been limited impact on overall population coverage. In fact, Senegal's health financing system continues to cover primarily formal sector workers, leaving the informal sector largely unaccounted for. Further, households continue to be the primary payers of health services, second to the Ministry of Health, suggesting that other payers within the system have not supplanted the burden of costs on households. Ultimately, the success of Senegal's UHC program rests on the ability to implement data-driven financing reforms that would ensure the new extension strategies embedded in the UHC program lead to substantial impacts on population coverage and health outcomes. The following health financing reforms are recommended: compulsory enrollment in a minimum package of services, regulation for the cost of the package among all public health providers, and improvement of supply-side financing through case-based payments.

Table of Contents

CHAPTER I: INTRODUCTION 1
 1. CONTEXT AND RATIONALE 1
2. PROBLEM STATEMENT 2
3. PURPOSE OF PROJECT 4
4. SIGNIFICANCE OF PROJECT 4
5. DEFINITION OF TERMS 5
CHAPTER II: LITERATURE REVIEW 7
 1. THE SENEGALESE HEALTH CARE SYSTEM 7
2. THE FUNCTIONS OF HEALTH FINANCING 8
3. THE SENEGALESE HEALTH FINANCING SYSTEM 10
4. GHANA'S NATIONAL HEALTH INSURANCE SCHEME: WHAT LESSONS LEARNED? 13
5. SUMMARY OF CURRENT PROBLEM AND PROJECT RELEVANCE 15
CHAPTER III: METHODOLOGY 16
 1. POPULATION AND SAMPLE 16
2. RESEARCH DESIGN 17
3. PROCEDURES 18
4. INSTRUMENTS 19
4.1 National Health Accounts database 19
4.2 Ministry of Health Projected Coverage data 21
4.3 Population-Level Data Sources & Reports 22
4.4 Ministry of Finance Civil Servants database 23
5. PLANS FOR DATA ANALYSIS 23
5.1 Descriptive Analysis 24
5.2 Comparative Analysis 24
6. ETHICAL CONSIDERATIONS 25
7. LIMITATIONS AND DELIMITATIONS 25
CHAPTER IV: RESULTS 27
 1. FLOW OF FUNDS OF SENEGAL'S HEALTH FINANCING SYSTEM 27
2. HEALTH SECTOR FINANCING CONTRIBUTION BY PAYER 30
3. POPULATION-LEVEL HEALTH COVERAGE OVER TIME 31
4. SUMMARY 33
CHAPTER V: DISCUSSION 35
 1. DISCUSSION OF PRINCIPAL FINDINGS 35
2. STRENGTH AND LIMIT OF ANALYSIS 38
3. IMPLICATIONS FOR SENEGAL'S UHC PROGRAM 38
CHAPTER VI: CONCLUSION & RECOMMENDATIONS 42
 1. POLICY RECOMMENDATIONS 42
2. PUBLIC HEALTH IMPLICATIONS 44
REFERENCES 45
FIGURES AND TABLES 48

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