HEALTHCARE IN SENEGAL is a center topic of discourse in understanding
the wellbeing and vitality of the Senegalese people. According to 2001
data, 54% of the population is below the poverty line , which has
implications on people's wellbeing. Common medical problems in
Currently, there is a need to improve Senegal’s infrastructure to
promote a healthy, decent living environment for the Senegalese.
Additionally, the country needs more doctors and health personnel,
particularly general practitioners, gynecologists, obstetricians,
pediatricians, and cardiologists. Moreover, there is a strong need to
have more of these personnel in rural areas: as of 2008,
* 1 History
* 2 Organization of the health care system
* 2.1 Financing care
* 3 Changes to health care strategies
* 4.1 Barriers to healthcare and medicine * 4.2 Disparities between rural and urban areas * 4.3 Transportation to health facilities
* 5 Specific diseases
* 5.1 HIV/AIDS
* 6 Women\'s healthcare concerns
Female genital mutilation
* 7 Approaching healthcare inadequacies
* 7.1 Community-based health insurance plans (CBHI) * 7.2 Community health workers (CHWs)
* 8 Children’s healthcare
As is the case in the rest of the African continent, the Senegalese
have long used traditional medicines and rely on traditional healers
for their ailments. During the colonial era, the health care system
was drastically changed. In 1905,
ORGANIZATION OF THE HEALTH CARE SYSTEM
Senegal’s health system is pyramidal, with three main parts: a central level, a regional level, and a peripheral level. The central level contains the minister’s office, branches, and related services. The regional level is known as the "medical region", an administrative region that addresses healthcare services within a given region. The peripheral level is known as the "health district", with each district having at least one health center and a network of smaller centers.
The national health system is divided into three levels: regional
hospitals, district health centers, and health posts.
In 1999, 53% of health funding came from the government, 11% from individuals, 6% from communities, and 30% from international partners. Of a household's health expenditures, 89% is out-of-pocket spending while 11% is in the form of health insurance contributions. Additionally, only 15.2% of Senegalese people have health insurance, most of whom work in the formal sector. On average, a facility charges 2.90 USD for inpatient care for the median length of stay (five days), 0.43 USD for adult outpatient care, and 0.24 USD for children's outpatient care. In terms of expanding health insurance, it seems that policies that will reduce the negative effect of the time lost to seek care by workers, or policies that will increase the accessibility and the quality of care, will be more effective to increase health care utilization than would the introduction of health insurance to those who do not yet have it.
CHANGES TO HEALTH CARE STRATEGIES
One of the most influential pieces to the transformation of
Senegal’s healthcare system in the late 1990s was the Bamako
Initiative . The
Bamako Initiative started in 1987, when health
ministers from two dozen African countries met with representatives of
Bamako Initiative also led to the establishment of health
Decentralization began in the late 1990s, following the Bamako initiative. The key goal has been to make the state more responsive and adaptable to local and regional needs, as opposed to when administrative power and responsibility were concentrated more centrally. This has resulted in more accountability and real power on part of local officials. The state funds a significant portion of the local health budget, but health targets, goals, and interventions are determined at the local level. However, because most local officials have no training on how decentralization should work; there has been a vacuum in terms of planning and management, and weak institutional capacity and the few resources to allocate among increasing responsibilities have exacerbated issues. Decentralization has failed in two major ways: the first three years failed to render politics and local government more participatory and more responsive to local communities, and there has been no attention to gender equality and participation. Decentralization has meant that authorities have completely failed to engage with women’s situations and concerns. There have been additional issues in creating conflicts between city officials and medical district officers over disbursement of money for the health sector.
In addition to changes with the
Bamako Initiative and
decentralization, Senegalese healthcare has become privatized.
HEALTH CARE UTILIZATION
Two women and an infant at a maternity ward on Niodior Island,
BARRIERS TO HEALTHCARE AND MEDICINE
Some of the greatest barriers to health care utilization include lack
of information, lack of communication, low number of health care
workers, and social and religious barriers. Currently, there is a
strong need for strategies to empower and better support the knowledge
role of health coordinators and supervisors. Additionally, the lack
of access to current, relevant information by health professionals and
Some Senegalese people, particularly in rural areas, face inadequate
access to medicines and prescriptions . Improving access to medicine
is a priority in developing nations like Senegal. In 2001, Senegal
had only 520 pharmacies (1 per 18,320 people) and 731 health centers
(1 per 13,032 people). Access to medicine in
DISPARITIES BETWEEN RURAL AND URBAN AREAS
Major disparities exist in health care access for those living in
urban versus rural areas. Approximately 70% of doctors and 80% of
pharmacists and dentists are located in
TRANSPORTATION TO HEALTH FACILITIES
Often, distance from health care facilities, rough roads, and improper means of transportation limit healthcare access in Senegal. For 80.5% of households, the poorly equipped health post is the only accessible health facility in an average distance of 4.3 kilometers. The closest high-level provider (i.e. a hospital) is located, on average, 20 if ambulances are not available, horse-drawn trailers may also be effective. The most effective avenue is to improve the mobility of health care providers rather than solely focusing on improving the mobility of rural populations, which requires far less structural support and funding than does providing transportation for every household.
In Senegal, Mbacke Primary School students compete in a trivia contest to see who knows the most about malaria. (Antoinette Sullivan/USAID), 24 August 2011.
A number of diseases continue to afflict persons who live in and
travel to Senegal, some of which are related to Senegal's tropical
climate. One of the most prominent diseases is malaria , a parasitic
disease transmitted by mosquito bites. One of Senegal's strategies for
combating malaria has been the National Program for the Fight Against
Malaria. Other diseases affecting
Syphilis , which is directly related to the social environment,
poor health, and housing conditions
The rate of
WOMEN\'S HEALTHCARE CONCERNS
A number of healthcare concerns afflict women in particular, among them female genital mutilation, maternal healthcare, and gendered healthcare discrepancies. Further, the restructuring of the health care system has also affected women significantly.
FEMALE GENITAL MUTILATION
About 20 percent of Senegalese women undergo female genital
mutilation (FGM) of some kind, with the most prevalent procedure being
the removal of the tip of the clitoris, according to the National
Program Against Female Genital Mutilation. It is not widespread among
the Wolof or Serer , but is more common among the Fulani , the Diola ,
the Toucouleurs and the Mandingo . Notably, FGM has no
BIRTHS AND FERTILITY
The birth rate in
There are many cultural and social barriers that limit abortion in Senegal. Studies have shown that there is strong opposition, from both men and women, to women’s individual choice and agency with abortions, family planning, and sexual health. Therapeutic abortion is allowed to protect a woman’s health or life if threatened by pregnancy, but abortion of any other kind is banned.
Midwife and birthing bed at an island in the Sine Saloum in Senegal, 2006.
WOMEN AND STRUCTURAL CHANGES
In Senegal, gender relations have been largely ignored in processes of decentralization and implementation of community management strategies. One of the key problems resulting in changes to the health sector is that elected officials and health sector personnel have failed to engage with women as potential leaders and participants in community health structures, instead viewing them in some cases as family health managers and targets of health education messages. As household health managers and primary consumers of public health care, women are intimately connected with realities of managing illness and seeking medical treatment. However, in spite of their marginalization, women are not completely passive in the face of disease. As an example, some women have created networks of service providers in the informal sector for the majority of health care needs in the region of Pikine.
WOMEN’S HEALTH SERVICES AND ACTIVISM
Social opposition to women’s rights and agency have, as some have
argued, barred women from receiving necessary choice and capabilities
in regard to family planning , abortions, and sexual health . Health
services targeted at women primarily concern childbearing. As a
result, diseases like cancer or infertility, or those linked to
menopause or violence, may be ignored. In Senegal, a large number of
health care providers believe unmarried women should not be given
information on family planning methods. Moreover, the Senegalese
government has in some cases failed to enforce international human
rights treaties it has already signed, some of which protect women’s
health services and rights. Also, women’s groups in
APPROACHING HEALTHCARE INADEQUACIES
COMMUNITY-BASED HEALTH INSURANCE PLANS (CBHI)
One of the major proposed solutions to solving issues within the realm of maternal health care is the inclusion of membership in community-based health insurance plans (CBHI). CHBI schemes are voluntary, non-profit health insurance schemes organized and managed at the community level. In developing nations, CBHI plans are seen as a mechanism to meet health-financing needs of rural informal sector households. CHBI has been incorporated into the national health financing strategy in Senegal. CBHI increases facility-based maternal health services by reducing direct payments, thus facilitating timely use of healthcare. It is beneficial in guarding households against unpredictable and potentially catastrophic medical fees associated with pregnancy-related complications. It can also increase women’s interaction with the formal health care sector through its coverage of non-maternal health services. The most important element is the inclusion of maternal health care in any CBHI benefits package, which makes the most significant difference. CBHI plans can increase the demand for and quality of maternal care though requiring certain standards in contracts with health facilities. However, membership in a CBHI scheme is not always sufficient in influencing maternal health behaviors.
COMMUNITY HEALTH WORKERS (CHWS)
In some countries, community health workers, or CHWs, act as a bridge
between the health care delivery system and the community, and ensure
that people receive adequate primary health care. CHWs are part of a
larger goal to find appropriate strategies to improve the attraction
and retention of health workers in remote and rural areas, which is
particularly important in Senegal. CHWs may also empower the community
to identify its needs. In Senegalese villages, CHWs are often unable
to leave their home community for training and education, which has
been a major obstacle for developing effective CHW schemes. Other
obstacles include poor transportation, poverty, the need to run
families, and the absence of an economic plan for CHW training. In
particular, village populations in
A child waits outside a medical clinic as part of Western Accord 2012 in Thies, Senegal, June 10, 2012.
Children’s healthcare in
Rates of malnutrition are most pronounced among infants between one and two years old. Barriers to children’s health include:
* maternal misunderstanding of the nutritional needs of the child * a lack of nutritional follow-up of the children * the non-practice of the exclusive breast feeding at least for the first four months of life of the infant * a misunderstanding of good weaning practices * the precariousness of the health condition of the children (frequency of the febrile episodes associated with diarrhea and respiratory infections) * poor living standards * difficulty accessing access to certain basic elements
The nutritional health conditions of children less than five years old may relate to the age as well as the child’s cycle of life, the size and place of residence, elements linked to the household environment such as the nature of the soil of the housing, the source of supply in drinking water, the evacuation mode of the domestic garbage, and the mother's level of education.
The majority of Senegal’s healthcare budget goes to physical health
needs; mental health remains an area of concern. The Senegalese
government spends 9% of its total health budget on mental health.
* ^ A B C D E F G Central Intelligence Agency, "World Fact Book:
Senegal." Last modified Feb 05 2013. Accessed March 19, 2013.
* ^ A B C D E F G H I Heyen-Perschon, Jürgen. "Report on current
situation in the health sector of
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