Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)
Central African Journal of Public Health
Volume 5, Issue 4, August 2019, Pages: 156-164
Received: Mar. 25, 2019;
Accepted: Jun. 17, 2019;
Published: Jul. 1, 2019
Views 426 Downloads 85
Mamadou Makhtar M. Backe Leye, Department of Preventive Medicine and Public Health, University Cheikh Anta Diop, Dakar, Senegal
Oumar Bassoum, Department of Preventive Medicine and Public Health, University Cheikh Anta Diop, Dakar, Senegal
Ndeye Marème Sougou, Department of Preventive Medicine and Public Health, University Cheikh Anta Diop, Dakar, Senegal
Marc Raffinot, Department of Organization Sciences, University Paris Dauphine, Paris, France
Anta Tal Dia, Department of Preventive Medicine and Public Health, University Cheikh Anta Diop, Dakar, Senegal
Follow on us
The promotion of departmental units of health insurance (UDAM) is an essential path advocated by the State of Senegal to access to universal health coverage. The UDAM is a departmental mutual, professionalized with an expanded package of covered services and allowing early recourse of beneficiary patients to the public health structures of the district. After two years of implementation (2014-2015) from this initiative in a pilot phase, this work is to study the viability of UDAM Koungheul. A quantitative and qualitative evaluation study was conducted from July 20 to August 15, 2016. For the quantitative part, the study population of all records (logs and records) of members of UDAM Koungheul. A comprehensive recruitment files was conducted. An observation grid was crafted to collect data. As for the qualitative aspect, it was the UDAM officials, members, and non-members. Of individual interviews and focus group guides were used to collect the perceptions of these different targets on UDAM. Quantitative data were entered and analyzed using Excel 2007. Content analysis of about was conducted for qualitative data. Administratively, the UDAM had a good overall score of its operation tracking quality with 85% in 2014 and 100% in 2015 but gaps were noted in the use of some tools for managing and monitoring its operation. Functionally, the number of members and beneficiaries increased during 2015 with rates of monthly recoveries were around 100%. The penetration rate increased from 2% to 8% from 2014 to 2015. Technically, the beneficiaries of the least supported UDAM benefit costs covered compared to non-beneficiaries. Excluding this benefit to populations, UDAM was submitted the risks of abuse and adverse selection. Financially and economically, loss of membership fees failed to cover the cost of benefits with ratios of 52% (2014) and 55% (2015). The capital remained insufficient to cover its operating expenses and investment. Operating expense ratios for 2014 and 2015 were 85% and 176% respectively. The own financing rate increased from 62% to 35% in 2015. Apart from administrative and operational viabilities, other sustainability dimensions: technical, financial and technical threatened once the partner withdraws. Thus, it is important that the additional funding is UDAM able to fill the financial gap with the withdrawal of a partner to face the charges and to strengthen its outreach activities in order to join the people and retain members.
Risk Prevention, Health Insurance, Mutual, Viability
To cite this article
Mamadou Makhtar M. Backe Leye,
Ndeye Marème Sougou,
Anta Tal Dia,
Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal), Central African Journal of Public Health.
Vol. 5, No. 4,
2019, pp. 156-164.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
National Agency of Statistics and Demography. Demographic and Health Survey with Multiple Indicators in Senegal 2010-11 (EDS-MICS). Dakar: ANSD; 2012; 482p.
NHDP. National Health Development Plan 2009-2018. Dakar: MSAS; January 2009; 86p.
CIDR, GTZ et al. Report of the evaluation mission of the "Strengthening Community Capacity" component of GTZ. March 2005.
Ministry of Finance. Report of the Senegal Poverty Monitoring Survey ESPS 2005-2006. Dakar: ANSD; August 2007; 63p.
National Agency of Statistics and Demography (ANSD). Report on the General Census of Population and Housing, Agriculture and Livestock (RGPHAE) 2013. Dakar: ANSD; March 2014; 63p.
International Labor Office-International Center for Development and Research. Guide for monitoring and evaluating health microinsurance schemes. Geneva: ILO / STEP; 2001; 102p.
Butera J D. Effect of national mutual health guarantee fund on the use of health services in district and national referral hospitals. National University of Rwanda: School of Public Health. 2009.
From Allegri M, Sanon M, Sauerborn R. To enrol or not enrol? A qualitative investigation of demand for health insurance in rural West Africa, Social. Science Medicine. 2006a; 62 (6): 1520-1527.
Criel B., Barry A., Von Roenne F. The PRIMA project in Guinea Conakry. An experience of organization of mutual health in rural Africa. Brussels: Medicus Mundi Belgium; 2002; 255P.
Criel B, Waelkens MP. Declining subscriptions to the Maliando Mutual Health Organization in Guinea-Conakry (West Africa): what is wrong? Social Science Medicine. 2003; 57 (7): 1205-1219.
Basaza R, Criel B, Van Der Stuyft P. Community health insurance in Uganda: Why does enrolment remain low? A view from beneath. Health Policy. 2008; 87 (2): 172-184.
Fonteneau B. The challenges of health micro-insurance policies in West Africa. Policy framework, institutional environment, functioning and sustainability. Hoger Instituut voor de Arbeid, Leuven. 2004.
Emmanuel M B. Evaluation of the mutual health insurance of Manjo state of the places, analysis of the problems and proposal of the measures of adjustment. Evaluation 1. Manjo (Cameroon): Provincial Cell of Promotion and Development of Health Mutuals. Provincial Unit for Promotion and Development of Mutual Health / GTZ; April 2010. 65p.
Criel B, Blaise P, Ferette D. Health Mutuals in Africa and quality of care in services: a dynamic interaction. in G Dussault, P Fournier, A Letourmy (eds), Health Insurance in Francophone Africa; improve access to care and fight against poverty. Health, Nutrition and Population Series, International Bank for Reconstruction and Development / The World Bank, Washington, 2006: 353-372.
Nsiah-Boateng E, Aikins M. Performance assessment of Ga district mutual health insurance scheme, Greater Accra Region, Ghana. Value in health regional issues. 2013; 2: 300-5.
Toussiida Kagambega M. Low-income populations and health protection in Burkina Faso: the conditions for people's adherence to mutualist principles. Sociologies; 2014.
Meessen B, Criel B, Kegels G. Formal arrangements for pooling health risks in sub-Saharan Africa: ways to think about obstacles encountered. International Social Security Review. 2002; 55: 91-116.
Kanyeshuli J. and Kakoma JB. Study of the viability of health mutuals: case of the health mutual of the district of Musanze / Rwanda (2006-2008). Rwandan Medical Review. 2010; 68 (4): 41-46.
Leye MM M M Diongue, Faye A, Coumé M, Faye A, Tall AB Niang K Wone I, Seck I, P Ndiaye, Tall A Dia. Analysis of the operation of the free care plan for elderly people "Plan Sesame" in Senegal. Public health. 2013; 1 (25): 101-106.
Waelkens MP, Criel B. Mutual health insurance in sub-Saharan Africa. State of play and reflections on a research agenda, HNP Discussion Paper, World Bank, Washington DC. 2004.