Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)

Mamadou Makhtar M. Backe Leye; Oumar Bassoum; Ndeye Marème Sougou; Marc Raffinot; Anta Tal Dia

doi:doi:10.11648/j.cajph.20190504.14

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Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)

Mamadou Makhtar M. Backe Leye, Oumar Bassoum, Ndeye Marème Sougou, Marc Raffinot, Anta Tal Dia

Published in Central African Journal of Public Health (Volume 5, Issue 4)

Received: 25 March 2019 Accepted: 17 June 2019 Published: 1 July 2019

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Abstract

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.

Published in	Central African Journal of Public Health (Volume 5, Issue 4)
DOI	10.11648/j.cajph.20190504.14
Page(s)	156-164
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Risk Prevention, Health Insurance, Mutual, Viability

References

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[2]	NHDP. National Health Development Plan 2009-2018. Dakar: MSAS; January 2009; 86p.
[3]	CIDR, GTZ et al. Report of the evaluation mission of the "Strengthening Community Capacity" component of GTZ. March 2005.
[4]	Ministry of Finance. Report of the Senegal Poverty Monitoring Survey ESPS 2005-2006. Dakar: ANSD; August 2007; 63p.
[5]	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.
[6]	International Labor Office-International Center for Development and Research. Guide for monitoring and evaluating health microinsurance schemes. Geneva: ILO / STEP; 2001; 102p.
[7]	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.
[8]	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.
[9]	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.
[10]	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.
[11]	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.
[12]	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.
[13]	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.
[14]	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.
[15]	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.
[16]	Toussiida Kagambega M. Low-income populations and health protection in Burkina Faso: the conditions for people's adherence to mutualist principles. Sociologies; 2014.
[17]	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.
[18]	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.
[19]	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.
[20]	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.

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APA Style

Mamadou Makhtar M. Backe Leye, Oumar Bassoum, Ndeye Marème Sougou, Marc Raffinot, Anta Tal Dia. (2019). Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal). Central African Journal of Public Health, 5(4), 156-164. https://doi.org/10.11648/j.cajph.20190504.14

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ACS Style

Mamadou Makhtar M. Backe Leye; Oumar Bassoum; Ndeye Marème Sougou; Marc Raffinot; Anta Tal Dia. Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal). Cent. Afr. J. Public Health 2019, 5(4), 156-164. doi: 10.11648/j.cajph.20190504.14

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AMA Style

Mamadou Makhtar M. Backe Leye, Oumar Bassoum, Ndeye Marème Sougou, Marc Raffinot, Anta Tal Dia. Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal). Cent Afr J Public Health. 2019;5(4):156-164. doi: 10.11648/j.cajph.20190504.14

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@article{10.11648/j.cajph.20190504.14,
  author = {Mamadou Makhtar M. Backe Leye and Oumar Bassoum and Ndeye Marème Sougou and Marc Raffinot and Anta Tal Dia},
  title = {Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)},
  journal = {Central African Journal of Public Health},
  volume = {5},
  number = {4},
  pages = {156-164},
  doi = {10.11648/j.cajph.20190504.14},
  url = {https://doi.org/10.11648/j.cajph.20190504.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20190504.14},
  abstract = {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.},
 year = {2019}
}

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TY - JOUR
T1 - Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)
AU - Mamadou Makhtar M. Backe Leye
AU - Oumar Bassoum
AU - Ndeye Marème Sougou
AU - Marc Raffinot
AU - Anta Tal Dia
Y1 - 2019/07/01
PY - 2019
N1 - https://doi.org/10.11648/j.cajph.20190504.14
DO - 10.11648/j.cajph.20190504.14
T2 - Central African Journal of Public Health
JF - Central African Journal of Public Health
JO - Central African Journal of Public Health
SP - 156
EP - 164
PB - Science Publishing Group
SN - 2575-5781
UR - https://doi.org/10.11648/j.cajph.20190504.14
AB - 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.
VL - 5
IS - 4
ER -

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Author Information

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

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APA Style

Mamadou Makhtar M. Backe Leye, Oumar Bassoum, Ndeye Marème Sougou, Marc Raffinot, Anta Tal Dia. (2019). Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal). Central African Journal of Public Health, 5(4), 156-164. https://doi.org/10.11648/j.cajph.20190504.14

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ACS Style

Mamadou Makhtar M. Backe Leye; Oumar Bassoum; Ndeye Marème Sougou; Marc Raffinot; Anta Tal Dia. Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal). Cent. Afr. J. Public Health 2019, 5(4), 156-164. doi: 10.11648/j.cajph.20190504.14

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AMA Style

Mamadou Makhtar M. Backe Leye, Oumar Bassoum, Ndeye Marème Sougou, Marc Raffinot, Anta Tal Dia. Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal). Cent Afr J Public Health. 2019;5(4):156-164. doi: 10.11648/j.cajph.20190504.14

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@article{10.11648/j.cajph.20190504.14,
  author = {Mamadou Makhtar M. Backe Leye and Oumar Bassoum and Ndeye Marème Sougou and Marc Raffinot and Anta Tal Dia},
  title = {Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)},
  journal = {Central African Journal of Public Health},
  volume = {5},
  number = {4},
  pages = {156-164},
  doi = {10.11648/j.cajph.20190504.14},
  url = {https://doi.org/10.11648/j.cajph.20190504.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20190504.14},
  abstract = {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.},
 year = {2019}
}

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