Senegalese communities unite to improve health services

For many Senegalese, getting basic health care is costly and time-consuming because they have no health clinics near their homes or the clinics lack equipment, medicine and other supplies. People walk long distances or pay for transportation by horse cart to reach a health facility. The consequences are that women often skip pre-natal consultations and give birth at home, contributing to high maternal mortality, children are not regularly immunized, and malaria, the number one killer in the country, often goes untreated until it is too late.

Senegal's policy of giving local governments responsibility for providing primary health care to their citizens, introduced in 1996, creates an opportunity to redress this situation. The difficulty is that local governments' financial resources are extremely limited and they have no experience working with health officials. USAID's community health initiatives project, implemented by Development Associates Inc., seeks to bring elected local councilors, community members and health workers together to identify the health needs in their community and carry out priority projects using a combination of local revenue (mostly head taxes), modest transfers from central government and incentive matching grants from USAID. Communities receive matching grants for three successive years, with the percentage of the match declining over the period.

In the fourth year, communities still receive assistance with their planning process but are expected to fund health activities entirely with their own revenues increased by funds from local or central partners. To date, the project has worked with 145 local governments out of 441 in the country and spent, over the last three years $1,351,793 in matching grants. At end of this second phase of the project (3 years) the project will work with 214 local governments in the regions of Fatick, Louga, Kaolack , Thiès , and Ziguinchor.

The fruits of this collaboration are evident in every community. Almost all have built health huts -- two-room structures where people chosen by the community provide rudimentary care and medical personnel visit regularly to provide more advanced services. The health agent in one village commented that before they had a health hut, most women gave birth at home but now all of them do pre-natal consultations and come to the health hut to deliver. The health huts extend the reach of the primary health care system and are a tangible reminder to villagers of their taxes at work.

The marked improvement in health services has inspired some communities to do more. Joal, the birthplace of Senegal's first president, has upgraded its health center, brought medical specialists for regular visits and improved neighborhood sanitation. During the community's most recent planning session, women's and youth groups pressured the local council to increase the health budget and pledged to make their own contribution. Creating the reflex to listen to the needs of the population and invest the community's own resources in health is exactly what the project strives to do.

The municipality of Kahone began working on health financing five years ago under a pilot USAID project. At that time, the only health facility for 10,000 residents was a two-room maternity with little equipment that was rarely used. After several years of investing their own funds and receiving matching grants, the municipality has built six health huts and a modern, well-equipped health post that serves 15-20 people a day. When the nurse running the post was transferred, the municipality had trouble finding a replacement so it built a house next to the post and was soon able to fill the position. In 2004, Kahone no longer receives a matching grant but it plans to spend $18,000 of its own revenues, 8% of its budget (the budget spent in 2002 totals $225,000) for health services.

The mayor of Kahone, Cheikh Mbaye, says that the majority of the municipality's problems in terms of infrastructure and equipment have been addressed. Now, he says, "it is for us, the elected representatives of the people, to continue the route that [the project] has traced."