Improving health conditions
In Senegal, communities plan and finance their own health care

Village elders and community members in Koulouk Mbada play a pivotal role in planning for and financing their own health care. Photo: R. Nyberg, USAID

More than one third of Senegal’s population has seen improvements in community health care and infrastructure owing to a six-year, $15.8 million project financed by United States Agency for International Development (USAID).

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.  

USAID, in partnership with the Ministry in charge of decentralization and the Ministry of Health, creates an opportunity to redress this situation.  The health care decentralization project (Decentralisation et Initiative de Santé Communautaire - USAID-DISC), has helped local governments, in collaboration with health officials and civil society, to prioritize, plan, and budget for activities they choose based on their most pressing health needs.

Between 2000 and 2006, USAID-DISC, assisted 149 local governments in 22 health districts in the regions of Fatick, Kaolack, Louga, Thiès, and Ziguinchor.  In total, 37% of Senegal’s population of 11 million benefited from this support.

In 1996, lawmakers ratified new decentralization reforms that transferred greater decision-making responsibility to locally-elected officials.  Among the changes brought by the legislation, responsibility for planning local health development and managing health funds was transferred to local governments.

USAID-DISC’s main innovative approaches are twofold: 1) a matching grant program supporting decentralized health planning at the community level along with funding the plans locally developed with local resources, and 2) the introduction of contractual services between elected officials and health promoters.

The matching grant program has increased financial resources to fund the local health needs and reinforce participation of the population in securing their own health services.  It focused on accessibility, integration, and decentralization and helped mobilize $1.6 million from local taxes that the USAID-DISC project matched with $4.2 million to fund community health projects.  This money has been used to build or reinforce capacities of locally-elected health workers and members of local civil society.

Through the USAID-DISC project, communities built and equipped 277 health huts and rehabilitated and equipped 24 referral health centers, 138 health posts, and 162 health huts.

"What is important is the demonstration of good practices through the project, so people from other zones are able to profit from the approach of USAID," said Farba Lamine Sall, Cabinet Director in Senegal's Ministry of Health, who had previously worked for three years on the USAID-DISC activity.

Thanking USAID for its financial backing, Mr. Sall told a recent workshop:  "We are counting on a continued partnership, because what we have learned from the USAID-DISC project is that the community should decide and act upon its priorities."

According to Dr. Pape Amadou Diack, chief medical officer in the Thiès region, "USAID-DISC has done everything it set out to do.  There has been a true partnership.  We want this partnership to continue between the locally-elected officials, the community health promoters and civil society at large."

This approach taken by the USAID-DISC project will remain part of USAID’s strategy in the years to come.  In late 2006, USAID and the Government of Senegal signed a health assistance package for maternal and child health, activities for preventing HIV/AIDS, tuberculosis and malaria, and reinforcement of health services, planning, and financing at the community level.  The five-year program will be implemented in the regions of Kaolack, Kolda, Louga, Thiès, and Ziguinchor.