Healthcare in Senegal

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Dimboli Health Post (Kedougou region, September 2009 Dimboli Health Post.jpg
Dimboli Health Post (Kédougou region, September 2009

Healthcare in Senegal is a center topic of discourse in understanding the well-being and vitality of the Senegalese people. As of 2008, there was a need to improve Senegal's infrastructure to promote a healthy, decent living environment for the Senegalese. [1]

Contents

Additionally, the country needs more doctors and health personnel, particularly general practitioners, gynecologists, obstetricians, pediatricians, pulmonologist, and cardiologists. In fact, Senegal has seven doctors per 100,000 citizens, while 32% of rural citizens have no access to medical care at all. [2] [3] Moreover, there is a strong need to have more of these personnel in rural areas: in 2008, Senegal had only twenty full-fledged hospitals, seven of which are in Dakar. [4]

From approximately 1905 to the present, there have been significant shifts in Senegal's healthcare system, the system's structures, specific diseases that are problematic in Senegal, as well as issues affecting women and children and access to healthcare in the country. As of 2019, there were 1,347 medical facilities, including 20 major hospitals. [5]

History

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, France laid the foundation for health policy in the area, though primarily to serve the French colonial officials and not the native Senegalese. Imperialist extraction from African colonies meant that the health care infrastructure was primarily constructed in large, coastal cities such as Dakar. [6] Infrastructure in rural areas was largely left out of the picture. Later in 1905, Medical Assistance for the Indigenous was created. It was responsible for providing free medical care and health advice to indigenous peoples, promoting immunization, and promoting maternal and child health. After the Second World War, international public opinion became more critical of colonial policy, and comprehensive programs were put in place to fight against major diseases. Since its independence from France, Senegal has become more involved in major international programs for development and health. Some historians argue that the commoditization and commercialization of healthcare, moving from the colonial to the post-colonial era, has reduced health care to a convenience that is only available to the wealthy, with those in dire poverty often unable to access care. [6] As a result of the development of health care infrastructure in the colonial era by the French, access remains very uneven across regions and between income levels.

Organization of the health care system

Dakar Government Palace and Hospital, circa 1920. AOF-Dakar-Palais du Gouvernement.JPG
Dakar Government Palace and Hospital, circa 1920.

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. [7] Rural health care is divided into three parts: health centers, health posts, and health points. Health centers are at the top, with one to two medical doctors and 15-20 people as part of the health staff. Health posts are below these, with four or five health workers. At the lowest level are health points, which house one or two health agents and a midwife. [7] The system has been the subject of much criticism, especially because of the increasing demands of profitability and the corruption in this part of the government as in other domains of public life.

Hospitals

Senegal, administrative divisions in colour 2.svg

In 2019, there were 1,347 medical facilities in Senegal, including 13 regional hospitals, 5 national hospitals and two university hospitals. The largest number of hospitals was in the Dakar Region. [5]

In 2021, four new hospitals were established in Touba, Kaffrine, Kédougou and Sédhiou.

Hospitals in Senegal
NameRegionType HospitalCoordinatesRef
Abass Ndao University Hospital Center Dakar Region University hospital center 14°41′06″N17°27′17″W / 14.6849985°N 17.454746399°W / 14.6849985; -17.454746399 (Abass Ndao University Hospital Center) [5]
Albert Royer National Hospital Center Dakar Region National hospital center 14°41′35″N17°27′54″W / 14.6931815895173°N 17.4650645256042°W / 14.6931815895173; -17.4650645256042 (Albert Royer National Hospital Center) [5]
Amadou Dieuguene Regional Hospital Thiès Region Regional hospital 14°45′08″N16°54′52″W / 14.7521°N 16.9145°W / 14.7521; -16.9145 (Amadou Dieuguene Regional Hospital) [5]
Aristide Le Dantec Hospital Center Dakar Region National hospital center 14°39′26″N17°26′12″W / 14.65735°N 17.43672°W / 14.65735; -17.43672 (Aristide Le Dantec Hospital Center) [5] [8]
De Syllacounda Hospital Kédougou Region Hospital 12°43′16″N12°07′26″W / 12.721029114581958°N 12.123975817554232°W / 12.721029114581958; -12.123975817554232 (De Syllacounda Hospital) [9]
Elisabeth Diouf de Rufisque Hospital Dakar Region Hospital 14°42′54″N17°16′48″W / 14.715°N 17.28°W / 14.715; -17.28 (Elisabeth Diouf de Rufisque Hospital) [5]
Fann University Hospital Center Dakar Region University hospital center 14°41′34″N17°27′58″W / 14.6929°N 17.46621°W / 14.6929; -17.46621 (Fann University Hospital Center) [5] [8] [10]
Fatick Regional Hospital Fatick Region Regional hospital 14°19′41″N16°24′15″W / 14.3280309853688°N 16.4041972160339°W / 14.3280309853688; -16.4041972160339 (Fatick Regional Hospital) [5]
Grand Yoff General Hospital Dakar Region General hospital 14°43′54″N17°26′41″W / 14.731667°N 17.444722°W / 14.731667; -17.444722 (Grand Yoff General Hospital) [5]
Kaffrine Regional Hospital Kaffrine Region Regional hospital 14°05′56″N15°33′25″W / 14.099°N 15.557°W / 14.099; -15.557 (Kaffrine Regional Hospital) [5]
Kaolack Regional Hospital Kaolack Region Regional hospital 14°10′57″N16°15′12″W / 14.1825°N 16.2533°W / 14.1825; -16.2533 (Kaolack Regional Hospital) [5]
Kolda Regional Hospital Kolda Region Regional hospital 12°53′34″N14°56′27″W / 12.8928091142872°N 14.9407732486724°W / 12.8928091142872; -14.9407732486724 (Kolda Regional Hospital) [5]
La Paix Hospital Ziguinchor Region Hospital 12°34′07″N16°16′34″W / 12.5686028°N 16.2761°W / 12.5686028; -16.2761 (La Paix Hospital) [5]
Louga Regional Hospital Louga Region Regional hospital 15°37′22″N16°13′12″W / 15.62266°N 16.22008°W / 15.62266; -16.22008 (Louga Regional Hospital) [5]
Lubke Regional Hospital Diourbel Region Regional hospital 14°38′36″N16°13′56″W / 14.6434239°N 16.232144°W / 14.6434239; -16.232144 (Lubke Regional Hospital) [5]
Maguette Lo Hospital Louga Region Hospital 15°26′13″N15°13′10″W / 15.4370399°N 15.21948079°W / 15.4370399; -15.21948079 (Maguette Lo Hospital) [5]
Matam Regional Hospital Matam Region Regional hospital 15°39′36″N13°15′42″W / 15.659878°N 13.261768°W / 15.659878; -13.261768 (Matam Regional Hospital) [5]
Matlaboul Fawzaïni Hospital Center Diourbel Region National hospital center 14°51′30″N15°54′32″W / 14.858285°N 15.908856°W / 14.858285; -15.908856 (Matlaboul Fawzaïni Hospital Center) [5]
Military Hospital of Ouakum Dakar Region Military hospital 14°43′01″N17°28′59″W / 14.716819224276515°N 17.48296624743821°W / 14.716819224276515; -17.48296624743821 (Military Hospital of Ouakum) [11]
Ndamatou Hospital Diourbel Region Hospital 14°51′30″N15°51′46″W / 14.8584398469°N 15.8627434974°W / 14.8584398469; -15.8627434974 (Ndamatou Hospital) [5]
Ndioum Regional Hospital Saint-Louis Region Regional hospital 16°30′46″N14°38′50″W / 16.5129°N 14.6471°W / 16.5129; -14.6471 (Ndioum Regional Hospital) [5]
Ouroussogui Hospital Matam Region Hospital 15°36′13″N13°19′49″W / 15.6036959°N 13.3303938°W / 15.6036959; -13.3303938 (Ouroussogui Hospital) [5]
Pikine Centre National Hospital Dakar Region National hospital center 14°44′55″N17°23′19″W / 14.74873°N 17.38874°W / 14.74873; -17.38874 (Pikine Centre National Hospital) [5]
Principal Hospital Dakar Region National hospital center, Military hospital 14°39′41″N17°26′05″W / 14.661344°N 17.43477°W / 14.661344; -17.43477 (Principal Hospital) [5] [8] [11]
Roi Baudoin Hospital Dakar Region Hospital 14°46′25″N17°23′04″W / 14.7737465°N 17.38430859°W / 14.7737465; -17.38430859 (Roi Baudoin Hospital) [5]
Saint-Louis Regional Hospital Saint-Louis Region Regional hospital 16°01′23″N16°30′21″W / 16.023023°N 16.505927°W / 16.023023; -16.505927 (Saint-Louis Regional Hospital) [5]
Sedhiou Regional Hospital Sédhiou Region Regional hospital 12°42′17″N15°33′22″W / 12.704604°N 15.55623°W / 12.704604; -15.55623 (Sedhiou Regional Hospital) [5]
Tambacounda Regional Hospital Tambacounda Region Regional hospital 13°46′44″N13°40′25″W / 13.7788623°N 13.6736359°W / 13.7788623; -13.6736359 (Tambacounda Regional Hospital) [5]
Tivaouane Hospital Thiès Region Hospital 14°56′59″N16°48′50″W / 14.949584°N 16.813847°W / 14.949584; -16.813847 (Tivaouane Hospital) [5]
Youssou Mbargane Diop Hospital Dakar Region Hospital 14°43′34″N17°15′35″W / 14.7262171°N 17.2597°W / 14.7262171; -17.2597 (Youssou Mbargane Diop Hospital) [5]
Ziguinchor Regional Hospital Ziguinchor Region Regional hospital 12°33′30″N16°16′56″W / 12.558208°N 16.282158°W / 12.558208; -16.282158 (Ziguinchor Regional Hospital) [5]
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Financing care

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. [12] Additionally, only 15.2% of Senegalese people have health insurance, most of whom work in the formal sector. [12] On average, a facility charges US$2.90 for inpatient care for the median length of stay (five days), US$0.43 for adult outpatient care, and US$0.24 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. [12] A study assessing health policy in Senegal concluded that government institutions should play a central role in "all stages of the policy process" and should implement "defined policies"; [13] the study recommended focusing more on efforts to implement existing policies, instead of voting new laws without follow through.

Changes to health care strategies

Bamako Initiative

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 WHO and UNICEF to discuss the limited success of health care strategies in Africa and the need for intervention. [14] At the conference, leaders agreed to provide a minimum of health care services with severely reduced social services budgets. As a result of the meeting, major changes to Senegal's health system occurred. The meeting resulted in the decentralization of Senegal's health sector, which some critics believe has brought about chaos in local governments and administration in Senegal.

The Bamako Initiative also led to the establishment of health committees in Senegal in 1992. The committees strive to meet three central goals: to promote health of their community, to mobilize the community around health development, and to improve the quality of services rendered at their health post, clinic, or hospital. [14] In practice, the committees have not been completely representative, and have become problematic to clinic staff and medical personnel. Women have been almost entirely absent from committee elections and seldom are selected for committee boards. Rather, these boards are held by males who may ignore the needs of women, children, and the disadvantaged in their committees. Critics believe the committees have been characterized by mismanagement, mistrust, and a lack of transparency. Despite these issues, there have been significant gains from the Bamako Initiative and health committees. The changes have led to the improved availability of pharmaceuticals, and have also made up for the shortage of health personnel in many instances. [14]

Decentralization

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. [14] 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. [14] 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. [15]

Privatization

In addition to changes with the Bamako Initiative and decentralization, Senegalese healthcare has become privatized. Privatization in Senegal has meant that user fees and the sales of pharmaceuticals finance a significant part of the health sector. [14] The state still funds the health sector by paying salaries of state employees and giving each district a discretionary budget each year that it decides. However, user fees and pharmaceutical sales are only the most evident parts of the privatized health system in Senegal. Now, patients must buy a ticket to stand in line and receive care at a health clinic, which can be particularly problematic for mothers, the elderly, and the poorest of the poor. [14] Moreover, hospitals require even more available cash. The effects of privatization in have especially disadvantaged women, because they typically manage the health of the household. Additionally, many preventable deaths have occurred as a direct result of privatization.

Digitalization

In June 2021, Senegal's Agency for Universal Health launched sunucmu.com (SunuCMU), a website that the agency hopes will streamline health care in the country. The website is a part of the Minister of State Mohammad Abdallah Dionne's plan for digitalization. He aims to make Senegal's health care system effective and sustainable. Using SunuCMU, Senegal hopes to achieve 75 percent coverage within two years of the launch. [3]

The website shows four clear initiatives: [16]

Health care utilization

Two women and an infant at a maternity ward on Niodior Island, Sine Saloum, Senegal (January 2006). Niodior2.jpg
Two women and an infant at a maternity ward on Niodior Island, Sine Saloum, Senegal (January 2006).

Health care utilization in Senegal has been shaped by a variety of factors. Women have a greater likelihood of using care than men by 1.4 percentage points. [12] At the individual level, the likelihood of seeking treatment is influenced by the relationship to the head of the household, employment status, gender, and age. It has been found that wealthier people are also more likely to use care by 8 percentage points than the poorest. Moreover, workers who belong to households that require a high load of farm work are less likely to seek care by 7.5 percentage points than the non-workers of households with a low agricultural work requirement. [12]

Barriers to healthcare and medicine

The implementation and spread of healthcare and medicine in Senegal is slow and faces barriers. Some of the greatest barriers to health care utilization include lack of information, lack of communication, [17] low number of health care workers, social and religious barriers, and overreliance on traditional medicine. According to a study done in 2017, 97.7% of households were not visiting a dentist annually. Only 25% of households consult a dentist when in pain, compared to 37% using traditional medicine as their first response to oral illnesses; [18] the study found that bigger households (> 5 members) tended to rely more on traditional medicine when facing oral pain. There is currently, there is a strong need for strategies to empower and better support the knowledge role of health coordinators and supervisors. [19] Additionally, the lack of access to current, relevant information by health professionals and decision-makers in Senegal has been problematic. Moreover, health workers desire information on ways to motivate men's involvement in reproductive health and to address rumors and religious barriers to family planning, which have hindered women's health care utilization. [19]

Healthcare providers are trying to raise the awareness of the population on modern medicine and its implication. Research has focused on the relationship between doctors and patients in Senegal, and its impact on medical outcomes. An anthropological study seeking to identify barriers to an effective TB control in Senegal showed that one of the main reasons why TB is underdiagnosed is because of poor-quality information given by healthcare providers to their patients. [20] Another study seeking for ways to improve adherence to TB treatment in the country showed that "improving patients counseling and communication, […] and reinforcement of supervision activities led to improvement in patient outcomes." [21] Thus, a good communication between doctors and patients is needed. Researchers examine how the role and actions of patients impacts the quality of care they receive. After analyzing TB patients and the way healthcare providers consulted them, the study found that doctors were 27% more likely to diagnose the disease correctly when patients shared more information. [17] Healthcare providers should also be trained on how to present medicine to a person who has never been in contact with modern medicine. [22] Better health outcomes in Senegal, research suggests, is obtained when the relationship between healthcare providers and patients is based on the sharing of information, care, and trust. This relationship will make patients more active during consultations and allow them to receive better treatments.

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. [23] In 2001, Senegal had only 520 pharmacies (1 per 18,320 people) and 731 health centers (1 per 13,032 people). Most of the population rely on traditional medicine without the use of modern drugs [24] and access to medicine in Senegal may be limited in three main areas: inadequate supply of drugs, including critical drugs missing in health centers and pharmacies; insufficient health infrastructures to cover needs of the entire population; and high costs of drugs, which are sometimes higher than the minimum price, which can be problematic for the poorest of the poor. [23]

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 Dakar, the capital city. However, only 42% of the Senegalese population lives in urban areas, such as Dakar, which means that few doctors are available to rural residents. [25] Of every 10,000 women who give birth, 24 will die in urban areas, but nearly 100 will die in rural areas. [7] Additionally, there are major disparities in children's nutrition in urban versus rural areas, with those in rural areas being more heavily disadvantaged. [1] Therefore, great attention may be placed on narrowing the gap between urban and rural healthcare access.

Narrowing the gap between rural and urban areas is done by training and attracting health professionals to remote areas. Physicians, nurses, and midwives require special training on how to work with patients who have never been in contact with modern medicine and have not learned modern health-seeking behaviors. Health workers would endure better and for longer periods in remote areas of the country if they were offered permanent contracts and better equipment. [22] The "Plan Cobra" project was launched in 2006, and was a government effort to attract health professionals to underserved areas by hiring them under annual government contracts which offer them greater stability. Research also suggest that annual contracts may not be as effective in the long run, because workers do not stay in those regions after the end of their contract. [22]

Transportation to health facilities

Ambulance in Agnam-Goly, 2006 Ambulance de Agnam-Goly.JPG
Ambulance in Agnam-Goly, 2006
First local hospital ambulance with driver, Ziguinchor, 1973 ASC Leiden - Coutinho Collection - G 09 - Ziguinchor, Senegal - First hospital ambulance with driver - 1973.tiff
First local hospital ambulance with driver, Ziguinchor, 1973

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. [7] The closest high-level provider (i.e. a hospital) is located, on average, 20& km away from the village of the household. The improvement in the accessibility of health facilities through better road quality and better means of transport will have a positive effect on health care utilization. [12] Because of extreme distances and environmental conditions, such as muddy roads, only 32% of rural households have regular access to a health center and thereby access to a medical doctor. [7] There are two times more unpaved roads in Senegal than there are paved roads. [25] Often, there is trouble with transportation and vehicles in that non-governmental organizations, or NGOs, may not have a large enough fleet, or vehicles are inappropriate for terrain and dirt roads. [7] Some health centers have ambulances, but there is no plan for vehicle maintenance and replacement. Additionally, there are issues with the transportation of sick, pregnant women; 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. [7]

Maternal mortality

Midwife and birthing bed at an island in the Sine Saloum in Senegal, 2006. MidwifeSenegal.jpg
Midwife and birthing bed at an island in the Sine Saloum in Senegal, 2006.

Maternal mortality rates in Senegal remain high relative to those of more developed countries. In 2008, the World Health Organization estimated a maternal mortality rate of 450 deaths per 100,000 live births in Senegal. [26] Maternal deaths are typically clustered around labor, delivery, and the immediate postpartum period. One of the most prevalent issues is the regional imbalance in the distribution of health personnel and health indicators, with a disproportionate burden of disease in Eastern Senegal. Expanding coverage of healthcare workers present at birth, in particular midwifery care, can lessen delays, thus minimizing the risk of severe complications and even death. Increased numbers of health workers in a given region is associated with improved outcomes in maternal mortality. Additionally, extreme conservative practices and fundamentalism can limit dispersal of health personnel, especially that of midwives and other female health workers. [26]

Women and structural changes

In Senegal, gender relations have been largely ignored in processes of decentralization and implementation of community management strategies. [14] 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. [14]

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. [27] 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 Senegal have not made sexual health a priority, as some believe they should. [27]

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. [28] 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. [28] However, membership in a CBHI scheme is not always sufficient in influencing maternal health behaviors.

Community health workers (CHWs)

In Senegal 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. [29] During the coronavirus pandemic, these workers became a point of contact for many Senegalese citizens with limited access to other healthcare professionals. [30]

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 Senegal do not necessarily recognize in the CHW the skills necessary for outreach activities. [29]

Mental health

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. [31] Senegal has no national mental health program, but mental health issues are prevalent. In 2005, nearly 17% of children had emotional, behavioral or neuropsychiatric disorders. Additionally, 16% of adults had psychiatric illness. Primary sources of mental health financing include, in descending order, private insurance, social insurance, out of pocket expenditures by patient or family, and taxes. Mental health is part of primary health care system, with the treatment of severe mental disorders available at the primary level. NGOs are involved with advocacy, prevention, treatment, and rehabilitation. [31] Still, more attention and concern remains to be paid to mental health in Senegal.

See also

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<span class="mw-page-title-main">Health in Burkina Faso</span>

A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index. Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.

<span class="mw-page-title-main">Health care systems by country</span>

Examples of health care systems of the world, sorted by continent, are as follows.

The public healthcare system in India evolved due to a number of influences since 1947, including British influence from the colonial period. The need for an efficient and effective public health system in India is large.

Government-guaranteed health care for all citizens of a country, often called universal health care, is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at broadly extending access to health care and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis.

<span class="mw-page-title-main">Healthcare in Peru</span>

Peru has a decentralized healthcare system that consists of a combination of governmental and non-governmental coverage. Five sectors administer healthcare in Peru today: the Ministry of Health, EsSalud, and the Armed Forces (FFAA), National Police (PNP), and the private sector.

<span class="mw-page-title-main">Health in Senegal</span>

Expenditure on health in Senegal was 4.7% of its GDP in 2014, US$107 per capita.

<span class="mw-page-title-main">Healthcare in India</span>

India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. Economic Survey 2022-23 highlighted that the Central and State Governments’ budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It ranks 77th on the list of countries by total health expenditure per capita.

<span class="mw-page-title-main">Healthcare in Nicaragua</span>

Healthcare in Nicaragua involves the collaboration of private and public institutions. Although Nicaragua's health outcomes have improved over the past few decades with the efficient utilization of resources relative to other Central American nations, it still confronts challenges responding to its population's diverse healthcare needs.

The Twelfth Five Year plan for health services in India covering 2012-2017 was formulated based on the recommendation of a High Level Experts Group (HLEG) and other stakeholder consultations. The long-term objective of this strategy is to establish a system of Universal Health Coverage (UHC) in the country. Key points include:

  1. Substantial expansion and strengthening of public sector health care system, freeing the vulnerable population from dependence on high cost and often unreachable private sector health care system.
  2. Health sector expenditure by central government and state government, both plan and non-plan, will have to be substantially increased by the twelfth five-year plan. It was increased from 0.94 per cent of GDP in tenth plan to 1.04 per cent in eleventh plan. The provision of clean drinking water and sanitation as one of the principal factors in control of diseases is well established from the history of industrialized countries and it should have high priority in health related resource allocation. The expenditure on health should increased to 2.5 per cent of GDP by the end of Twelfth Five Year Plan.
  3. Financial and managerial system will be redesigned to ensure efficient utilization of available resources and achieve better health outcome. Coordinated delivery of services within and across sectors, delegation matched with accountability, fostering a spirit of innovation are some of the measures proposed.
  4. Increasing the cooperation between private and public sector health care providers to achieve health goals. This will include contracting in of services for gap filling, and various forms of effectively regulated and managed Public-Private Partnership, while also ensuring that there is no compromise in terms of standards of delivery and that the incentive structure does not undermine health care objectives.
  5. The present Rashtriya Swasthya Bima Yojana (RSBY) which provides cash less in-patient treatment through an insurance based system should be reformed to enable access to a continuum of comprehensive primary, secondary and tertiary care. In twelfth plan period entire Below Poverty Line (BPL) population will be covered through RSBY scheme. In planning health care structure for the future, it is desirable to move from a 'fee-for-service' mechanism, to address the issue of fragmentation of services that works to the detriment of preventive and primary care and also to reduce the scope of fraud and induced demand.
  6. In order to increase the availability of skilled human resources, a large expansion of medical schools, nursing colleges, and so on, is therefore necessary and public sector medical schools must play a major role in the process. Special effort will be made to expand medical education in states which are under-served. In addition, a massive effort will be made to recruit and train paramedical and community level health workers.
  7. The multiplicity of Central sector or Centrally Sponsored Schemes has constrained the flexibility of states to make need based plans or deploy their resources in the most efficient manner. The way forward is to focus on strengthening the pillars of the health system, so that it can prevent, detect and manage each of the unique challenges that different parts of the country face.
  8. A series of prescription drugs reforms, promotion of essential, generic medicine and making these universally available free of cost to all patients in public facilities as a part of the Essential Health Package will be a priority.
  9. Effective regulation in medical practice, public health, food and drugs is essential to safeguard people against risks and unethical practices. This is especially so given the information gaps in the health sector which make it difficult for individual to make reasoned choices.
  10. The health system in the Twelfth Plan will continue to have a mix of public and private service providers. The public sector health services need to be strengthened to deliver both public health related and clinical services. The public and private sectors also need to coordinate for the delivery of a continuum of care. A strong regulatory system would supervise the quality of services delivered. Standard treatment guidelines should form the basis of clinical care across public and private sectors, with the adequate monitoring by the regulatory bodies to improve the quality and control the cost of care,

In Senegal, abortion is illegal unless the life of the mother is in danger. Senegal is one of the only countries whose criminal code completely bans abortion. An exception requires a medical certificate and the approval of three doctors. Illegal abortion is punishable by fines and prison. Nearly all abortions in the country are unsafe. Post-abortion care is widely available.

References

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  2. ↑ "Physicians (per 1,000 people) - Senegal | Data". data.worldbank.org. Retrieved 2021-07-06.
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