MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Senegal: The effects of Global Health Initiatives on
the health system
Abstract
Papa Salif Sow, * Fatou Francesca Mbow, † Aliou Diallo, ‡ Demba Dione, ‡ Marième Ba ,‡
Senegal depends heavily on foreign assistance. In the health sector, however, Senegal is less
dependent on donor resources than many other countries in sub-Saharan Africa (SSA). Qualitative
and quantitative research on the interaction of GHIs and the health system in Senegal found an
important joint effort to ensure national ownership and to promote equitable access through
support for subsidies and promotion of increased service coverage. There are important GHIsupported
programmes that balance the weaknesses of the health system. Moreover, the funding
they provide is relatively independent of political changes and helps promote accountability by
linking funding to performance (although assessment of performance requires a sound
monitoring and evaluation (M&E) system which the researchers found to be weak). In some areas,
however, the interaction between GHIs and health systems was found to be less positive.
Promoting health system quality requires that clients be able to access physicians’ expertise if
desired. GHIs should also be better integrated with other global initiatives with significant
implications for population health, such as the environment.
Background
Senegal is bordered by Mauritania to the north; Mali to the east; and Guinea and Guinea-Bissau to
the south. It is home to 12.4 million people and averaged a 2.6% population growth rate from 2001
to 2007 [1]. Senegal ranked 153rd out of 179 countries on the UN Human Development Index in
2006 [2]. Since 1997, the country’s real gross domestic product (GDP) growth has averaged 4.5%
[3]. Official development assistance to Senegal was USD 824.9 million in 2006 [4]. The country’s
total external debt was USD 1.98 billion or 21.4% of GDP [3],[4].
Senegal has one of the lowest rates of HIV prevalence in sub-Saharan Africa (SSA), due in part to
the quick response from government and civil society after the first AIDS case was diagnosed in
1986. In 2007, there were 67,000 people living with HIV [5].
* Infectious Diseases Department, Fann’s Teaching Hospital, Dakar, Senegal (Study Coordinator)
† Independent Consultant, Dakar, Senegal (Senior Research Assistant)
‡ Ministry of Health, Dakar, Senegal (Research Assistant)
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