MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Senegal depends heavily on foreign assistance, which in 2007 represented about 23% of overall
government spending [6]. However, in health, Senegal is less dependent on donor resources than
are many countries in SSA.
Over the last ten years, government contributions to health system financing have become
increasingly important as has the contribution of Senegalese households through user fees.
Figure 1: Trends in Senegal’s health system funding - billions of XOF (1 USD= 500 XOF)
(by source of funding, 1998 to 2007).
Source: Draft PNDS- 03, November 2008.
Senegal’s public health system has swung between horizontal and vertical programming ever
since the French colonial administration began providing free medical services to all “indigenous
populations” in 1905. For most of the last decade the National Health and Social Development
Plan (“Plan National de Développement Sanitaire et Social,” or PNDS-1) has governed national
health strategy. Covering the years 1998-2007, PNDS-1 adopted a “horizontal,” integrative model
of health action with payment for health services as a part of its financing strategy. To complement
this policy, Senegal put in place a set of subsidy initiatives to reduce barriers that prevented access
for specific groups and service areas. The adoption of the Millennium Development Goals (MDGs)
within the two Poverty Reduction Strategic Papers (PRSP) produced by Senegal (2003-2005 and
2006-2010) paved the way for the 2009-2018 Plan National de Développement Sanitaire (PNDS-2).
PNDS-2 is strongly results-oriented, aiming toward the achievement of the MDGs through specific
vertical national programmes (including those for HIV, TB, malaria and vaccination). Funding for
some of these programmes is heavily dependent on support from GHIs.
Senegal’s performance on the achievement of the health-related MDGs shows some important
improvements, especially in child health. Reproductive health care remains the weakest area. HIV
prevalence has increased, but this could be due to decreased AIDS mortality in an era when
antiretroviral therapy coverage is now estimated at 68.8 % (it was 29.3% in 2004) [7]. TB indicators
reveal weaknesses in the national TB programme that only started benefiting from Global Fund
support in 2008.
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