Ridde Valéry auteur aut IRD Ba M. F. auteur aut IRD Guyot M. auteur aut IRD Kane B. auteur aut IRD Mbow N. B. auteur aut IRD Senghor I. auteur aut IRD Faye A. auteur aut IRD text journalArticle eng text/pdf born digital access In an effort to establish universal health coverage (UHC), Senegal set up two departmental health insurance units (UDAM) to scale-up health insurance to rural communities. Part of this innovation meant that health insurance was no longer managed by volunteers, but by professionals. Several years after the conclusion of the project in 2017 that supported their initial development, both UDAMs still operate successfully. This mixed methods research aims to understand the factors that have contributed to the sustainability of both UDAMs, as well as discuss the remaining challenges. The factors deemed favourable to sustainability are actions undertaken to ensure financial stability and organizational risk taking. However, the mobilization of the population, relationships with health professionals and the role of the State have been more difficult to organize. Challenges concern the payment of subsidies and the supply of medicines by the State and partnership with the health care system, the maintenance of contributions, the digitalization of administration, as well as fraud and abuse. specialized social protection health social security financing universal benefit scheme coverage Senegal SENEGAL 056 75 2 97-117 2022 0020-871X https://www.documentation.ird.fr/hor/fdi:010085262 10.1111/issr.12300 0020-871X [F B010085262] https://www.documentation.ird.fr/hor/fdi:010085262 https://www.documentation.ird.fr/intranet/publi/2022-09/010085262.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2022-09-02 2025-02-24 fdi:010085262 fre