@article{fdi:010093875,
  title = {{T}he sustainability of two departmental health insurance units in {S}enegal : a qualitative study},
  author = {{R}idde, {V}al{\'e}ry and {K}ane, {B}. and {M}bow, {N}.{B}. and {S}enghor, {I}. and {F}aye, {A}.},
  editor = {},
  language = {{ENG}},
  abstract = {{D}espite decades of implementation, community-based health insurance ({CBHI}) in {A}frica has not effectively achieved {U}niversal {H}ealth {C}overage ({UHC}). {A}s a response, from 2014 to 2017, a {B}elgian-{S}enegalese project organized an alternative solution: {D}epartmental {H}ealth {I}nsurance {U}nits ({UDAM}). {P}rofessionals managed {UDAM}s at a departmental level, and healthcare providers charged a flat-rate fee. {W}hile research on sustainability is scarce in {A}frica, this study aims to understand the factors that explain why, four years after the end of the project, {UDAM}s are sustained. {T}his qualitative research used {S}chell et al. (2013) conceptual framework on factors influencing sustainability. {T}he data came from 13 months of field observations, a documentation review, 120 interviews at the local level and nine at the regional and national level, and a focus group. {W}e carried out a thematic analysis according to the conceptual framework. {T}he results show that central political support has strengthened over time. {UDAM}s have managed to stabilize their funding through {S}tate subsidies and social marketing strategies to improve membership. {UDAM}s kept their management fees at 13%, below the 25% standard proposed by the {W}est {A}frican {E}conomic and {M}onetary {U}nion. {M}ultiple partnerships have been established at international, national, and local levels. {B}uilding on the professionalization of its staff, {UDAM}s have strengthened their organizational capacity. {I}nternal controls and a complaints system have been organized to improve {UDAM}s' accountability. {M}any communication activities were carried out before the end of the project to prepare the exit strategy. {W}ith their extensive coverage (penetration rate over 60%), {UDAM}s impact the health system (between 2014 and 2021, they paid 2.5 million {EUR} to healthcare providers). {I}nnovations have been implemented, such as organizing a group contribution based on collective work in fields of culture supported by the communities and local stakeholders. {A}s part of its {UHC} strategy, {S}enegal decided at the end of 2022 to transition its 676 communal {CBHI} into 46 departmental units. {T}he sustainability of two {UDAM}s has demonstrated the relevance of this model. {H}owever, sustainability can only be assured if the {S}tate prioritizes the health sector and donors place greater emphasis on alignment and sustainability. {W}e need to study how it is organized to scale up nationally.},
  keywords = {{SENEGAL}},
  booktitle = {},
  journal = {{SSM} - {H}ealth {S}ystems},
  volume = {2},
  numero = {},
  pages = {100006 [10 ]},
  ISSN = {2949-8562},
  year = {2024},
  DOI = {10.1016/j.ssmhs.2023.100006},
  URL = {https://www.documentation.ird.fr/hor/fdi:010093875},
}