Agence Nationale de la Couverture Maladie Universelle, Dakar, Senegal.
Graduate School of Economics, Hitotsubashi University, Tokyo, Japan.
Bull World Health Organ. 2020 Feb 1;98(2):100-108. doi: 10.2471/BLT.19.239665. Epub 2019 Dec 5.
Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, . One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country.
推进公共医疗保险体系是塞内加尔政府实现全民健康覆盖的关键战略之一。2013 年，政府启动了一项全民健康财务保障计划， 其中一个目标是为 2013 年以前未参保的非正规部门人群建立一个社区为基础的健康保险计划。该计划通过非营利性社区组织提供保障，到 2016 年底，全国已经建立了 676 个组织。然而，这些组织面临着一些挑战，如参保率低和保障计划的便携性低。为了解决这些挑战，并改善社区为基础的健康保险计划的治理和运营，政府自 2018 年以来规划并部分实施了两项重大改革。第一项改革涉及一系列机构重组，以提高风险池的规模。这些重组包括将风险聚集和部分保险管理从各个组织转移到部门联盟，并将弱势群体的免费医疗保健倡议的运营和财务责任转移到社区为基础的计划。第二项改革是引入一个综合管理信息系统，以实现计划的高效和有效数据管理和运营。在这里，我们讨论了社区为基础的健康保险计划的当前进展和未来发展计划，并讨论了政府在努力实现国家全民健康覆盖方面应解决的挑战。
