healthcare in senegal healthcare in senegal healthcare in senegal is a center topic of discourse in understanding the well-being and vitality of the senegalese people. as of 2008, there was a need to improve senegal's infrastructure to promote a healthy, decent living environment for the senegalese. dimboli health post (kedougou region, september 2009 additionally, the country needs more doctors and health personnel, particularly general practitioners, gynecologists, obstetricians, pediatricians, pulmonologist, and cardiologists. in fact, senegal has seven doctors per 100,000 citizens, while 32% of rural citizens have no access to medical care at all. moreover, there is a strong need to have more of these personnel in rural areas: in 2008, senegal had only twenty full-fledged hospitals, seven of which are in dakar. from approximately 1905 to the present, there have been significant shifts in senegal's healthcare system, the system's structures, specific diseases that are problematic in senegal, as well as issues affecting women and children and access to healthcare in the country. as of 2019, there were 1,347 medical facilities, including 20 major hospitals. history as is the case in the rest of the african continent, the senegalese have long used traditional medicines and rely on traditional healers for their ailments. during the colonial era, the health care system was drastically changed. in 1905, france laid the foundation for health policy in the area, though primarily to serve the french colonial officials and not the native senegalese. imperialist extraction from african colonies meant that the health care infrastructure was primarily constructed in large, coastal cities such as dakar. infrastructure in rural areas was largely left out of the picture. later in 1905, medical assistance for the indigenous was created. it was responsible for providing free medical care and health advice to indigenous peoples, promoting immunization, and promoting maternal and child health. after the second world war, international public opinion became more critical of colonial policy, and comprehensive programs were put in place to fight against major diseases. since its independence from france, senegal has become more involved in major international programs for development and health. some historians argue that the commoditization and commercialization of healthcare, moving from the colonial to the post-colonial era, has reduced health care to a convenience that is only available to the wealthy, with those in dire poverty often unable to access care. as a result of the development of health care infrastructure in the colonial era by the french, access remains very uneven across regions and between income levels. organization of the health care system dakar government palace and hospital, circa 1920. senegal's health system is pyramidal, with three main parts: a central level, a regional level, and a peripheral level. the central level contains the minister's office, branches, and related services. the regional level is known as the "medical region", an administrative region that addresses healthcare services within a given region. the peripheral level is known as the "health district", with each district having at least one health center and a network of smaller centers. the national health system is divided into three levels: regional hospitals, district health centers, and health posts. rural health care is divided into three parts: health centers, health posts, and health points. health centers are at the top, with one to two medical doctors and 15-20 people as part of the health staff. health posts are below these, with four or five health workers. at the lowest level are health points, which house one or two health agents and a midwife. the system has been the subject of much criticism, especially because of the increasing demands of profitability and the corruption in this part of the government as in other domains of public life. hospitals in 2019, there were 1,347 medical facilities in senegal, including 13 regional hospitals, 5 national hospitals and two university hospitals. the largest number of hospitals was in the dakar region. in 2021, four new hospitals were established in touba, kaffrine, kédougou and sédhiou. hospitals in senegal name region type hospital coordinates ref abass ndao university hospital centerdakar regionuniversity hospital center14.6849985°n 17.454746399°w﻿ / 14.6849985; -17.454746399﻿ (abass ndao university hospital center) albert royer national hospital centerdakar regionnational hospital center14.6931815895173°n 17.4650645256042°w﻿ / 14.6931815895173; -17.4650645256042﻿ (albert royer national hospital center) amadou dieuguene regional hospitalthiès regionregional hospital14.7521°n 16.9145°w﻿ / 14.7521; -16.9145﻿ (amadou dieuguene regional hospital) aristide le dantec hospital centerdakar regionnational hospital center14.65735°n 17.43672°w﻿ / 14.65735; -17.43672﻿ (aristide le dantec hospital center) de syllacounda hospitalkédougou regionhospital12.721029114581958°n 12.123975817554232°w﻿ / 12.721029114581958; -12.123975817554232﻿ (de syllacounda hospital) elisabeth diouf de rufisque hospitaldakar regionhospital14.715°n 17.28°w﻿ / 14.715; -17.28﻿ (elisabeth diouf de rufisque hospital) fann university hospital centerdakar regionuniversity hospital center14.6929°n 17.46621°w﻿ / 14.6929; -17.46621﻿ (fann university hospital center) fatick regional hospitalfatick regionregional hospital14.3280309853688°n 16.4041972160339°w﻿ / 14.3280309853688; -16.4041972160339﻿ (fatick regional hospital) grand yoff general hospitaldakar regiongeneral hospital14.731667°n 17.444722°w﻿ / 14.731667; -17.444722﻿ (grand yoff general hospital) kaffrine regional hospitalkaffrine regionregional hospital14.099°n 15.557°w﻿ / 14.099; -15.557﻿ (kaffrine regional hospital) kaolack regional hospitalkaolack regionregional hospital14.1825°n 16.2533°w﻿ / 14.1825; -16.2533﻿ (kaolack regional hospital) kolda regional hospitalkolda regionregional hospital12.8928091142872°n 14.9407732486724°w﻿ / 12.8928091142872; -14.9407732486724﻿ (kolda regional hospital) la paix hospitalziguinchor regionhospital12.5686028°n 16.2761°w﻿ / 12.5686028; -16.2761﻿ (la paix hospital) louga regional hospitallouga regionregional hospital15.62266°n 16.22008°w﻿ / 15.62266; -16.22008﻿ (louga regional hospital) lubke regional hospitaldiourbel regionregional hospital14.6434239°n 16.232144°w﻿ / 14.6434239; -16.232144﻿ (lubke regional hospital) maguette lo hospitallouga regionhospital15.4370399°n 15.21948079°w﻿ / 15.4370399; -15.21948079﻿ (maguette lo hospital) matam regional hospitalmatam regionregional hospital15.659878°n 13.261768°w﻿ / 15.659878; -13.261768﻿ (matam regional hospital) matlaboul fawzaïni hospital centerdiourbel regionnational hospital center14.858285°n 15.908856°w﻿ / 14.858285; -15.908856﻿ (matlaboul fawzaïni hospital center) military hospital of ouakumdakar regionmilitary hospital14.716819224276515°n 17.48296624743821°w﻿ / 14.716819224276515; -17.48296624743821﻿ (military hospital of ouakum) ndamatou hospitaldiourbel regionhospital14.8584398469°n 15.8627434974°w﻿ / 14.8584398469; -15.8627434974﻿ (ndamatou hospital) ndioum regional hospitalsaint-louis regionregional hospital16.5129°n 14.6471°w﻿ / 16.5129; -14.6471﻿ (ndioum regional hospital) ouroussogui hospitalmatam regionhospital15.6036959°n 13.3303938°w﻿ / 15.6036959; -13.3303938﻿ (ouroussogui hospital) pikine centre national hospitaldakar regionnational hospital center14.74873°n 17.38874°w﻿ / 14.74873; -17.38874﻿ (pikine centre national hospital) principal hospitaldakar regionnational hospital center, military hospital14.661344°n 17.43477°w﻿ / 14.661344; -17.43477﻿ (principal hospital) roi baudoin hospitaldakar regionhospital14.7737465°n 17.38430859°w﻿ / 14.7737465; -17.38430859﻿ (roi baudoin hospital) saint-louis regional hospitalsaint-louis regionregional hospital16.023023°n 16.505927°w﻿ / 16.023023; -16.505927﻿ (saint-louis regional hospital) sedhiou regional hospitalsédhiou regionregional hospital12.704604°n 15.55623°w﻿ / 12.704604; -15.55623﻿ (sedhiou regional hospital) tambacounda regional hospitaltambacounda regionregional hospital13.7788623°n 13.6736359°w﻿ / 13.7788623; -13.6736359﻿ (tambacounda regional hospital) tivaouane hospitalthiès regionhospital14.949584°n 16.813847°w﻿ / 14.949584; -16.813847﻿ (tivaouane hospital) youssou mbargane diop hospitaldakar regionhospital14.7262171°n 17.2597°w﻿ / 14.7262171; -17.2597﻿ (youssou mbargane diop hospital) ziguinchor regional hospitalziguinchor regionregional hospital12.558208°n 16.282158°w﻿ / 12.558208; -16.282158﻿ (ziguinchor regional hospital) financing care in 1999, 53% of health funding came from the government, 11% from individuals, 6% from communities, and 30% from international partners. of a household's health expenditures, 89% is out-of-pocket spending while 11% is in the form of health insurance contributions. additionally, only 15.2% of senegalese people have health insurance, most of whom work in the formal sector. on average, a facility charges us$2.90 for inpatient care for the median length of stay (five days), us$0.43 for adult outpatient care, and us$0.24 for children's outpatient care. in terms of expanding health insurance, it seems that policies that will reduce the negative effect of the time lost to seek care by workers, or policies that will increase the accessibility and the quality of care, will be more effective to increase health care utilization than would the introduction of health insurance to those who do not yet have it. a study assessing health policy in senegal concluded that government institutions should play a central role in "all stages of the policy process" and should implement "defined policies"; the study recommended focusing more on efforts to implement existing policies, instead of voting new laws without follow through. changes to health care strategies bamako initiative one of the most influential pieces to the transformation of senegal's healthcare system in the late 1990s was the bamako initiative. the bamako initiative started in 1987, when health ministers from two dozen african countries met with representatives of who and unicef to discuss the limited success of health care strategies in africa and the need for intervention. at the conference, leaders agreed to provide a minimum of health care services with severely reduced social services budgets. as a result of the meeting, major changes to senegal's health system occurred. the meeting resulted in the decentralization of senegal's health sector, which some critics believe has brought about chaos in local governments and administration in senegal. the bamako initiative also led to the establishment of health committees in senegal in 1992. the committees strive to meet three central goals: to promote health of their community, to mobilize the community around health development, and to improve the quality of services rendered at their health post, clinic, or hospital. in practice, the committees have not been completely representative, and have become problematic to clinic staff and medical personnel. women have been almost entirely absent from committee elections and seldom are selected for committee boards. rather, these boards are held by males who may ignore the needs of women, children, and the disadvantaged in their committees. critics believe the committees have been characterized by mismanagement, mistrust, and a lack of transparency. despite these issues, there have been significant gains from the bamako initiative and health committees. the changes have led to the improved availability of pharmaceuticals, and have also made up for the shortage of health personnel in many instances. decentralization decentralization began in the late 1990s, following the bamako initiative. the key goal has been to make the state more responsive and adaptable to local and regional needs, as opposed to when administrative power and responsibility were concentrated more centrally. this has resulted in more accountability and real power on part of local officials. the state funds a significant portion of the local health budget, but health targets, goals, and interventions are determined at the local level. however, because most local officials have no training on how decentralization should work; there has been a vacuum in terms of planning and management, and weak institutional capacity and the few resources to allocate among increasing responsibilities have exacerbated issues. decentralization has failed in two major ways: the first three years failed to render politics and local government more participatory and more responsive to local communities, and there has been no attention to gender equality and participation. decentralization has meant that authorities have completely failed to engage with women's situations and concerns. there have been additional issues in creating conflicts between city officials and medical district officers over disbursement of money for the health sector. privatization in addition to changes with the bamako initiative and decentralization, senegalese healthcare has become privatized. privatization in senegal has meant that user fees and the sales of pharmaceuticals finance a significant part of the health sector. the state still funds the health sector by paying salaries of state employees and giving each district a discretionary budget each year that it decides. however, user fees and pharmaceutical sales are only the most evident parts of the privatized health system in senegal. now, patients must buy a ticket to stand in line and receive care at a health clinic, which can be particularly problematic for mothers, the elderly, and the poorest of the poor. moreover, hospitals require even more available cash. the effects of privatization in have especially disadvantaged women, because they typically manage the health of the household. additionally, many preventable deaths have occurred as a direct result of privatization. digitalization in june 2021, senegal's agency for universal health launched sunucmu.com (sunucmu), a website that the agency hopes will streamline health care in the country. the website is a part of the minister of state mohammad abdallah dionne's plan for digitalization. he aims to make senegal's health care system effective and sustainable. using sunucmu, senegal hopes to achieve 75 percent coverage within two years of the launch. the website shows four clear initiatives: caesarean initiative: the caesarean initiative seeks to provide better health care for pregnant women and their fetuses and newborn babies. the sesame plan: the sesame plan seeks to provide adequate and cheap medical coverage for all those who are 60-years-old and older. the dialysis plan: the dialysis plan seeks to provide medical coverage for all those with renal (kidney) failure, whether it be endgame or acute. the zero to 5 plan: the zero to five plan seeks to provide medical coverage for all infants and young children. health care utilization two women