Rationalizing health service subsidies in Senegal

Senegal's health system has benefited from user payments for health services under the “Bamako Initiative” in improved quality of services, availability of drugs, and consumer appreciation of the cost of the services that they use. However, Senegal recognizes that payments can represent a barrier to the use of services when needed. Hence, it has put in place subsidies and exemptions from payment for a variety of services or for specific population groups. For example, childhood immunizations are offered at no charge. The decisions to subsidize and exempt have been made incrementally over several decades. The result is a set of subsidy/exemption policies that do not necessarily provide the best response to the barrier of payments to use of services. To respond to this situation, the Ministry of Health decided to start afresh on the issue. It laid out the principles of what it would like to achieve with its subsidy policy, then evaluated existing and proposed subsidies against the principles, including examining the costs of the subsidies in terms of foregone revenue and cost of administration. The result is a rational subsidy regime that is truer to the principles of protecting access to services that is achieved at lower cost. In addition to the revising the subsidy and exemption policy, the Ministry recognized that the administration of the policy is critical to realizing its benefits. Thus, the effort also included the identification of the key steps needed to implement effectively the policy decisions taken.