The benefits of setting the ground rules and regulating contracting practices.

In recent years, health systems have increasingly made use of contracting practices; despite results that are often promising, there have also been failures and occasionally harsh criticism of such practices. This has made it even more necessary to regulate contracting practices. As part of its stewardship function, in other words its responsibility to protect the public interest, the ministry of health has the responsibility of introducing the tools needed for such regulation. Several tools are available to help it do this. Some of them, such as standard contracts or framework contracts, useful as they may be, are nevertheless specific and ad hoc. Contracting policies, when carefully linked to overall health policies, are undoubtedly the most comprehensive of these tools, since they enable contracting to be accommodated within the management of the health system as a whole and thus take into account its potential contribution to improving health system performance. However, the requirements for success are not present automatically and it has to be ensured that there are mechanisms for vitalizing these regulatory mechanisms and that the key actors make proper use of the framework laid down by the ministry of health. The first three authors of this article have participated in the preparation and implementation of national policies on contracting in their own countries, viz. Chad, Madagascar and Senegal

For Universal Health Coverage to happen, health systems need to be strengthened: The case of Senegal

Introduction: The Government of Senegal is firmly committed towards universal health coverage (UHC). Various initiatives have been launched over the last decade to extend the coverage of risk protection to the entire population. The objective of UHC is mainly pursued through (i) a desire to expand coverage in services in poor areas and (ii) improvement of financial access through the Universal Health Insurance Policy (called CMU). However, the proportion of the population actually covered is still low, and access to health services and funding of national public health priorities are limited by inadequate allocation of resources. The concept of UHC is closely linked to health system strengthening (HSS). The latter comprises the means, while UHC is a way of framing the policy objectives.1 Aim: This study aims to assess the main gaps and henceforth necessary requirements in terms of HSS so as to facilitate progress towards UHC in Senegal. Methods: Based on a critical review of existing data and documents, completed by authors’ experience in supporting UHC policymaking and implementation in Senegal, we apply the World Health Organization’s health system conceptual framework based on 6 building blocks, plus an analysis of populations. Results: A number of bottlenecks hampering progress towards UHC were identified in terms of leadership and governance – especially, fragmentation of insurance schemes and institutions in charge of managing CMU; financing – insufficient governmental expenditure for health, large share of out-of-pocket expenditure, inefficient and inequitable spending; inequitable allocation of health workforce; supply chain management issues with respect to equipment and medical products; low quality and timeliness of financial statements; important disparities and poor quality of health services; low consideration of the social determinants of health, including access barriers. Conclusion: Despite the fact that many institutions are now in place in Senegal to deliver UHC, challenges related to health systems need to be addressed more systematically if progress has to be made with regard to the two dimensions of UHC, namely financial protection and quality services. Reference: 1. Kutzin J., Sparkes S.P. Health systems strengthening, universal health coverage, health security and resilience. Bull World Health Organ 2016; 94(2): 2.ARC Effi-Santé; PRD-CMU; ARC grant for Concerted Research Action

For Universal Health Coverage to happen, health systems need to be strengthened: The case of Senegal

Introduction: The Government of Senegal is firmly committed towards universal health coverage (UHC). Various initiatives have been launched over the last decade to extend the coverage of risk protection to the entire population. The objective of UHC is mainly pursued through (i) a desire to expand coverage in services in poor areas and (ii) improvement of financial access through the Universal Health Insurance Policy (called CMU). However, the proportion of the population actually covered is still low, and access to health services and funding of national public health priorities are limited by inadequate allocation of resources. The concept of UHC is closely linked to health system strengthening (HSS). The latter comprises the means, while UHC is a way of framing the policy objectives.1Aim: This study aims to assess the main gaps and henceforth necessary requirements in terms of HSS so as to facilitate progress towards UHC in Senegal.Methods: Based on a critical review of existing data and documents, completed by authors’ experience in supporting UHC policymaking and implementation in Senegal, we apply the World Health Organization’s health system conceptual framework based on 6 building blocks, plus an analysis of populations.Results: A number of bottlenecks hampering progress towards UHC were identified in terms of leadership and governance – especially, fragmentation of insurance schemes and institutions in charge of managing CMU; financing – insufficient governmental expenditure for health, large share of out-of-pocket expenditure, inefficient and inequitable spending; inequitable allocation of health workforce; supply chain management issues with respect to equipment and medical products; low quality and timeliness of financial statements; important disparities and poor quality of health services; low consideration of the social determinants of health, including access barriers.Conclusion: Despite the fact that many institutions are now in place in Senegal to deliver UHC, challenges related to health systems need to be addressed more systematically if progress has to be made with regard to the two dimensions of UHC, namely financial protection and quality services.Reference:1.Kutzin J. Sparkes S.P. Health systems strengthening, universal health coverage, health security and resilience. Bull World Health Organ 2016; 94(2): 2.info:eu-repo/semantics/nonPublishe

How to recruit and retain health workers in underserved areas: the Senegalese experience

PROBLEM: Significant regional disparities in human resources for health deployment in Senegal weaken the country's health system and compromise population health. APPROACH: In recent years, the Ministry of Health adopted measures to improve the posting, recruitment and retention of health workers in rural and remote areas. One was the introduction of a special contracting system to recruit health workers. LOCAL SETTING: Health workers in Senegal are concentrated in specific urban centres, particularly Dakar. Whereas the Dakar region has 0.2 physicians per 1000 population, the Fatick, Kaolack, Kolda and Matam regions have fewer than 0.04. The density of midwives and, to a lesser extent, of nurses also varies considerably among different regions in Senegal. RELEVANT CHANGES: Between 2006 and 2008, the introduction of the special contracting system contributed to the successful recruitment of health workers in remote and rural regions and the reopening of health outposts. LESSONS LEARNT: The introduction of a special contracting system for health workers was a successful approach to reopening health posts in regions with low health workforce density in Senegal. However, the long-term sustainability of such an approach, particularly in fiscal terms, must be considered, as a single policy intervention may not be enough to address the diverse and complex challenges in human resources for health facing different regions of Senegal

Synthesis, spectroscopic studies and X-ray structure determination of two mononuclear copper complexes derived from the Schiff base ligand N,N-dimethyl-N'-((5-methyl-1H-imidazol-4-yl)methylene)ethane-1,2-diamine

Reactions of the Schiff base N,N-dimethyl-N'-((5-methyl-1H-imidazol-4-yl)methylene) ethane-1,2-diamine (HL), synthesised in situ, with chloride or thiocyanate copper (II) salt; afforded two new mononuclear complexes, [Cu(HL)Cl2]·H2O (1) and [Cu(HL)(SCN)2] (2). These compounds have been studied and characterized by elemental analysis, IR and UV-Vis spectroscopies, electrochemistry, molar conductivity and room temperature magnetic measurements. Single crystal X-ray structure determination of the complexes revealed the presence of neutral moieties in the asymmetric unit. The mononuclear (1) crystallises in the monoclinic space group P21/c with the following unit cell parameters a = 7.4355(3) Å, b = 7.2952(3) Å, c = 26.2729(11) Å, β = 93.461(4)°, V = 1422.52(10) Å3, Z = 4, R1 = 0.033 and wR2 = 0.082 and the mononuclear complex (2) crystallises in the monoclinic space group C2/c with the following unit cell parameters a = 26.2578(7) Å, b = 7.4334(2) Å, c = 16.6237(5) Å, β = 99.089(3)°, V = 3203.95(16) Å3, Z = 8, R1 = 0.037 and wR2 = 0.104. In both complexes the ligand acts in tridentate fashion and the coordination environment of the copper atom can be described as distorted square pyramidal. The crystal lattice of the complex 1 is stabilized by electrostatic forces of attraction and O–H···Cl, C–H···O, N–H···Cl, and C–H···Cl, hydrogen bonding interactions while the crystal lattice of the complex 2 is stabilized by N–H···S and C–H···N

Long Way to Universal Health Coverage (UHC): Are Policy Dialogue Processes Appropriate to Negotiate Trade-Offs in Africa? The Cases of Benin and Senegal

The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors’ own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of transparency and accountability. Our analytical framework enables us to identify rooms for improvement with regard to country-led negotiation processes relating to UHC.Les nombreux acteurs impliqués dans l’élaboration des politiques de couverture santé universelle (CSU) sont susceptibles d’avoir des intérêts divergents sur les dimensions à privilégier, d’où l’importance de garantir un dialogue politique efficace et transparent. Ce papier de recherche a pour but d’examiner si les processus de dialogue politique sur la CSU fonctionnent ou non bien au Bénin et au Sénégal. Sur la base d’une revue de la littérature, nous avons identifié un certain nombre de caractéristiques garantissant la qualité des processus de dialogue politique, que nous avons intégrées dans une grille d’analyse. Les critères de qualité identifiés ont été classés selon quatre dimensions : la participation des parties prenantes, le processus de dialogue/négociation, la qualité de l’analyse de la situation et les critères de décision, et les résultats du processus de négociation. Sur la base des données recueillies par le biais d’une revue documentaire, d’entretiens, d’une enquête électronique et de l’expérience des auteurs, nous avons appliqué cette grille d’analyse aux cas du Bénin et du Sénégal. Dans ces deux pays, les processus de dialogue politique sont largement imparfaits en ce qui concerne bon nombre des critères de qualité identifiés. Les décisions ont été prises sous un leadership politique fort, assurant la coordination et l’appropriation par le gouvernement, et l’accent a été mis sur l’élargissement de la protection contre les risques financiers. Pourtant, les deux pays affichent de piètres performances dans un certain nombre de domaines, notamment en ce qui concerne les conflits d’intérêts, la transparence et la redevabilité. Aucun d’entre eux n’a réellement institutionnalisé un processus de dialogue politique en vue de la CSU, et les processus d’élaboration des politiques de CSU ont en fait contourné les mécanismes de coordination existants dans le secteur de la santé. Les deux pays obtiennent de bons résultats en ce qui concerne la qualité de l’analyse de la situation. Une petite coalition gouvernementale (dans le cas du Bénin) ou plus large (dans le cas du Sénégal) a réussi à imposer ses vues, compte tenu de la participation insuffisante des parties prenantes. Les réseaux politiques ont été particulièrement influents au Sénégal. Dans l’ensemble, il existe des lacunes importantes qui réduisent la qualité des processus de dialogue politique sur la CSU, ce qui explique les faiblesses de leurs résultats en termes de transparence et de redevabilité. Notre cadre analytique nous permet d’identifier les possibilités d’amélioration des processus de négociation menés par les pays en matière de CSU.ARC Effi-Sant

Long Way to Universal Health Coverage (UHC): Are Policy Dialogue Processes Appropriate to Negotiate Trade-Offs in Africa? The Cases of Benin and Senegal

The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors’ own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of transparency and accountability. Our analytical framework enables us to identify rooms for improvement with regard to country-led negotiation processes relating to UHC.Les nombreux acteurs impliqués dans l’élaboration des politiques de couverture santé universelle (CSU) sont susceptibles d’avoir des intérêts divergents sur les dimensions à privilégier, d’où l’importance de garantir un dialogue politique efficace et transparent. Ce papier de recherche a pour but d’examiner si les processus de dialogue politique sur la CSU fonctionnent ou non bien au Bénin et au Sénégal. Sur la base d’une revue de la littérature, nous avons identifié un certain nombre de caractéristiques garantissant la qualité des processus de dialogue politique, que nous avons intégrées dans une grille d’analyse. Les critères de qualité identifiés ont été classés selon quatre dimensions :la participation des parties prenantes, le processus de dialogue/négociation, la qualité de l’analyse de la situation et les critères de décision, et les résultats du processus de négociation. Sur la base des données recueillies par le biais d’une revue documentaire, d’entretiens, d’une enquête électronique et de l’expérience des auteurs, nous avons appliqué cette grille d’analyse aux cas du Bénin et du Sénégal. Dans ces deux pays, les processus de dialogue politique sont largement imparfaits en ce qui concerne bon nombre des critères de qualité identifiés. Les décisions ont été prises sous un leadership politique fort, assurant la coordination et l’appropriation par le gouvernement, et l’accent a été mis sur l’élargissement de la protection contre les risques financiers. Pourtant, les deux pays affichent de piètres performances dans un certain nombre de domaines, notamment en ce qui concerne les conflits d’intérêts, la transparence et la redevabilité. Aucun d’entre eux n’a réellement institutionnalisé un processus de dialogue politique en vue de la CSU, et les processus d’élaboration des politiques de CSU ont en fait contourné les mécanismes de coordination existants dans le secteur de la santé. Les deux pays obtiennent de bons résultats en ce qui concerne la qualité de l’analyse de la situation. Une petite coalition gouvernementale (dans le cas du Bénin) ou plus large (dans le cas du Sénégal) a réussi à imposer ses vues, compte tenu de la participation insuffisante des parties prenantes. Les réseaux politiques ont été particulièrement influents au Sénégal. Dans l’ensemble, il existe des lacunes importantes qui réduisent la qualité des processus de dialogue politique sur la CSU, ce qui explique les faiblesses de leurs résultats en termes de transparence et de redevabilité. Notre cadre analytique nous permet d’identifier les possibilités d’amélioration des processus de négociation menés par les pays en matière de CSU.info:eu-repo/semantics/publishe

Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis.

INTRODUCTION: Rotavirus is the leading cause of acute severe diarrhea among children under 5 globally and one of the leading causes of death attributable to diarrhea. Among African children hospitalized with diarrhea, 38% of the cases are due to rotavirus. In Senegal, rotavirus deaths are estimated to represent 5.4% of all deaths among children under 5. Along with the substantial disease burden, there is a growing awareness of the economic burden created by diarrheal disease. This analysis aims to provide policymakers with more consistent and reliable economic evidence to support the decision-making process about the introduction and maintenance of a rotavirus vaccine program. METHODS: The study was conducted using the processes and tools first established by the Pan American Health Organization's ProVac Initiative in the Latin American region. TRIVAC version 2.0, an Excel-based model, was used to perform the analysis. The costs and health outcomes were calculated for 20 successive birth cohorts (2014-2033). Model inputs were gathered from local, national, and international sources with the guidance of a Senegalese group of experts including local pediatricians, personnel from the Ministry of Health and the World Health Organization, as well as disease-surveillance and laboratory specialists. RESULTS: The cost per disability-adjusted life-year (DALY) averted, discounted at 3%, is US$92 from the health care provider perspective and US$ 73 from the societal perspective. For the 20 cohorts, the vaccine is projected to prevent more than 2 million cases of rotavirus and to avert more than 8500 deaths. The proportion of rotavirus deaths averted is estimated to be 42%. For 20 cohorts, the discounted net costs of the program were estimated to be US$17.6 million from the healthcare provider perspective and US$ 13.8 million from the societal perspective. CONCLUSION: From both perspectives, introducing the rotavirus vaccine is highly cost-effective compared to no vaccination. The results are consistent with those found in many African countries. The ProVac process and tools contributed to a collaborative, country-led process in Senegal that provides a platform for gathering and reporting evidence for vaccine decision-making