Discussion of Principal Findings. The evaluation of Senegal’s health financing system raises important questions about the country’s ability to carry out successful extension strategies for population health coverage in order to achieve the goal of universal health coverage. The analysis, based on National Health Accounts and population-level data, shows five principal findings. First, full coverage for medical care is only available to seniors over 60 covered under the ‘Plan Sésame’. Public and private employees in the formal sector and their families benefit from automatic health coverage for basic curative and preventive services. However, the informal sector is largely unaccounted for within Senegal’s health financing system. Among the system’s five key payers, none target the informal sector specifically and only two (mutuelles and private insurance firms) offer insurance plans for which informal workers, the unemployed and their families are eligible. A study conducted in Senegal seems to suggest that the cost of many of the plans offered by mutuelles, and likely private insurance firms as well remains an important deterrent to access health insurance (Xxxxxxxxx, 2014). Second, an important health-financing indicator measured by the descriptive analysis of the 2006 to 2008 National Health Accounts is the per capita health spending. This indicator can be considered as a good proxy measure of the funds allocated to health, and the ability of such funds to support population health. The analysis of Senegal’s spending pattern suggests that issues of health sector financing appear unrelated to the amount of funds spent on health per capita. In fact, Senegal’s per capita health spending surpasses the minimal amount recommended by the WHO in a 2010 report. It is however important to note the limitations inherent in this indicator given it only illustrates a per person average amount for total health expenditure. This average amount therefore hides inequalities in wealth distribution and access within country. This is key point to consider for Senegal and other countries aiming for UHC because spending the minimal recommended amount may not necessarily mean that actual health expenditure needs are being met. Thus countries should not focus solely on meeting the recommendation, but rather figure out their specific need within their national context. Third, The results also confirm the substantial amount of out-of-pocket expenditure on health spent at the household level in Senegal. This is an...
