User:Heidimkahle/sandbox

Hello, my name is Heidi Kahle. I am a sophomore in college studying Sociology and Poverty, Justice, and Human Capabilties. The purpose of my Wikipedia page is to present a topic to the Wikipedia and world community for one of my classes, Introduction to Poverty, Justice, and Human Capabilities.

Health in Senegal

Healthcare in Senegal is a central topic of discourse in understanding the wellbeing and vitality of the Senagelese people. Interestingly, 54% of the population is below the poverty line, according to 2001 data. The main medical health problems in Senegal are as follows: child mortality, maternal death, malaria, and sexual diseases including HIV/AIDS (Heyen-Perschon, 2005). There is a high disparity in both the quality and extent of health services between urban and rural areas. Additionally, the greatest problems in public health are in East and South (Louga, Kaolack, and Tambacounda) and region of Casamanche. Currently, there is a need to improve Senegal’s infrastructure to promote a healthy, decent living environment. This article examines the very recent history of Senegal’s healthcare systems, the system’s structures, specific diseases that are problematic in Senegal, as well as issues affecting women and children and access to healthcare in Senegal.

History
As is the case in the rest of the African continent, the Senegalese have long used, and continue to use, traditional medicines and rely on traditional healers for medical ailments. However, in 1905, France laid the foundation for health policy in the area, though mainly for its own people, the French. 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. Then, after the Second World War, the international public opinion became more critical of colonial policy, and priorities became refocused on child health. Comprehensive programs were put in place to fight against major diseases. Since its independence from France, and from the Gambia and Mali, Senegal has become more involved in major international programs for development and health. Today, access to health care remains very uneven across regions and between different income levels.

Organization of the health care system
Senegal’s health system is comprised of three main parts. The central part contains the minister’s office, branches, and related services. The regional level is the medical region, an administrative region. Lastly, the peripheral level is the health district, with each district having at least one health center and a network of smaller centers. The system is the subject of much criticism, especially because of the increasing demands of profitability and also corruption in this part of the government as in other domains of public life. The national health system is divided into three levels: Regional hospitals, district health centers, and health posts. Even further, rural health care is divided into three parts. Health centers are at the top, with 1 to 2 medical doctors and 15-20 people as part of the health staff. Health posts are below these, with 4-5 health workers. At the lowest level are health points, which house 1-2 health agents and midwife.

Bamiko initiative
One of the most influential pieces to the transformation of Senegal’s healthcare system in the late 1990s was the Bamiko initiative. The Bamako Initiative started in 1987, when health ministers from two dozen African countries met with representative of WHO and UNICEF to discuss limited success of health care strategies in Africa and the need for intervention. At the conference, leaders agreed upon a need 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 has brought about chaos in local government and administration in Senegal.

The Bamiko 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 are anything but representative, and have become problematic to clinic staff and medical personnel. Additionally, women are almost entirely absent from committee election and seldom selected for committee boards. Rather, the committees have, to some, been characterized by mismanagement, mistrust, and a lack of transparency. Despite these issues, there have been significant gains from 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 Bamiko 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 are concentrated more centrally. This has resulted in more accountability and real power on part of local officials. The state funds a significant portion of health budget, but health targets, goals, and interventions are determined at local level. However, problems have arisen in that 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 main 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. Decentralization has meant 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 health sector.

Privatization
In addition to changes with the Bamiko 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 sum every year that it decides how to spend. However, user fees and pharmaceutical sales are most evident part of privatized health system in Senegal. Now, patients must buy a ticket to stand in line and receive care at a health clinic, which is problematic for the poorest of the poor. Moreover, hospitals require even more available cash. The effects of privatization in particular have hit women hard, especially because they typically manage the health of the household. Additionally, Many preventable deaths that occurred as direct result of privatization

Women and structural changes
In Senegal, gender relations have been largely ignored in processes of decentralization and implementation of community management strategies One of the key problems resulting in changes to the health sector is that elected officials and health sector personnel have failed to engage with women as potential leaders and participants in community health structures, rather viewing them as merely family healthy managers and targets of health education messages. As household health managers and primary consumers of public health care, women are intimately connected with realities of managing illness and seeking medical treatment. However, in spite of their marginalization, women are not passive in face of disease. As an example, women have created network of service providers in the informal sector for the majority of health care needs in the region of Pikine.

Financing care
In 1999, the health budget was comprised 53% by government, 11% by population, 6% by communities, and 30% by international partners. Interestingly, 89% of a households’ health expenditure 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 who work in the formal sector. On average, a facility charges 2.9 USD for inpatient care for the median length of stay (5 days), and 0.43 USD for adult outpatient care and 0.24 USD for children 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 the introduction of health insurance.

Health care utilization
Health care utilization in Senegal has been shaped by a variety of factors at play. Interestingly, women have a greater likelihood of using care than men by 1.4 percentage-points. At the individual level, the likelihood of seeking treatment is influenced by the relationship to the head of the household, employment status, gender, and age. It has been found that that the richest people are also more likely to use care by 8 percentage-points than the poorest. Moreover, workers who belong to households that require a high load of farm work are less likely to seek care by 7.5 percentage-points than the non-workers of households with a low agricultural work requirement.

Specific diseases
Below are listed a variety of specific diseases that have affected indigenous peoples and visitors to Senegal.

Malaria
Malaria is a parasitic disease transmitted by mosquito bites. One of Senegal’s strategies for combatting malaria has been the National Program for the Fight Against Malaria.

HIV/Aids
The rate of AIDS in Senegal is one of the lowest in Africa, at approximately 0.9%. According to the UNAIDS, the proportional of adults between the ages of 15 and 49 with HIV/AIDS is about 0.9%. The Casamance region has the highest prevalence of HIV/AIDS at 2.0%, which can be attributed in part to the conflict in Casamance. There are about 59,000 people in Senegal living with HIV/AIDS as according to a 2009 estimate.

Syphillis
Syphillis in Senegal is directly related to the social environment, poor health, and housing conditions. Additonally, the risk of Syphillis increases with prostitution and sex tourism.

Tuberculosis
Tuberculosis is mostly localized in Dakar and Thies, and effects more men than women. There are approximately 9500 cases of Tuberculosis per year in Senegal, with 2-4% mortality rate.

Schistosomiasis
Schistosomiasis is a parasitic disease common in the tropics, and in Senegal in particular. It is contracted by bathing in fresh water infested with worms. In Senegal, there are two forms: a urogenital form and an intestinal form.

Trypanosomiasis
Trypanosomiasis, or sleeping sicknes, is a parasitic diease that has long affected the valleys in Eastern Senegal, known as Ferlo.

Meningitis
Rates of Meningitis in Senegal are declining because of increased vaccinations, but there are often outbreaks between February in March until the spring, especially in Eastern Senegal and occasionally in Dakar.

Women’s healthcare concerns
A number of healthcare concerns afflict women in particular, among them female genital mutilation, maternal healthcare, and gendered healthcare discrepancies.

Female genital mutilation (FGM)
The prevalence of female genital mutilation, or FGM, in Senegal is approximately 18-20%. It is not widespread in Wolof or Sere, but is more common in Fulani, the Diola, the Roucouleurs and the Mandingo.

Births and fertility
The birth rate in Senegal is about 36.19 births per 1000 people, according to an 2012 estimate. The fertility rate, according to 2007 estimates, is relatively high, with an average of 5 children per woman. Moreover, the infant mortality rate is 55.16 deaths per 1,000 live births, and interestingly the infant mortality rate of males is slightly higher than that of females. Additionally, the maternal mortality rate is 370 deaths for every 100,000 according to data from 2010.

Solutions for maternal healthcare
One of the major proposed solutions to solving issues within the realm of maternal health care is the inclusion of membership in community-based health insurance plans (CBHI). CHBI schemes are voluntary, non-profit health insurance schemes organized and managed at the community level. . In developing nations, CBHI plans are seen as a mechanism to meet health-financing needs of rural informal sector households. CHBI has been incorporated into the national health financing strategy in Senegal. CBHI increases facilty-based maternal health services by reduce direct payments, thus facilitating timely use of healthcare. It is beneficial in guarding households against unpredictable and potentially catastrophic medical fees associated with pregnancy-related complications. It can also increase women’s interaction with the formal health care sector through its coverage of non-maternal health services. The most important element is the inclusion of maternal health care in any CBHI benefits package that makes the most significant difference. CBHI plans can increase the demand for maternal care by improving quality of care though requiring certain standards in contracts with health facilities. However, membership in a CBHI scheme is not always sufficient to influence maternal health behaviors.

Children’s healthcare
Children’s healthcare is of primary concern to development strategists, and is heavily influenced by the health, education, and wellbeing of women.

According to data from 20005, 14.5% percent of children under the age of 5 are underweight. Only 42% of all children between 12 and 23 months receive all necessary vaccinations (Heyen-Perschon, 2005). Children whose mothers have a primary education have a lower prevalence of malnutrition, and children whose mothers have advanced education are most likely to have the lowest incidence of malnutrition (Badji and Boccanfuso 2008). Rates of malnutrition are also most pronounced among infants between one and two years old (Badji and Boccanfuso 2008). Barriers to of children’s health include the following: misunderstanding of the nutritional needs of the child by the mothers, lack of nutritional follow-up of the children, non-practice of the exclusive breast feeding at least for the first four months of life of the infant as well as the misunderstanding of good weaning practices, the precariousness of the health condition of the children (frequency of the febrile episodes associated to diarrhea, to respiratory infections, etc), poor living standards, and difficulties of access to certain basic elements, among other barriers. Factors that seem to explain significantly the nutritional health condition of the children of less than five in Senegal would come down to the age as well as the child’s cycle of life, the size and place of residence of household, elements linked to the household environment such as the nature of the soil of the housing, the source of supply in drinking water, the evacuation mode of the domestic garbage, etc. and finally the level of education of the mother.

Transportation to health facilities
Oftentimes, distance from health care facilities, rough roads, and improper means of transportation limit peoples’ healthcare access in Senegal. For 80.5% of households, the poorly equipped health post is the only accessible health facility in an average distance of 4.3 kilometers. The closest high-level provider (i.e. a hospital) is located, on average, 20 km away from the village of the household. The improvement in the accessibility of health facilities through better road quality and better means of transport will have a positive effect on health care utilization. Because of extreme distances and environmental conditions, such as muddy roads, only 32% of rural households have regular access to a health center, and thereby access to a medical doctor. Interestingly, too, there are two times more unpaved roads in Senegal than there are paved roads. Oftentimes, there is trouble with transportation and vehicles in that NGOs may not have a large enough fleet, or vehicles are inappropriate for terrain and dirt roads ). Some health centers have ambulances, but there is no plan for vehicle maintenance and replacement. Additionally, there are issues with transportation of sick, pregnant women, during which times if ambulances are not available, horse-drawn trailers may also be effective. The most effective avenue is to improve mobility of health acre providers rather than improving mobility of rural population, which requires far less structural support and funding than does providing transportation for every household.

Disparities between rural and urban areas
Major disparities exist in health care access for those living in urban versus rural areas. Approximately 70% of doctors and 80% of pharmacists and dentists are located in Dakar, the capital city. However, only 42% of the Senegalese population lives in urban areas, such as Dakar, which means that few doctors are available to rural residents. Of every 10000 women who give birth, 24 will die in urban areas, but nearly 100 will die in rural areas. Additionally, there are major disparities in nutrition of children in urban versus rural areas, with those in rural areas being more heavily disadvantaged (Badji and Boccanfuso 2008). Therefore, great attention shall be placed on narrowing the gap between urban and rural healthcare access.

Mental health
Though the majority of Senegal’s healthcare budget goes to physical health needs, mental health remains an area of concern. Senegalese government spends 9% of total health budget on mental health. Currently, Senegal has no national health program, but mental health issues are prevalent. Nearly 17% of children had emotional/behavioral or neuropsychiatric disorders based on 2005 data. Additionally, 16% of adults had psychiatric illness. Primary sources of mental health financing include, in descending order, private insurance, social insurance, out of pocket expenditures by patient or family, and taxes. Mental health is part of primary health care system, with actual treatment of severe mental disorders available at the primary level. NGOs are involved with advocacy, prevention, treatment, and rehabilitation. Still, more attention and concern remains to be paid to mental health in Senegal.