Senegal: Healthy measures

Infant and maternal health has been identified as a priority in Senegal, and both public and private sector initiatives are being ramped up to improve the quality of care and bring down mortality rates. At the May 9 meeting of the Ministry of Health’s Internal Monitoring Committee, Senegal’s minister of health and prevention, Modou Diagne Fada, announced that the budget for infant and maternal health programmes would be doubled, and that the Division for Reproductive Health would be transformed into an Office for Infant and Maternal Health.

These new measures fall under the umbrella of Senegal’s National Health Programme (Plan National de Développement Sanitaire, PNDS). The May ministerial meeting focused on measures to address weaknesses in the execution of the 2009-18 PNDS. The plan’s outline highlights the important progress made in a number of crucial health areas, including the fight against HIV/AIDS and malaria, but notes that high infant mortality rates and weak maternal health indicators continue to present a challenge for the country.

2008 World Health Organisation (WHO) data put the under-five mortality rate at 108 per 1000 live births, down from 149 per 1000 births in 1990 and 131 in 2000. Senegal’s rate is still high, but is better than the overall African average of 147 deaths per 1000 births in 2008. Interagency estimates from 2005 reported by the WHO put the maternal mortality rate at 980 per 100,000 live births, while country-reported estimates were more optimistic, at 401 per 100,000 live births. According to the WHO numbers, Senegal’s rates are slightly above the African average of 900 deaths per 100,000.

The PNDS focuses on several preventative health practices that currently hinder the improvement of infant and maternal health indicators, including low rates of contraceptive use, delayed prenatal consultations, limited postnatal checkups and frequent home deliveries, among other factors. The most recent WHO data found that only 52% of births in Senegal are attended by skilled health personnel; contraceptive use is just 11.8%, well below the continent-wide average of 23.7%; and the unmet need for family planning services is estimated at 31.6%.

The PNDS describes the improvement of infant and maternal health indicators as “the major challenge” the plan seeks to address because of their significant impact on Senegal’s economic development. Better equipment, improved funding and greater staffing of health centres throughout the national system, including more modern surgical centres and expanding the number of midwives, are all goals of the PNDS. A second primary objective is to strengthen and extend coverage of essential health services, most notably in rural areas.

This essential package of health services is expected to include the reinvigoration of family planning services, adequate coverage of quality prenatal and postnatal consultation in all districts, regular HIV testing among pregnant women, generalised delivery assistance (including adequate facilities and personnel for Caesarean sections and availability of blood for transfusions), essential newborn care, targeted care for premature and underweight babies, and disease prevention measures for HIV-positive mothers. For children over one year of age, promotion of nutrition programmes, prevention and early testing for infectious and parasitic diseases such as malaria, tuberculosis and respiratory infections will be particularly emphasised.

While calls are growing for increased collaboration for public-private partnership in financing health programmes, the PNDS relies primarily (64%) on state funding, and expects to receive only 12% from external partners, 5% from local collections and the remainder from additional donors. The state is expected to contribute CFA126bn ($273.2m) to these efforts in 2011 and CFA138.5bn ($300.4m) in 2012.

Key projects are also being launched by private and external partners. The Global Fund to Fight AIDS, Tuberculosis and Malaria has regularly provided financing to strengthen local programmes aimed at eradicating these diseases in Senegal since the early 2000s. A Global Fund grant of $11.7m for the Ministry of Health and Prevention between 2010 and 2012 is aimed at bolstering health programmes in maternal and infant health, malaria, tuberculosis, and HIV/AIDS. The funding will be directed primarily toward vulnerable districts to support rural health posts, provide quality control missions, upgrade equipment and infrastructure, and improve the recruitment and training of skilled health workers.

Another 2010 Global Fund grant agreement will provide $20.98m to the National Council for the Fight Against AIDS (Conseil National de Lutte Contre le SIDA, CNLS) for targeted programmes on a number of issues including mother-to-child transmission of HIV. Local media reported that CNLS is expected to announce a comprehensive plan for the elimination of mother-to-child transmission of HIV/AIDS on Monday, May 16.

While maternal and infant mortality rates continue to pose a problem for the country’s economic development, their improvement has been identified as a central objective of the national health strategy in the coming years. Realigned priorities and new resources brought to bear in this effort may promise advances in the years ahead.