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Health Expenditures - Senegal

Individual Health Expenditures in Senegal

Nene Ly – BA Economics (4th year)
Africana Health Research Lab
University of Cincinnati
Professor Whembolua
7 June 2015

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Introduction:
For decades, health has been seen as a primary determinant in human welfare and
economic growth (Zon, 2003). Over the years, high-income countries have continued to
spend significant portions of their GDP on their health sector, powering their population
and economy. In contrast, many low-income nations find their health infrastructure
staggering, oftentimes neglected (Dupas, 2011). Others, like the West African nation of
Senegal for instance, have witnessed recent bouts of growth, thus progressing into
difference economic class cohorts (Abdon, 2012). Over the years, many explanations
have been given for this progression; from the discovery of natural wealth to highly
specialized sectors, low-income countries have found many routes leading towards
upward economic success. It has also been a long-standing assumption that economic
growth improves human welfare, which includes the health and education level of a given
population (Zon, 2003). As stated earlier, recent discussion has raised the question of
whether the cause and effect were reciprocal; could heath lead to economic growth?
According to the World Bank, Senegal’s recent transition to a lower middleincome country has been marked by its increased GDP, which as of last year, stands at
$15.58 billion (The World Bank, 2015). With a population of approximately 14.5 million,
the GDP per capita in Senegal is approximately $2,311 (The World Bank, 2014). Such
strides towards economic growth are impressive, but how effective has Senegal’s
economic development process been thus far? How significant do these improvements
witnessed in Senegal, translate in terms of health and life expectancy?
In 2009, Harvard University published a paper that discussed the relationship
between health and economic growth. It concluded that a healthier population (translated

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as lower mortality rates & longer life expectancy) positively impacts their per capita GDP
growth (Aghion, 2009). This study, along with many others conducted, shows that the
economic success of a nation depends heavily on the health of its population (Canning,
2008). As countries like Senegal continue to progress economically, are their health
sectors able to keep up?
With that said, the purpose of this research is to identify the costs of health
treatments in Senegal, and to identify the proportion of income that Senegalese families
typically allot to health – related goods and services. The methodology design of this
study is to consist of two primary methods. The first is to be the review of available
literature on the subject. This will include specialized health documents, reports, and
previously published articles all pertaining to the direct costs of health treatments and
pharmaceuticals in Senegal. Next, several economic principles, if applicable, will be
incorporated to provide insight into the emotional conditions that affect health-spending
behavior. This will be done through qualitative interviews. These interviews will be
conducted with health workers, professionals, and community members.
A final step to take will be discussing with representatives from Senegal’s
Ministry of Health to learn more about health costs and accessibility through the
perspective of the administrators. The findings of this research may 1) highlight the level
of accessibility and affordability of both pharmaceuticals and health treatments in
Senegal, and 2) underline how Senegal prioritizes its health sector, and 3) ultimately lead
to possible propositions for improving Senegal’s health infrastructure.

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Methods:
Methodology used for this study primarily consists of analytical study of relevant
literature. Academic articles and health related documents were searched using various
scholarly online platforms such as PubMed and JSTOR, and all sought materials provide
useful insight into the level of affordability and accessibility of health care in Senegal.
Materials were then reviewed and approved by a public health expert. Many articles were
first collected and vetted for relevant information, with many being void due to their
outdated nature. The articles that were chosen for this study include information collected
recently, to provide a more accurate detail of Senegal’s health care system today. All
articles chosen for analysis for this study have been deemed to contain accurate and
applicable information that can speak appropriately to the current conditions faced by
Senegalese individuals who look for quality and affordable health care in Senegal.
In addition to the article review, qualitative interviews with key informants were
also conducted. After a lengthy procedure, which entailed contacting and discussing with
several individuals, three individuals were chosen to provide key information for this
report. The first individual chosen to provide important insight is Madame D, a health
patient who suffers from type II diabetes. A native of Thies, Madame D has stated that
she frequents many health facilities in Dakar, hoping to obtain affordable and quality
treatment. The next individual to be featured in this study is Dr. Cheikh Tidiane Ndour, a
professor at the Cheikh Anta Diop University – Medical center. He is to deliver key
insight into problems facing Senegal’s heath infrastructure, its target areas for
improvement, and positive change happening today. The third and final participant is
Khady Samb, a nurse who works in the Sanu medical center located in Scat Urbam, a

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suburb of Dakar. She works directly with patients of little economic means, and
oftentimes deals with supply shortages and electrical outages. She understands first hand
the problems facing many Senegalese families who struggle to afford basic health
necessities and treatments, making her a vital informant for this study.

Results:
The information derived from the data analysis and interviews provides solid
comprehension of Senegal’s health sector, its current performance level, and its
opportunities for improvement. Notable discoveries have been made in regards to the
general costs of treatment, accessibility of care, and quality of care found today in
Senegal. Focus has also been placed on the public perception of Senegal’s health care
system, and information provided by key informants reiterated the findings.
The first method used for this study led to a series of discoveries surrounding the
general costs of treatment for Senegal’s leading health concerns. Of all the health
problems facing the nation, malaria has been deemed the biggest health concern (World
Bank, 2014). Data analysis has proven that the total average general costs associated with
treatment for severe malaria in Dakar, Senegal totals out to 299,957 CFA ($502.14), with
nearly forty percent (115,000 CFA = $192.51) being typically subsidized by the state
(Faye, 2012). The total amount eventually paid by patients (184,500 CFA) equates to
approximately $305.7 (Faye, 2012).
Furthermore, financial information released by the University Hospital of Fann
provides a cost analysis for general services, consultations, and medication from within
their psychiatric department. The study concludes that on average, the hospitalization

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Health Expenditures - Senegal

costs amounts to 91,398 CFA ($152.99), and that consultation costs amount to 6,664 CFA
($11.16) (Wone, 2010). This is of extreme relevance, given the fact that psychiatric
disorders contribute to an estimated seven percent of the country’s disease burden
(Monteiro, 2014). In many scenarios, health costs exceeds the means of many Senegalese
families (IRIN, 2014). For example, the annual supply of hepatitis B virus anti-retroviral
drugs can cost up to $4,000, which is nearly four times the amount of Senegal’s average
annual income (IRIN, 2014). Such a reality certainly makes health accessibility difficult,
causing many to go to extreme lengths to afford essential treatments and medication
(Seibert, 2014). Additionally, key informants also provided financial information
regarding treatment costs associated with Senegal’s leading health problems. Key
informant Madame C.D., a patient suffering from type II diabetes, indicated that her
medication costs varies, depending on the location of the clinic.
“When visiting clinics here in Keur Moussa (a suburb of Thies), I find the medication to
be pretty cheap, but of course not as effective. I think they keep the better medication in
the city, and leave the lesser ones here!”

The key informant then went on to indicate the costs associated with medication
purchased in small clinics outside the city ranged from 3,000 – 6,000 CFA ($6 - $12),
while treatment in State hospitals or facilities can cost up to 20,00 – 28,000 CFA ($40 $56). When asked if she found the costs to be affordable, she replied:
“Sometimes my husband tells me, if I give you money for the Ndiaga Ndiaye (public
transportation bus), and money for the medicine, what are we going to do for
lunch/dinner?

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Professor Cheikh Tidiane Ndour, a professor of infectious and tropical diseases at
the Cheikh Anta Diop University, was similarly asked “Do you agree with the following
statement: Quality health care in Senegal is affordable for the majority of Senegalese
households, why or why not? He replied with saying:
“I don’t think so. Working in a facility that is supposed to care of the poorest of our
society, I note that every single day the majority of the discharged patients are not able to
afford the hospitalization and treatment fees, whatever the amount”.
Similarly, Khady Samb, a nurse practitioner from the Sanu Medical center, discussed
similar costs, while providing further detail into the hardships faced by patients looking
to afford the costs. When asked about the most common illnesses/diseases experience by
patients, Khady Samb explained that tropical diseases and bacterial infections were most
common. In regards to treatment costs, she said the following:
“The costs really depend. For simple treatments like oral anti-biotics and topical creams,
we normally charge between 2,000 – 7,000 CFA ($4 - $14). If the health condition is too
severe and requires a significant amount of medication and/or strength of a medication,
we will just make a prescription. This unfortunately, can cost a patient between 25,000 –
40,000 CFA ($50 - $80), and sometimes even more:
When asked if she found the costs to be affordable for patients, she went on to say:
“It depends again. The location of our medical center is Scat Urbam, which is one of
those neighborhoods that houses people of many different socio-economic backgrounds.
Granted that our clinic is the primary clinic for this area, everyone comes here. We find
patients that believe our prices to be affordable, while others may not think so. Located

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right next door to our facility is a convenient store, and often times, we hear that patients
go there and take small loans before coming to purchase their medicine”
She concluded that the Sanu Medical center, and many others across Dakar,
regularly faced daily difficulties that make running a clinic difficult. She cited a shortage
of staff, outdated equipment, and not enough space as major areas of concern, and she
followed up by explaining how some days, she worked as the nurse, cashier, therapist,
and secretary all at once (Samb, 2015). Moving on, potential geographic barriers were
also accessed to determine the level of accessibility of quality care for those living
outside large cities. The study kicked off with a comprehensive look into documented
findings concerning locations of most of Senegal’s health facilities. According to the
Voice of America, 65 percent of people in Senegal do not have access to health care
coverage, and 80% of those individuals live in rural settings (VOA, 2014). This coincides
with findings made by the international labour organization, which states that 65 percent
of people living in rural areas in Senegal do not have access to essential healthcare
services (ILO, 2015). Furthermore, key informants provided greater detail surrounding
disparities with accessing health care during various interview sessions. Professor Cheikh
Ndour shared his opinions on the level of accessibility of quality health care in Senegal.
When asked, “Given your field of expertise, what do you deem to be the biggest issues
facing Senegal’s health sector?” he said the following:
The biggest Senegalese health issue is un-parallel access to health care for those living
in remote rural areas since the majority of health care workers want to work only in big
cities, for themselves in economical terms, and for their family’s comfort and quality of
education. I do believe that the national health care repartition shows big disparities

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between urban and rural areas, mainly due to a shortage of medical doctors, midwives,
and updated medical equipment.”
The objective of this study was to answer the following questions: How accessible
and affordable are pharmaceuticals and health treatments in Senegal? With thorough
investigation and insightful discussion with various key informants, information has been
gathered to answer the question. Despite the fact that Senegal has witnessed economic
growth and a higher GDP per capita, but fundamental changes are still necessary to allow
for economic growth to follow. With health being a focal point for productivity and
progression, it’s unarguably fathomable to witnessed healthy populations associated with
great economics. While other factors exist that can alter and affect the success of a state
economically, Health will always have a strong impact on development by leading to
higher productivity, improved learning, and reduced family size which leads to reduced
poverty (DSEAD, 2010). Senegal, a prime example, has experienced growth through
boosted income from its tourism and communication sectors, while little progress has
been made within its health sector.

Conclusion:
The results of this study, through the use of data analysis and qualitative interviews,
indicate several things about Senegal’s health sector. First, it can be inferred by the
information gathered that pharmaceuticals and health treatments remain relatively
expensive and unaffordable for many Senegalese households. With health costs reaching
up to 40,000 CFA ($80), an individual experiencing a significant health problem would
be expected to allocate a substantial portion of his or her income towards treatment,

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which for many is impossible. In a country nearly half of the population lives below the
poverty line ($1.25 a day), such amounts become seemingly impossible to afford.
Furthermore, key informants have provided supporting evidence pertaining to
health costs, all suggesting that costs are oftentimes too expensive for patients.
Additionally, geographic barriers were listed as an ongoing issue with accessing health; it
was even described as one of Senegal’s leading health concerns by Professor Cheikh
Ndour. Reasons for this disparity in quality/access of health care ranged from a shortage
of qualified personnel to unrefrigerated storage opportunities.
Conclusively, this reports closes with the following thoughts: though Senegal has
recently made strides towards economic growth, the information gathered does not
support the notion that its economic growth and development process are improving
simultaneously. Evidence from this report determines that the nation’s health sector is one
with much room for improvement in its quest to improve the quality of life of its people.
Potential areas for improvement? Subsidization opportunities for patients, healthcare
services in rural settings, and widespread health insurance coverage would all make a
great start towards making quality health care affordable and accessible in Senegal.

Appendix

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Health Expenditures - Senegal
Name: Madame CD
Occupation: Homemaker
Date & Time: July 9th 2015; 11:00am
Location: Patient’s home, Thies, Senegal
Interview method: in-person

Summary: Madame C.D. is a mother of three who suffers from high blood pressure and
Type II Diabetes. She regularly visits clinics and health facilities across Thies and Dakar
looking for affordable medical attention and medication.
1) For approximately how long have you been suffering with both type II diabetes
and high blood pressure?
I have had type II diabetes for about 15 years now. It was worse in the beginning, but my
son was alive then and was supporting my medication.
2) Has your diet been effected by this?
I have to watch what I eat, and the quantity, and it is very hard! If I consume too many
sweets, I can immediately feel the effect. It is hard to pay special attention to my diet
when I cook for a family of seven, but I try my best to avoid sugar and rice
3) Now in terms of medication, how accessible and affordable has it been for you?
The medication costs depends. When visiting clinics here in Keur Moussa (a suburb of
Thies), I find the medication to be pretty cheap, but of course not as effective. I think they
keep the better medication in the city, and leave the lesser ones here! This is an issue for
me because getting to Dakar is not easy or cheap. Sometimes my husband tells me, if I
give you money for the Ndiaga Ndiaye (public transportation bus), and money for the
medicine, what are we going to do for lunch/dinner? I feel obligated to take care of my
health, but at the same time, I sometimes feel guilty for asking for money.
4) Do you believe Senegal’s health care system is prepared to provide quality care to
those with limited means and/or those living outside large cities?
Senegal’s health sector? I’m sure those people have good health, and I am sure their
families are healthy as well. I don’t think they are worried too much about the rest of us. I
am struggling, my family is struggling, and no matter what we do, we can never seem to
find the money to afford my medication.

Appendix

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Name: Dr. Cheikh Tidiane Ndour
Occupation: Professor
Date & Time: July 10th 2015; 10:45am
Location: Suite 203, Batiment 12A, Dakar University
Interview Method: In-person, Telephone, email
1) Could you please introduce yourself and describe your professional background?
My name is Cheikh Tidiane Ndour, professor of infectious diseases at the university
teaching hospital of Fann in Dakar. I’m working in this area since around 25 years and
our 3 main activities are research, patients’ care and student and specialist training. My
areas of interest are HIV aids infection, tuberculosis, malaria, and since 2014 the Ebola
virus disease
2) Given your field of expertise, what do you deem to be the biggest issues currently
facing Senegal’s health sector?
The biggest Senegalese health issue is access in remote rural areas since the majority of
health care workers want to work only in big cities, for themselves in economical terms,
and for their family’s comfort and quality of education.
3) What would you identify specifically as target areas of improvement?
The target areas of interest are:
- Health care training
- Health facilities equipment
4) Do you agree with the following statement: “quality health care in Senegal is
affordable for the majority of Senegalese household”. Why or why not?
I don’t think so. Working in a facility that is supposed to care for the poorest of our
society, I note that every single day the majority of the discharged patients are not able to
afford the hospitalization and treatment fees, whatever the amount.
5) Research has shown that disparities in access to health care exist for those living
in rural and urban settings, do you agree? Do you think access to quality health care
is still limited for those outside Dakar and/or other large cities?
I do believe that the national health care repartition show big disparities between urban
and rural areas, mainly for medical doctors and midwives

Appendix

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Name: Khady Samb
Occupation: Nurse Practitioner
Date & Time: July 16th 2015; 11:30am
Location: Sanu health center, Scat Urbam (Dakar), Senegal
International Method: Phone
1) As a nurse practitioner, can you please describe to me your principal
responsibilities?
Well, I am a nurse practitioner, but since our clinic regularly experiences staff
shortages, I sometimes find myself working multiple positions. At this time, it is only
three of us, so we have all become jack-of-all-trades. Still, my principal roles include
consulting with first time patients and performing x-rays and allergic testing services.
2) Which types of maladies do you come across most often in this clinic?
We deal with mostly tropical diseases, allergies, ulcers, and bacterial infections. As a
result, we mostly prescribe oral anti-biotics and topical creams.
3) What are the price ranges for these prescriptions?
(Laughs). The costs really depend. For simple treatments like oral anti-biotics and
topical creams, we normally charge between 2,000 – 7,000 CFA ($4 - $14). If the
health condition is too severe and requires a significant amount of medication and/or
strength of a medication, we will just make a prescription. This unfortunately, can
cost a patient between 25,000 – 40,000 CFA ($50 - $80), and sometimes even more.
4) Do you find the prices to be affordable for your patients?
It depends again. The location of our medical center is Scat Urbam, which is one of
those neighborhoods that houses people of many different socio-economic
backgrounds. Granted that our clinic is the primary clinic for this area, everyone
comes here. We find patients that believe our prices to be affordable, while others
may not think so. Located right next door to our facility is a convenient store, and
often times, we hear that patients go there and take small loans before coming to
purchase their medicine
5) What are the biggest obstacles faced by the clinic?
Our biggest concerns are our staff shortage, outdated equipment, and not enough
space
6) Do you feel that the Sanu medical center is well equipped to satisfy the needs
of the habitants of the neighborhood (Scat Urbam)?
Not at all, as of now, there are two other clinics in Scat, and together we are still
failing to meet the needs of the area’s residents.

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