Study of the Viability of the Departmental Health Insurance Unit in the Health District of Koungheul (Senegal)

The promotion of departmental units of health insurance (UDAM) is an essential path advocated by the State of Senegal to access to universal health coverage. The UDAM is a departmental mutual, professionalized with an expanded package of covered services and allowing early recourse of beneficiary patients to the public health structures of the district. After two years of implementation (2014-2015) from this initiative in a pilot phase, this work is to study the viability of UDAM Koungheul. A quantitative and qualitative evaluation study was conducted from July 20 to August 15, 2016. For the quantitative part, the study population of all records (logs and records) of members of UDAM Koungheul. A comprehensive recruitment files was conducted. An observation grid was crafted to collect data. As for the qualitative aspect, it was the UDAM officials, members, and non-members. Of individual interviews and focus group guides were used to collect the perceptions of these different targets on UDAM. Quantitative data were entered and analyzed using Excel 2007. Content analysis of about was conducted for qualitative data. Administratively, the UDAM had a good overall score of its operation tracking quality with 85% in 2014 and 100% in 2015 but gaps were noted in the use of some tools for managing and monitoring its operation. Functionally, the number of members and beneficiaries increased during 2015 with rates of monthly recoveries were around 100%. The penetration rate increased from 2% to 8% from 2014 to 2015. Technically, the beneficiaries of the least supported UDAM benefit costs covered compared to non-beneficiaries. Excluding this benefit to populations, UDAM was submitted the risks of abuse and adverse selection. Financially and economically, loss of membership fees failed to cover the cost of benefits with ratios of 52% (2014) and 55% (2015). The capital remained insufficient to cover its operating expenses and investment. Operating expense ratios for 2014 and 2015 were 85% and 176% respectively. The own financing rate increased from 62% to 35% in 2015. Apart from administrative and operational viabilities, other sustainability dimensions: technical, financial and technical threatened once the partner withdraws. Thus, it is important that the additional funding is UDAM able to fill the financial gap with the withdrawal of a partner to face the charges and to strengthen its outreach activities in order to join the people and retain members