Although Senegal has achieved notable progress in improving neonatal and maternal health, some challenges remain. Senegal has demonstrated a commitment to overcome previous challenges and has evolved to sustain progress over the last two decades. Addressing these challenges may represent the next phase of maternal and neonatal health in the country.
Out-of-pocket spending
In 2020, out-of-pocket spending constituted 41.6% of all health expenditures in Senegal.1 Forms of community-based health insurance exist in Senegal, but new evidence suggests that this scheme may not address all barriers to care for the poorest people in the country, leaving those below the poverty line at increased risk for catastrophic health spending.2 Although initiatives such as the National Free Delivery and Caesarean Policy may remove the user fees for delivery-related health services, they do not necessarily cover all financial barriers to accessing care, such as transportation costs.
Figure 32: Sources of Health Expenditure in Senegal from 2000 to 2020
Lingering inequalities
Key reproductive, maternal, newborn and child health indicators have been instrumental in improving maternal and newborn health in Senegal, but antenatal care coverage, in-facility delivery, cesarean section, and postnatal care coverage have not increased at equal rates for all communities in Senegal. Many advancements have been concentrated in urban areas, especially Dakar, while other more rural communities have made slower progress. Although Senegal has decentralized much of its health care structure, the challenge of expanding access to more complex emergency care remains.
Abortion care
Although abortion is illegal in Senegal, unsafe abortions contribute to the country’s maternal mortality ratio. One assessment estimates that two-thirds of abortions were performed by untrained individuals, with 38% performed by traditional healers and 21% by women themselves.3 Three-quarters of poorer, rural women experienced complications compared with only 35% among richer, urban women.3 Although abortion may remain illegal in Senegal, evidence suggests that improved access to postabortion care and treatment may help avoid maternal deaths that contribute to the country’s maternal mortality rate.
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1
World Health Organization. Global Health Expenditure Database – Senegal [data set]. Accessed November 29, 2022. https://apps.who.int/nha/database/country_profile/Index/en
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2
Ly MS, Faye A, Ba MF. Impact of community-based health insurance on healthcare utilisation and out-of-pocket expenditures for the poor in Senegal. BMJ Open. 2022;12(12):e063035. https://doi.org/10.1136/bmjopen-2022-063035
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3
Sedgh G, Sylla AH, Philbin J. Estimates of the incidence of induced abortion and consequences of unsafe abortion in Senegal. International Perspectives on Sexual and Reproductive Health. 2015;41(1)11-19. https://doi.org/10.1363/4101115