Context

Understanding Senegal’s path to success requires an understanding of its national history and context.

Geography, demographics, and economics

Senegal is a small, mostly flat country on the western coast of Africa, bordered by Mauritania to the north, Mali to the east, and Guinea-Bissau and Guinea to the south. It surrounds The Gambia, which extends up the Gambia River from the coast into the interior of Senegal and divides the Casamance region from the rest of the country.

Senegal’s population of 16.7 million is predominantly Muslim, split about equally between rural and urban areas. In 2020, about 3 million people were living in metropolitan Dakar, the capital and largest city. Linked to a total fertility rate of about 4.5 children per woman, more than 40% of Senegal’s population is under 15, and the country expects further increases in population.¹ According to 2017 United Nations population figures, the country is projected to grow to over 34 million people by 2050.²

Senegal’s economy has already grown rapidly since 2000, and in 2009 it transitioned from a low-income to a lower-middle-income country. Its GDP per capita (purchasing power parity method, constant 2017 international dollars) has risen from $2,595 per person in 2000 to $3,300 in 2020.¹ The rate of extreme poverty in Senegal, defined by the World Bank as US$1.90 per day, declined from 62.6% in 1990 to 38.7% in 2006.³ Poverty rates remained fairly static until the COVID-19 pandemic, which was estimated to have raised the extreme poverty rate to 45% in 2020.³

Political history

Senegal, which gained its independence from France in 1960, is widely considered one of the most stable democracies in Africa. Under its multiparty political system, three presidents from different political parties have succeeded to power in the last two decades through general presidential elections.

Through successive waves of decentralization, the government of Senegal has sought to bring governance and service delivery closer to populations. In 1996, the Decentralization Law called for the transfer of health, population, and social affairs to local levels.⁴ In accordance with this law, three regions were subdivided in 2008. As a result, Senegal has 14 governmental regions today.

Senegal’s stability has been marred by conflict in the Casamance region, caused by religious, ethnic, and economic divisions. The conflict has abated since 2014, but irregular spates of combat continue to affect the area.⁵

Public health system

The central level of Senegal’s Ministère de la Santé et de l’Action Sociale (MSAS, Ministry of Health and Social Action), implements public health policies, monitoring and evaluation of programs, and coordination and partnership.⁶

In the 14 health regions (régions médicales) and 77 health districts (districts sanitaires), medical directors and public health officers coordinate and monitor implementation of national health policy. Health districts manage operational zones that include at least one health center (centre de santé) and associated health posts (postes de santé) and maternity hospitals.⁷ Health huts (cases de santé), the lowest tier of the health system, are staffed by community health workers who provide health education and coordinate delivery of basic services from health post staff.⁸ In 2018, Senegal had 102 health centers, 1,415 health posts, and 2,676 health huts (see table below).⁹

Health services, including vaccines, are provided free of charge to children under five years old.¹⁰ Some other health care services are also free, such as antenatal care and HIV and tuberculosis testing and treatment. However, other services may require user fees, which are paid directly to the facility. At health centers and health posts, the fee schedule is set by community health committees and varies from facility to facility. Fees generated within the health post from user fees are then used for community-level health programming.

It is not uncommon for Senegalese citizens who live near the border with The Gambia to travel there to access health services.¹¹

History of the immunization program

The Expanded Programme on Immunization (EPI) in Senegal was launched in 1979 and is managed by the MSAS. Funding for immunization in Senegal comes from the national government and from international development assistance (see figure below). In 2017, the total expenditure for immunization, including vaccine purchases and delivery costs, was US$19.2 million, of which 21.0% was provided by the government of Senegal and 74.4% came from development assistance.¹² Since 2002, Gavi, the Vaccine Alliance has provided over US$150 million for immunization in Senegal, contributing to the majority of the country’s external funding for immunization.¹³

These funds have supported the strengthening of health systems, cold-chain equipment optimization, new vaccine introductions, the purchase of new and underutilized vaccines, a human papillomavirus (HPV) vaccination demonstration project, and mass campaigns for meningitis A vaccination. Gavi has supported the introduction of vaccines against hepatitis B, Haemophilus influenzae type b, HPV, pneumococcus, poliovirus (inactivated vaccine), rotavirus, and rubella, as well as the rollout of a second dose of measles-containing vaccine. (See the two figures below on immunization coverage in Senegal and Senegal’s immunization schedule)

Below is a summary of significant events related to immunization coverage in Senegal since 2000. Apart from the support received from Gavi, various events and programs have played a crucial role in shaping immunization coverage in the country. Notably, the implementation of the Reaching Every District/Reaching Every Child (RED/REC) program has significantly enhanced DTP3 coverage nationwide. More information can be found in the What did Senegal do? section.

Senegal’s current immunization schedule for children up to 15 months of age can be seen in the figure below and has evolved since the country launched EPI services in 1979. When EPI started with the goal of ensuring full immunization of children against preventable diseases in 1979, Senegal’s schedule started targeting seven diseases at inception, which had evolved by 2005 to the current immunization schedule seen below.¹⁴