May 2014—Astou Dieng is the chief nurse at Senegal’s Bagadadgi health post, based in a rural community more than 700 kilometers from Dakar and serving more than 17,500 individuals from 91 small villages. One of her main concerns is persuading community members to visit a health professional as soon as they are ill.

Families often delay visiting the nurse because they cannot afford the cost of care. A USAID-supported community health insurance program, implemented at Bagadadji since 2011, has helped address this problem head-on: For about $6 a year, nearly 600 families are covered for 80 percent of any health costs incurred. The program is jointly funded by USAID and the Government of Senegal.

“I am excited to see families have been coming to the health post more frequently,” said Dieng. “They are coming earlier, rather than waiting until their symptoms worsen.”

Statistics show the numbers on curative care consultations in Bagadadgi rising steadily, from 5,484 per year in 2010 to 7,257 in 2011, 8,197 in 2012, and 9,005 in 2013. In 2013, the insurance plan mobilized $12,243 in community members’ contributions and paid $5,285 to the health post for health care services provided to members.

Another major barrier for patients is the low-quality care many public providers offer. At Bagadadji, however, Dieng and her team of health workers have been trained or re-trained to provide all essential health services through USAID’s Tutorat Plus continuing-education program. Tutorat Plus is an in-service training program for health professionals to enhance and reinforce their professional skills.

“Trainings on the prescription and use of long-acting contraceptive methods are very popular with local women,” Dieng said. “They have had a pronounced effect on the number of women opting for modern methods of family planning.”

As a result, family planning use at the health post has been climbing, from 268 women per year in 2010 to 285 in 2011, 542 in 2012, and 476 in 2013—a major feat in a country like Senegal, where almost 30 percent of women express an unmet need for contraception.

Incentivizing these types of changes in community-level statistics is part of another important USAID intervention: the USAID-World Bank-Senegalese Ministry of Health-sponsored performance based financing (PBF) project. The PBF project incentivizes improved quality of care through payments to health workers and health facilities on on the basis of improvements in local health indicators.

Over the last two years, statistics from the Bagdadgi district have shown rising numbers of individuals seeking consultations, accessing insurance, and using modern methods of family planning. These improvements in the coverage and quality of maternal and child health services have resulted in Bagadadgi receiving rewards from the PBF project of $3,235 in 2012 and $3,293 in 2013.

Twenty-five percent of these rewards are used to improve the health post—Madame Dieng has purchased new equipment, fixed up the waiting room, and put a new roof on the building. The remaining 75 percent goes for bonuses to the health workers to motivate them to continue their achievements.

Dieng says the complementary nature of these different approaches has been key to Bagadadji’s success. The new funds have made her health center better equipped and more welcoming, training has made her health team more competent and able to provide higher quality care, and the community health insurance allows more people to take advantage of the improved services her health post offers.

“Support of USAID health has had many impacts in Bagadadji. Relative to the health post, we have benefited from continuing training of agents, and support helped to improve working conditions, respect for standards and protocols, as well as regular monitoring of our results,” said Dieng. “The community health insurance scheme was a real benefit to the people, especially the early use of health care throughout the commune, as well as involvement of communities in managing the post.”

Dieng’s leadership in mobilizing the health team and community to take advantage of these interventions is also critical to the successful results.

The population is highly satisfied with the health post's cleanliness, convivial atmosphere, continuity and accessibility of services. The health personnel are motivated by improvements in their working conditions and revenues. Thanks to their efforts, Senegal is building a strong health care system that can respond rapidly and professionally to the needs of its population.

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