Despite the considerable sums allocated to subsidies in the health sector in Senegal, the service leaves much to be desired. Indeed, the 2021 Court of Auditors audit report highlighted a significant gap between the amounts disbursed and the actual health services provided by mutual health insurance (MS). This gap, amounting to 5.2 billion CFA francs, raises major concerns about the efficiency and transparency of the use of funds intended for Universal Health Coverage (CMU).
A careful examination carried out by the Court of Auditors in the budgetary management dedicated to the health sector amounting to nearly 20 billion CFA francs per year, representing more than 10% of the State budget allocated to the CMU, has revealed a series of shortcomings and irregularities.
The analysis exposed the fact that more than 85% of allocated resources are intended for free initiatives and subsidies, of which more than 35% are allocated in the form of direct grants. However, the provision of these subsidies suffers from a lack of transparency and fairness, with poorly defined criteria and an unpredictable management process, thus hindering the viability of mutual health insurance and compromising health benefits for beneficiaries.
150,200,000 CFA francs in untraceable subsidies
Even more worrying, the state control body points to irregular practices such as the irregular allocation of massive subsidies to certain entities, as well as alleged misappropriation of funds, in particular with 150,200,000 CFA francs in subsidies allocated but untraceable in the Louga region. Exceptions to the provision procedures were also observed, with mutual societies directly receiving subsidies bypassing departmental unions, sometimes without clear justification.
These failings cast serious doubt on the effectiveness and integrity of the resource allocation process, jeopardizing the very objectives of Universal Health Coverage. Despite the large sums disbursed, actual health services remain largely insufficient.
Faced with these alarming findings, the Court of Auditors calls for an in-depth financial audit to guarantee the receipt and adequate use of the amounts paid. In addition, it underlines the need for increased control of the Universal Health Coverage Agency to guarantee transparent and effective management of subsidies, as well as appropriate use of funds allocated to mutual health insurance companies.
According to the situational analysis report of mutual organizations, over the period from 2017 to 2019, the health services covered by these entities only totaled 1,631,337,625 CFA francs, well below the 6,856,312,459 F CFA paid by the Universal Health Coverage Agency (ACMU) in the form of subsidies as contributions. Over a longer period, from 2015 to 2019, the total subsidies paid reached 12,603,936,159 CFA francs, thus accentuating the imbalance between the funds allocated and the health services actually provided.
This blatant disparity between the amounts disbursed and actual benefits raises concerns about the management of resources and the quality of health care provided to CMU beneficiaries, particularly the most deprived.
The auditors also highlighted that the importance of the subsidies granted to mutualist organizations makes them largely dependent on the ACMU for their proper functioning. Indeed, these subsidies represent nearly 57% of their resources from 2017 to 2019, with a substantial part intended to support beneficiaries of the Performance-Based Financing Strategy (SF/BF), making them de facto public service providers. This calls for stronger monitoring of the use of funds to ensure universal health coverage that is truly effective and equitable for all citizens.
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