[Study of the Consumers' preference on the universal health coverage development strategy through health mutual in Ziguinchor Region, Southwest of Senegal]. / Étude de la préférence des usagers sur les stratégies de développement de la couverture sanitaire universelle à travers les mutuelles de santé dans la région de Ziguinchor au sud-ouest du Sénégal.

In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households. It was also based on focus groups of people with and without health mutual membership, and the Expert Committee meetings. The results showed that the most critical attributes in the decision-making of consumers to join the health mutual in Ziguinchor were the membership units; the content of the benefit package, the payment modalities of the premium, the premium amount, the availability of transportation, the co-payment level, convention arrangement with health facilities, and health mutual governance. For a successful implementation of the UHC development strategy through health mutual organizations, policymakers should explore the possibility of introducing the modality of payment in kind, the revision of the co-payment amount, and the promotion of equity through the introduction of a differentiated premium contribution by income. They should also establish a crossborder strategy with The Gambia and Guinea-Bissau to improve health care access to people living in the borders. The promotion of innovative funding and risk equalization between health insurance schemes is also recommended. In areas where the microfinance institutions are well organized and structured their substitution to health mutuals should be an option the decision-makers have to explore.

[Costs of operation of an urban reinforced community health post (Senegal)]. / Analyse des coûts de fonctionnement d'un Poste de Santé renforcé en milieu urbain (sénégal).

INTRODUCTION: In Senegal, the public funding in community health post is low. Resources are mainly obtained from the sale of services. The aim of this study is to analyse the operating cost of a community health post and to propose a relevant tariffing that would assure sustainable activities. METHODS: We used the method of complete costs. It comes out from our study that the total cost is 20 870 920F. RESULTS: Wages represent 70% of total expenses, operating costs represent 27% and 4% are investment. The public funding represents a value of 12 257 325F (60% of the total) in which 88% correspond to expenses induced by civil servant wages. The health committee participates for 33% and the other participants (7%). CONCLUSION: At the end of our study, a sustainable and social tariffing, was proposed.

Analyse des couts de fonctionnement d'un poste de sante renforce en milieu urbain (Senegal)

Introduction : Au Senegal; le financement de l'Etat au niveau poste de sante est tres faible; les ressources proviennent de la vente des prestations. Ce travail vise a analyser les couts d'un poste de sante; afin de proposer un systeme pertinent de tarification. Methodologie : La methode utilisee se conforme aux etapes principales du calcul des couts complets; alliant les couts constates avec les couts preetablis. Resultats : Il ressort de notre etude que pour un cout global de 20 870 920F. Les ressources humaines representent 70des ressources mobilisees contre 27pour les charges de fonctionnement et 4de charges liees aux investissements. l'Etat participe pour une valeur de 12 257 325F soit 60dont les 88correspondent aux charges induites par les ressources humaines. Le reste du financement du poste de sante est assure par le comite de sante (33) et les bailleurs (7). Conclusion : A la fin de notre etude; une tarification; tenant compte des possibilites de perequation; a ete proposee

[Models for calculating the cost of operational expenditure for a health centre in Senegal]. / Coûts de fonctionnement d'un centre de santé au Sénégal: modalités de calculs.

The transformation of a health post into a health centre generates new services which mobilise different resources. The objective of this work is to propose a budgetary forecasting model for this specific type of case, one which is recurrent although seldom documented. As a preliminary step, the quarterly operational costs were determined, and the "complete costs method" (or the homogeneous sections method) was utilised for this purpose. In the second phase, the "pre-established costs method" was used to set the budget forecasts. The amount to be recovered by the health committee for a three month period of operation is estimated at 1,574,967 F CFA (equivalent to approximately 2,400 Euros), representing 42% of the total cost. The states assures the contribution of public funds to cover 54.2% of the cost, and the commune of Kanel furnishes 3.8% of the total cost, however only in the form of in-kind contributions or other material resources. The overall estimated budget for the year 2004 is estimated at 14,835,425 F CFA (about 22,615 Euros) of which 57.6% is expected to be received from the state.

[Cost analysis of operating the oral health service of the regional hospital center of Ziguinchor (Senegal)]. / Analyse des coûts de fonctionnement du service de stomatologie du Centre Hospitalier Régional de Ziguinchor (Sénégal).

This study related to the analysis of the cost of operation of the service of oral health in the regional hospital complex of Ziguinchor for the year 2002. Its objective is to analyze the costs of operation of the service in order to allow a good covering of the costs while guaranteeing the accessibility to care and the perennity of the offer of service. The methodology used for the determination of the costs was the method of the complete costs (or method of the homogeneous sections). The various services provided by the service were identified. The resources mobilized for the realization of these services were determined and developed. They were classified in direct loads, i.e. directly ascribable to the provided service and in indirect loads when the resources are common to more than one service. The charge of the indirect loads was done thanks to a scale. The total cost of operation of the service of stomatology for year 2002 amounts to 11464943 F CFA. Two financial backers intervened with the financing of the service. The public funds support 75% of the loads and the community 25%. The cost to be recovered is 2845513 FCFA. The rate of covering is surplus for all the services safe for the oral surgery, the obturations with the composites and radiography. It is thus of primary importance to re-examine tariffing in force with the fall. This fall of tariffing will certainly make it possible to take restraint measures of the exemptions from payment. The covering of the costs by the means of the Community participation requires the installation of a tariffing likely to ensure the perennity of the services and to avoid exclusion.

[Cost analysis of psychiatric health care at the University Hospital of Fann (Senegal)]. / Analyse du coût des soins psychiatriques au CHU de Fann (Sénégal).

In the current senegalese context, marked by a political will of autonomisation of health services, is proves very important to study the costs of the services provided in hospitals. Our study, which consists in a retrospective analysis of accounting archives of the psychiatric department of Fann Hospital during the year 1998, had the following objectives: determine the costs related to the functioning of the service of psychiatry, according to the source of financing, determine the average cost of the main services provided by the psychiatric department, analyze the recovery of the cost of these services. The operating costs of the psychiatric department came to 86.824.477 FCFA in 1998. 88% of the total amount were brought by the State and the remaining 12% came from community participation. The average cost of hospitalization in Clinique Moussa Diop was 91.398 F CFA. For the former patients the visit cost 6.664 F CFA; for the outpatients the price was 12,886 F CFA. The average cost of a child psychiatric visit was 8.140 F CFA and 28 days of hospitalization in the same service cost 354.825 F CFA. The share supported by the community participation is in general largely covered by the current fees in spite of the high cost of these services.