{"id":165396,"date":"2026-08-11T12:24:45","date_gmt":"2026-08-11T12:24:45","guid":{"rendered":"https:\/\/www.one.org\/africa\/?p=165396"},"modified":"2026-08-11T12:51:31","modified_gmt":"2026-08-11T12:51:31","slug":"financing-senegals-health-future","status":"publish","type":"post","link":"https:\/\/www.one.org\/africa\/stories\/financing-senegals-health-future\/","title":{"rendered":"Could this be Senegal’s Health Financing Future?"},"content":{"rendered":"\n

As global health financing becomes increasingly uncertain, Senegal is confronting a defining question: how can it move from dependence on external assistance to a more sovereign, sustainable and accountable model of financing health?<\/em><\/p>\n\n\n\n

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For decades, development assistance has played an important role in financing health systems across Africa. But that model is under increasing pressure. As external funding becomes less predictable and countries face growing demands on public resources, the question for African governments is no longer simply how to attract more donor money. It is how to build health systems that are increasingly financed, governed and sustained through domestic institutions and resources.<\/p>\n\n\n\n

Senegal may be approaching precisely such a moment.<\/p>\n\n\n\n

That question was at the centre of a high-level public dialogue convened by ONE<\/a> <\/strong>in Senegal, in partnership with Coalition Plus<\/strong>,<\/a> under the theme \u201cFrom Dependency to Sovereignty: Toward Transparent and Accountable Health Financing in Senegal.\u201d<\/em> The dialogue brought together 45 participants from government institutions, civil society organisations, public health, development partners and advocacy. The group included representatives of the Ministry of Health and Public Hygiene, the National AIDS Control Council (CNLS), the Directorate of Maternal and Child Health, the National Alliance for Community Health (ANCS), ENDA Sant\u00e9, UNAIDS, ONE Champions and a member of ONE’s Health Advisory Council.<\/p>\n\n\n\n

The breadth of participation was significant because health financing is not simply a technical question for ministries of health or finance. It is a question of political choice, economic policy, governance, accountability and ultimately the kind of health system Senegal wants to build. What emerged from the dialogue was a recognition that Senegal may be facing an important opportunity to rethink not only how much it spends on health, but how the country mobilises, allocates, manages and accounts for those resources.<\/p>\n\n\n\n

Senegal’s financing challenge is also a sovereignty challenge<\/h2>\n\n\n\n

Dr. Farba Lamine Sall<\/strong>, former Chief of Staff at the Ministry of Health and former World Health Organization official, provided an overview of Senegal’s health financing landscape and highlighted several structural vulnerabilities. External assistance currently accounts for approximately 24% of health financing<\/strong>, while household out-of-pocket spending represents approximately 43%<\/strong> of total health financing.<\/p>\n\n\n\n

These figures reveal a system exposed to two different forms of pressure. A significant reliance on external assistance means that changes in global development priorities, donor budgets or geopolitical circumstances can have direct consequences for domestic health programmes. At the same time, when households carry such a substantial share of health costs themselves, the burden of financing the health system is transferred, in part, to individual families.<\/p>\n\n\n\n

This makes the conversation about health financing sovereignty particularly important. Senegal’s challenge is not simply to find more money for health. It is to change who finances health, how resources are pooled, how they are allocated and how citizens hold institutions accountable for the resources being spent.<\/p>\n\n\n\n

The challenge is therefore both to increase domestic resources and to make every existing franc work harder.<\/p>\n\n\n\n

That means asking difficult questions about public expenditure, procurement, coordination, decentralisation, efficiency and value for money alongside the traditional question of how much money is available. It also means considering whether Senegal’s changing economic circumstances could create new opportunities to invest in health.<\/p>\n\n\n\n\n\n

Could oil and gas change the equation?<\/h2>\n\n\n\n

Senegal’s emerging oil and gas revenues introduce another important dimension to this conversation. During the opening of the dialogue, Dr. William Menson<\/strong>, representing the leadership of ONE, highlighted the potential for revenues from Senegal’s emerging oil and gas sector to create additional fiscal space for domestic investment in health.<\/p>\n\n\n\n

This does not mean that natural-resource revenues automatically translate into stronger health systems. Experience across resource-rich countries demonstrates that the relationship between natural wealth and social outcomes depends heavily on governance, institutional capacity and political choices.<\/p>\n\n\n\n

Can Senegal’s new economic wealth be converted into long-term public health gains through transparent, accountable and well-designed financing mechanisms?<\/p>\n\n\n\n

This makes the development of a national framework particularly important. Rather than treating new revenues as an ad-hoc source of additional spending, Senegal could consider how emerging fiscal resources can be incorporated into a health financing architecture that defines how resources are mobilised, allocated, monitored and evaluated.<\/p>\n\n\n\n

The opportunity, therefore, is bigger than oil and gas. It is about using a changing economic landscape to rethink Senegal’s wider social investment model.<\/p>\n\n\n\n

From raising money to spending better<\/h2>\n\n\n\n

One of the strongest messages to emerge from the dialogue was that more financing alone will not solve Senegal’s health financing challenge. The country must also improve the efficiency, coordination and accountability of the resources already available.<\/p>\n\n\n\n

Ms. Ndeye Fatou Tall<\/strong> reinforced this point, representing the Delivery Unit of the Ministry of Health and Public Hygiene. She highlighted ongoing efforts by the Ministry to improve spending efficiency through better resource allocation, digitalisation, procurement reforms and stronger coordination among development partners<\/strong>.<\/p>\n\n\n\n

These reforms point towards a critical shift in thinking about health financing. The effectiveness of a health system should not be measured solely by how much money enters it. It should also be measured by what that money produces: whether more people can access quality primary healthcare, community health services are adequately supported, procurement delivers value, resources reach the communities that need them most and citizens can understand how public resources are being used.<\/p>\n\n\n\n

In that sense, the next frontier of health financing may be as much about productivity and efficiency as it is about revenue.<\/p>\n\n\n\n

The political choice behind health financing<\/h2>\n\n\n\n

According to Mr. Aliou Jalo, Executive Director of ENDA Sant\u00e9<\/strong>, health financing is ultimately a political choice. Adequately financing health requires political commitment to prioritise the sector within a national budget that must respond to competing demands.<\/p>\n\n\n\n

This framing is important because it moves health financing beyond the narrow confines of technical budgeting. Every national budget represents choices. Every allocation signals priorities. Every decision to invest, or not invest, in primary healthcare, community health, health insurance or public health infrastructure has consequences for citizens.<\/p>\n\n\n\n

The challenge is therefore to build the political case for health not simply as a social expenditure, but as a long-term investment in Senegal’s human capital, economic resilience and national development.<\/p>\n\n\n\n

That also means recognising that health financing reform cannot be separated from broader questions about public-sector performance. A larger allocation is only meaningful if institutions have the capacity to translate that allocation into better outcomes for citizens.<\/p>\n\n\n\n

\"Dr.<\/figure>\n\n\n\n

What would a more sovereign model look like?<\/h2>\n\n\n\n

Dr. Safi\u00e9tou Thiam<\/strong>, former Minister of Health and current Executive Secretary of the National AIDS Control Council (CNLS)<\/strong>, emphasised the importance of establishing a clear governance framework for emerging health financing sources. She argued for mechanisms that ensure revenues generated through health-related taxes contribute directly to health outcomes, while also pointing to debt-for-health swaps, diaspora financing and public-private partnerships<\/strong> as potential instruments for strengthening sustainability.<\/p>\n\n\n\n

Her intervention points to an important principle: Senegal does not need to depend on a single financing mechanism. A more sovereign health financing model could combine conventional public revenues with innovative instruments, provided those mechanisms are governed transparently and aligned with national priorities.<\/p>\n\n\n\n

Dr. Thian\u00e9 Gu\u00e8ye, Governance and Public Health Expert<\/strong>, brought another essential dimension to the discussion: decentralisation. Local governments increasingly carry responsibilities for health service delivery, but responsibilities without corresponding financial resources can create structural gaps between policy and implementation. Aligning local responsibilities with adequate financing is therefore essential if decentralisation is to improve rather than complicate health outcomes.<\/p>\n\n\n\n

Dr. Gu\u00e8ye also highlighted the potential contributions of the private sector and health insurance schemes<\/strong>, while underscoring the critical role of civil society in promoting transparency and accountability. This accountability function is particularly important because a more domestically financed health system should not become a less accountable health system. Greater domestic ownership should instead be accompanied by stronger mechanisms for citizens, communities and civil society organisations to scrutinise how resources are raised, allocated and spent.<\/p>\n\n\n\n

Community health cannot be an afterthought<\/h2>\n\n\n\n

Ms. Maguette Mbodj, Executive Director of the National Alliance for Community Health (ANCS)<\/strong> listed increasing domestic financing for community health as one of the priorities.<\/p>\n\n\n\n

That matters because community and primary healthcare are often where citizens experience the health system most directly. Reducing dependence on external donors without ensuring sustainable domestic financing for these services could simply shift the vulnerability rather than resolve it.<\/p>\n\n\n\n

Ms. Mbodj therefore made a complementary argument that civil society must advocate not only for increased financing but also for efficiency, accountability and value for money<\/strong> in health spending.<\/p>\n\n\n\n

This represents an important evolution in advocacy. The question cannot only be how much more government should spend. It must also ask where the money should go, what it should achieve, who is responsible for delivering the result and how citizens will know whether the promised results have been achieved.<\/p>\n\n\n\n

This is the difference between advocating for bigger budgets and advocating for better public investment<\/strong>.<\/p>\n\n\n\n

A financing strategy needs an accountability architecture<\/h2>\n\n\n\n

The dialogue ultimately pointed towards a model in which resource mobilisation and accountability are inseparable.<\/p>\n\n\n\n

Participants recommended that the Government develop a national framework to guide the mobilisation, allocation and oversight of innovative health financing mechanisms<\/strong>. They also called for the exploration of new financing instruments, including debt-for-health swaps, diaspora financing, public-private partnerships and the strategic use of revenues from emerging economic sectors.<\/p>\n\n\n\n

At the same time, participants recommended increased domestic financing for health, particularly primary healthcare and community health services<\/strong>, alongside stronger systems for resource allocation, digitalisation, pooled procurement and coordination among stakeholders.<\/p>\n\n\n\n

The recommendations also recognised that accountability must operate at both national and local levels. This includes stronger monitoring mechanisms, citizen engagement and civil society oversight, as well as a stronger role for local governments in health financing and service delivery, with responsibilities matched by adequate financial resources.<\/p>\n\n\n\n

The result would be a health financing system that is not simply more domestic, but also more transparent, more efficient and more responsive to citizens.<\/p>\n\n\n\n

From dialogue to policy<\/h2>\n\n\n\n

The real test now is whether the conversation moves beyond the conference room. ONE and Coalition Plus, together with participating stakeholders, have agreed to convene a follow-up virtual meeting<\/strong> to establish working groups around five priority areas: innovative financing mechanisms; domestic resource mobilisation; health financing governance and accountability; community health financing; and local government engagement and decentralisation.<\/p>\n\n\n\n

The next proposed step is the development of a joint advocacy paper<\/strong> setting out concrete policy recommendations for strengthening health financing sovereignty in Senegal and submitting those recommendations to relevant government institutions, including the Ministry of Health and Public Hygiene<\/strong> and other key decision-makers.<\/p>\n\n\n\n

This creates an opportunity to translate consensus into a practical policy proposition.<\/strong><\/p>\n\n\n\n

The objective is a framework that answers the questions policymakers will ultimately have to confront: <\/p>\n\n\n\n

    \n
  1. What should Senegal finance differently?<\/li>\n\n\n\n
  2. Where should new resources come from?<\/li>\n\n\n\n
  3. How should they be pooled?<\/li>\n\n\n\n
  4. How should they be allocated?<\/li>\n\n\n\n
  5. What should be decentralised?<\/li>\n\n\n\n
  6. What should be digitised?<\/li>\n\n\n\n
  7. How should procurement be reformed?<\/li>\n\n\n\n
  8. ow will citizens know whether the system is delivering value?<\/li>\n<\/ol>\n\n\n\n

    Senegal’s next health financing chapter<\/h2>\n\n\n\n

    There is a larger story here. Senegal’s health financing future is not contingent on whether the country can attract more donor commitment. The metric to watch is whether it can build the institutions, policies and political consensus required to finance health through its own resources and effectively use them.<\/p>\n\n\n\n

    The country’s emerging oil and gas revenues could provide an opportunity. Innovative financing could provide additional instruments. Digitalisation and procurement reforms could improve efficiency. Stronger local financing could bring resources closer to communities. Civil society could strengthen accountability. Political leadership could bring these pieces together.<\/p>\n\n\n\n

    None of these interventions, however, is sufficient on its own. The opportunity lies in connecting them into a coherent national strategy. That is why the conversation convened by ONE Senegal and Coalition Plus<\/strong> matters. The dialogue brought together government, civil society, public health experts and development partners around a question that will become increasingly important across Africa: what does health financing sovereignty actually look like in practice?<\/p>\n\n\n\n

    Could this be Senegal’s health financing future?<\/strong><\/h4>\n\n\n\n

    The answer could be the beginning of a new social contract around health, with domestic resources increasingly financing national priorities. Citizens are better protected from excessive out-of-pocket costs, communities have a stronger voice, and public institutions are accountable for delivering results.<\/p>\n\n\n\n

    The important question is whether the country can seize this moment to build greater health financing sovereignty. The next phase, turning dialogue into policy, policy into financing and financing into measurable health outcomes, will provide the answer.<\/p>\n\n\n\n

    <\/div>\n\n\n\n
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    Lesijolu Eric-Nwabuzor <\/em><\/strong>leads Communications and Influence for Africa at The ONE Campaign (ONE). Alongside colleagues, her work engages policymakers, investors, media and the public to reframe how Africa is perceived, understood and valued.<\/em><\/p>\n\n\n\n

    <\/p>\n

    <\/div>","protected":false},"excerpt":{"rendered":"

    As global health financing becomes increasingly uncertain, Senegal is confronting a defining question: how can it move from dependence on external assistance to a more sovereign, sustainable and accountable model of financing health? For decades, development assistance has played an important role in financing health systems across Africa. But that model is under increasing pressure. […]<\/p>\n","protected":false},"author":78,"featured_media":165415,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"161711,162067,162038,161762,161786,162087","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1],"tags":[239,72,428],"topic":[],"contributor":[],"one_content_audience":[],"one_content_type":[],"one_content_tone":[],"class_list":["post-165396","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-africa","tag-health","tag-health-financing"],"acf":[],"yoast_head":"\nCould this be Senegal's Health Financing Future? - ONE.org Africa<\/title>\n<meta name=\"description\" content=\"Senegal could shape a more sovereign health system using innovative financing, domestic resources, oil and gas revenues. 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