How can we ensure universal healthcare in Senegal

At the European Development Days last week, the Alliance participated in a session which debated how the post-2015 development agenda should build on and improve the current health Millennium Development Goals, addressing their shortages around equity, human rights, financing and ownership.

At the European Development Days last week, the Alliance participated in a session which debated how the post-2015 development agenda should build on and improve the current health Millennium Development Goals, addressing their shortages around equity, human rights, financing and ownership.

Magatte Mbodj Guèye, Executive Director of our Linking Organisation, Alliance Nationale Contre le SIDA (ANCS) in Senegal and Joel Gustave Nana, Executive Director of African Men for Sexual Health and Rights (AMSHER), our regional partner in the Alliance-led SHARP (Men’s Sexual Health and Rights Initiative in Africa) programme spoke at the event (Finishing and moving beyond the health MDGs) in Brussels on Thursday 26 November 2013.

With less than 1,000 days until the deadline for the Millennium Development Goals (MDGs), the big question regarding health remains as relevant and timely as ever: how can universal access to healthcare be guaranteed for all – particularly those that are vulnerable to or affected by HIV?

The global consultations on the shape of the post-2015 development framework are calling for health to be placed at its core, as a critical contributor to and outcome of sustainable development and human wellbeing. The Alliance has played a leading role in these consultations, ensuring harmonised messages and recommendations between organisations and partners working in the fields of HIV, tuberculosis and malaria.

Paving the way in Senegal

With bold commitments, Senegal has continued the success of its national AIDS response, keeping HIV prevalence low and earning the recognition of global partners for its progress and achievements. Senegal has a vibrant civil society. It has made major efforts in recent years to scale-up access to HIV prevention, treatment, care and support services, with a particular focus on key populations at higher risk. Our Linking Organisation, ANCS, is the leading civil society organisation working on HIV in the country.

However, despite this success, Senegal still faces many of the issues relevant to the post-2015 agenda, including the challenge of scaling up access to healthcare for the most marginalised groups affected by HIV. The HIV prevalence rates among men who have sex with men and sex workers remain worryingly high (21.8% and 18.45% respectively).

Speaking on the panel, Magatte Mbodj said: “The government of Senegal aims to increase the percentage of the overall population who benefit from the universal health coverage scheme form 20% currently to 50% in the longer term… But the big challenge we are facing now is that vulnerable groups such as people living with HIV, vulnerable children, people who use drugs , men who have sex with men and sex workers are not taken into account whereas […] under the Senegalese Programme to fight AIDS, these groups used to benefit from free treatment. Now the big challenge is how to expand healthcare to these groups.

Magatte is also a member of parliament. As a member of the Health Committee, she has been lobbying for these vulnerable groups to be included in the scheme, as well as for an increase in the Senegalese health budget – currently 10% of overall budget, below the 15% commitment in the Abuja Declaration.

Scaling up services for all

In its May 2013 report on the post-2015 development agenda, the African Union Commission explained the uneven and discouraging performance on the health MDGs due to inequity in access to services due to physical and financial barriers, as well as a lack of ownership.

Joel Gustave Nana from AMSHER said: ‘One of the major challenges that we have seen on the [African] continent has been the legal and policy framework around sexual orientation and gender identity. 39 out of 54 countries still sustain laws that criminalise same sex consensual activity.

Although this usually concerns men, we have also seen situations where women have been arrested. This makes it challenging for services to be made available for these communities […] because the mere fact that you do say that you are a gay man puts you at risk of being arrested rather than receiving the service that you went for in the first place.’

And Anne-Marie Descôtes, Director General of the Department of Globalisation, Development and Partnerships at the French Ministry of Foreign Affairs said: ‘One of the major gaps of the MDGs has been the lack of attention to equity […]So many people have no access to healthcare and this lack of access is simply wrong.”

In her concluding remarks, the moderator of the panel, Goedele Liekens, UNFPA Goodwill Ambassador, said: ‘Many challenges to ensuring the right to health still remain. 7 million people living with HIV still do not have access to treatment. Social and legal barriers in many countries violate the rights of marginalised groups denying them access to healthcare.

‘The overarching health goal in the Post-2015 Development Framework should be outcome-focused, with universal health coverage as a key mechanism for achieving the health goal. It needs to provide for universal access to health services that match the needs of the population and universal financial risk protection that eliminates cost as a barrier to accessing healthcare.”

The European Development Days are organised by the European Commission and is Europe’s premier forum on international affairs and development cooperation.

Download the Alliance discussion paper on health in the Post-2015 sustainable development framework. [add link]