The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal

• Published in: BMJ global health Vol. 7; no. Suppl 9; p. e010062
• Main Authors: Ridde, Valéry, Kane, Babacar, Mbow, Ndeye Bineta, Senghor, Ibrahima, Faye, Adama
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.12.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Coronaviruses; COVID-19; Emergency medical care; Epidemics; Fees & charges; Health facilities; Health insurance; health policy; health services research; health systems evaluation; Humans; Insurance coverage; Insurance, Health; Life Sciences; Original Research; Pandemics; Pharmacy; Public health; Santé publique et épidémiologie; Senegal; Severe acute respiratory syndrome coronavirus 2; Universal Health Insurance; Senegal; Africa; COVID-19; health systems evaluation; health services research; health policy; SAHEL; SENEGAL
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2022-010062

BackgroundIn its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers.MethodsThis study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews.ResultsThe results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes.ConclusionBoth UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.