Assessing the Viability of a Professionally Managed community-Based Health Insurance Scheme in Koungheul, Senegal: Perspectives for Universal Health Coverage

Introduction: This study examines the viability of the Departmental Health Insurance Unit (UDAM) of Koungheul in Senegal, an innovative model of a professionally managed health insurance scheme, implemented as part of universal health coverage. Unlike traditional community-based health insurance schemes, UDAMs are entirely managed by a salaried team, with elected leaders playing only a supervisory role. The study aims to assess the viability of this alternative model and analyze the perceptions of various stakeholders. Methodology: The study adopted a mixed approach, combining quantitative and qualitative methods. The quantitative analysis, based on a theoretical framework developed by the International Labor Office (ILO), assessed the viability of the UDAM across four dimensions: institutional, technical, functional, and financial/economic. Data collected in 2022 were analyzed. For the qualitative component, individual interviews and focus groups were conducted with various actors, including beneficiaries, non-beneficiaries, community leaders, UDAM officials, and healthcare providers. Results: The study reveals a contrasting situation for the UDAM of Koungheul. On the institutional and technical levels, the UDAM has a solid foundation with legal status, agreements with healthcare providers, and risk control mechanisms. Functional viability shows positive signs, with a membership growth rate of 16.15% and a high penetration rate of 76.66%. However, the contribution collection rate is low (52.29%), and the average payment delay to providers is long (7 months). The financial situation is concerning: the immediate liquidity ratio is low (0.248), the reserve rate is insufficient (0.93 months), and the loss ratio is high (90.34%). Stakeholder perceptions are generally positive, but significant practical difficulties are identified, including lack of information, funding problems, and procedural complexity. Conclusion: The study highlights the progress of the UDAM model compared to traditional schemes. However, persistent challenges, particularly in terms of financial viability, underscore the need for continuous evolution of the model. A more integrated approach, involving deeper integration into the national social protection system and stronger state investment, could be beneficial in consolidating the gains of the UDAM model.