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Table 4 Analysis of the way equity is approached in UHC policy documents in Benin and Senegal

From: How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

Document no.SourceTitleDefinition of equity?Way equity is approached in the document
C1Senegal/MoH 2009PNDS (NHSP) 2009–2018 [46]No- The Plan states that more than before, equity in health service distribution and financial access (financing the demand-side) were prioritised
- Strategies announced to improve equity in health service distribution:
  o Making a minimum healthcare supply capacity available in the regions (including creating district hospitals)
  o Revising the health map (norms in terms of infrastructure, equipment and personnel per level of care) to make it more ambitious in terms of supply capacities of services / ensuring a better distribution of health facilities throughout the country
  o Improving the resource allocation system (not further explained)
- A number of measures are announced to reinforce the regulatory function of the State, including regarding issues of equity, gender, discrimination, and social protection
- Associations of equity with UHC and other concepts:
  o Equity is viewed as a principle guiding the implementation of the NHSP, together with participation, multisectoriality, transparency, solidarity, and gender
  o Inequities are also associated with exclusion
C2Senegal/MoH 2013Strategic plan for the development of universal health insurance in Senegal 2013–2017 [47]No- The strategic plan starts from the observation that the evolution of the country’s health system has not promoted equity in access to health care, household financial protection, and equity in health financing; however, free and subsidised healthcare initiatives have enabled to increase equity
- The plan refers to the 2012 UNGA resolution on UHC which calls on each UN Member State to avoid out-of-pocket payments and to finance its health system through more equitable and supportive mechanisms
- The plan intends to reform the health financing system by expanding health insurance to rural and informal sectors, through promotion of community-based health insurance (CBHI) and subsidisation of premiums for the poorest, and the creation of the National Health Solidarity Fund
- Progressiveness in health financing is to be ensured through the development of information systems to scale contributions based on households’ ability to pay for health care (not further developed)
- The logical framework of the plan has an impact indicator of equity of access, measured through health service utilisation rates
- Associations of equity with UHC and other concepts:
  o The values and principles of the plan are: solidarity, equity and social justice, quality, efficiency, good governance, and partnership
  o Equity is viewed as a basic principle to ensure social inclusion, the inclusion of the poor and vulnerable groups, and equitable access to care
C3Senegal/MoH 2017Sector Investment Plan 2017–2021 [48]No- In order to respond to unequal distribution of infrastructures throughout the country, the plan announces that its priorities were defined taking into account the gaps identified by the “health and social map” and equity criteria with a focus on high-impact interventions (without further detail)
- It will give priority to two essential components: demand financing and construction of new infrastructure
C4Senegal/MoH 2017Strategic development plan of the Agency for universal health insurance [49]No- The plan states that respect for equity is a fundamental element in improving access to care and reducing poverty; and it also refers to the 2012 UNGA Resolution on UHC
- The plan recalls that the universal health insurance (“CMU”) policy is strongly affirmed as the strategy to ensure equitable access to quality health care without any form of exclusion for the entire population of Senegal, and that it is based on the development of mutual health insurance and the strengthening of free healthcare initiatives
- One of the main strategies envisioned is support to the affiliation of the poorest (beneficiaries of social assistance programmes, including equal opportunity card holders) to CBHIs
- Associations of equity with UHC and other concepts:
  o Equity is part of the Agency’s vision in order to fight exclusion, and of its values under the form of fair and equal treatment for every Senegalese
C5Senegal/MoH 2017National health financing strategy (NHFS) [50]No- The strategy is based on a situation analysis that emphasises the inequitable distribution of resources, including human resources, especially between regions and living environments but also between levels of care
- In particular, the identified obstacles to equitable access to health services are: remoteness, isolation, inadequate accommodation for persons with disabilities, high cost of health services, and lack of availability of health facilities
- The compulsory contributory scheme to health insurance for employees in the private sector is also judged inequitable
- The strategy reckons that the principle of equity will be clearly positioned in the criteria that support decisions on the allocation of resources in order to democratize access to health services
- The strategy comprises four strategic orientations:
  o The first one intends to improve the availability of quality health services, with a focus on ensuring equitable access to quality health services – notably through the “densification and democratisation of the supply of health services” (revising the health and social map)
  o The second one intends to expand protection against health-related financial risk, also with a focus on equity through promotion of CBHIs to the rural and informal sectors, subsidisation of the contribution of the poorest, and unification of governance mechanisms of the various UHC schemes
  o The third one intends to target behavioural and environmental determinants of health
  o The fourth one intends to raise more resources, and improve their efficiency, notably through the application of budget allocation criteria (not further explained)
- Associations of equity with UHC and other concepts:
  o Sustainable development necessitates the respect of the principles of equity and gender equality
  o The strategy is based on a vision of a Senegal where all populations have access to quality health services based on sustainable financing that respects the principles of equity and solidarity; the search for equity will be combined with the principle of solidarity to ensure the social inclusion of the poor and vulnerable groups in health risk coverage mechanisms
C6Benin/MoH 2010PNDS (NHSP) 2009–2018 [51]No- The plan is based on a situation analysis that points to inequitable distribution of staff, as well as financial barriers that do not favour equitable access to healthcare
- The plan intends to give priority to equitable financing and sound management of health expenditure
- Associations of equity with UHC and other concepts:
  o The 2025 vision of the plan intends to ensure the permanent availability of quality, equitable and accessible healthcare services to populations of all categories, based on the values of solidarity and risk sharing
C7Benin/MoH 2015National health financing strategy (NHFS) 2016–2020 [52]No- The situation analysis points to great geographical disparities – notably in the distribution of human resources – and to the fragmentation of financing schemes that lead to inequitable access to healthcare
- The strategy is based on several principles linked to equity, including: equitable and easy access to quality health care at affordable costs according to needs, the availability of health care provision to the entire population, solidarity and risk sharing based on obligation and non-exclusion, and protection against financial risk; equitable sources of financing are looked for
- The strategy comprises three strategic orientations:
  o Improve and streamline the utilisation of resources in the health sector
  o Implement the health insurance scheme and integrate other financial protection schemes
  o Guarantee that the health financing system is equitable, sustainable and predictable
- Concretely, the proposed measures to improve equity are:
  o The revision of the Ministry of Health’s budget allocation procedures to ensure equity and efficiency; budget should be allocated on the basis of existing resources and performance, in line with and linked to resources from community funding
  o Populations’ contribution to the State-led health insurance scheme in function of their income (and exemption for the poorest)
- Associations of equity with UHC and other concepts:
  o The strategy is based on the same vision as the NHSP 2009–2018; as well as on the following values: (i) accountability and leadership, (ii) equity, social justice, ethics and good governance, and (iii) effectiveness and efficiency
  o Equity repeatedly associated with sustainability and efficiency
C8Benin / Government 2019Project document: Insurance for the strengthening of human capital (ARCH) [53]Yes: see next column- The overall objective of the ARCH project is to increase capacity and access to basic social services and economic opportunities in a sustainable and equitable way for Beninese people, especially the poorest
- The project comprises 4 packages of social protection services (health insurance, training, credit and retirement) to improve the impact of programmes and equity in access to basic services
- In the context of the implementation of the ARCH health insurance service, equity is approached in two respects: (i) equity of access, i.e. facilitating access for all Beninese citizens to the package of basic benefits, according to their individual health needs, and (ii) contributory (vertical) equity, which aims to involve each social stratum in the functioning of the ARCH system according to their ability to pay
- Associations of equity with UHC and other concepts:
  o Equity associated with efficiency, economies of scale and sustainability