When microfinance leads to major healing: Bridging agriculture and health in Senegal

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Astou Dieng recently joined a savings group cooperative with many other women farmers that is changing her health and the health of her family.

These women in Senegal’s Kaffrine region are doing something novel with their agriculture – they are accessing health care.

By working together to raise and sell crops, they can access new markets with the greater volume that they collectively produce and thus they earn greater income from their fields.

They came together through a government microfinance programme that helped them form their Naikhene savings cooperative. That membership also entitles them to a health insurance scheme that pays all but 20% of any health care treatment they or their family may need at a health post, health centre or hospital.

The insurance plan costs each woman 3500 FCFA (US$6) a year, but each has the whole year to pay it off and can pay it in instalments.

Thanks to the cooperative, the women now have more income than ever before, they can afford to buy the health insurance.

In rural communities, like Naikhene, where there is a poor standard of living, the participation rate for local health services is low. A main reason is that the cost of treatment and medicines can be high for most of the people.

The Senegal Agency for Universal Health Coverage is tackling this situation by encouraging the community savings groups that then partner with an insurance company.

Women like Astou even earn extra money to contribute to their Naikhene savings fund. Astou is raising sheep and poultry and is already seeing results from the community health care scheme – an idea Senegal is pioneering to help make health care affordable and thus accessible.

“The benefits of the [health plan] are huge,” says Astou Dieng. “When our children had malaria [previously], it was difficult to get them treated. But today, for a small sum, we go to the health post because we have the certainty that even if the bill is 10 000 FCFA, we will have no problem for the care because we only pay 20% of the amount. For example, for an invoice of 10 000 FCFA, we only pay 2000 FCFA.

In the Kaffrine region, there are 109 such groups, including the Naikhene women’s savings group, which started in August 2018 and has grown to 250 members. The members now seek health care that they used to avoid.

The strategy targets vulnerable people who often need primary care but do not seek it out due to the expense. With the community health insurance schemes, attitudes have changed about getting primary care whenever it’s necessary.

Before this model was instituted, people waited until they had enough money to pay for health care, Amy Diop Faye Sot, the head nurse at Niahene health station. With this model, “the attendance rate has increased significantly. Before they were waiting for money, but today, women do not wait any more – as soon as the child gets sick, they come very early to the health facility, with their membership book. They even come very early to the health facility with their membership book. They have also abandoned home births because they spend less money, thanks to the mutual health insurance scheme.”

Due to the popularity of the concept, there are around 676 insurance companies in Senegal offering health insurance to women’s associations and other local groups, like Dieng’s credit union.

The scheme, says Mouhame Habib Cisse’ Sot, the President of the Mutual Bokk Fadj Kathiock insurance company, “allows people to carry out income-generating activities and not to go into debt to heal themselves. With their insurance membership, their financial income is no longer diverted to medical expenses.”

Through technical assistance on the drafting of a law on universal health coverage, the pooling of funds and communication campaigns targeting communities, the World Health Organization has contributed towards the launch of this innovative concept for Senegal.

By increasing their use of health services, the women of Kaffrine are also helping to bring Senegal one step closer to universal health coverage.