1. Social Protection for agricultural workers in Senegal
Aly CISSE
ILO/STEP Sénégal

2. Outline Context of MIS Development
Evolution of the extension of social security
Positive contribution and limits of micro insurance
National Strategy of Social Protection
Social Protection for agricultural workers

3. Reminder: Some data GDP / capita: less than 700 US $
Life expectancy: 50 years
Child infant mortality: / 1000
Maternal mortality: /
On average, more than 40% of population is poor
Poverty in worse in rural areas (57,5%)

4. Context Let’s go back in time:
In the 60s (following independance) government was the only garantee for health care access: free access for all was the principe;
Two major events changed the situation:
Structural adjustment policies;
Bamako Initiative.
Policies reinforces by international organizations such as world bank and MFI to improve what they called macroeconomics agregats:

5. Structural adjustment policies
Public health expenditures reduction;
Bad public health care supply;
Difficulties for government to ensure health care access and quality.

6. Bamako Initiative
Health care services recovery with a tarification policy
End of free access to health care: communities should participate to the health cost.
Participation of the population to health care services management
Policy

7. MIS a credible alternative
Democratization process in Africa
Development of a strong civil society
Presence of NGOs and international organizations
Government involvment
Encourages the development of a strong civil society

8. Evolution of the extension of social security in Senegal
10 years ago
Formal sector employees (10%)
Covered through social security and other mechanisms (private insurance)
Rural and informal sector (80%)
Excluded from social security
Isolated beneficiairies from social assistance funds
Very Poor (10%)

9. Evolution of the extension of social security in Senegal
Development of micro-insurance (bottom-up) :
Complementary mutuals
Civil servants / corporation / trade unions
Formal sector employees (10%) M
Micro-
Insurance developed by
a MFI
Pamecas in
Senegal M M M
IMF
Rural and informal sector (80%)
Insurance managed by a federative structure
ASSURCAD in Senegal M
Health Micro-Insurance Schemes « mutuelles »
Wer Werlé Thiès Oyofal Paj in Senegal,
Very poor (10%)

10. Evolution of the extension of social security in Senegal
Development of linkages : since 2000
Linkages formal /
informal SP schemes
Unions des Mutuelles de Santé de
Dakar, UMSD
Formal sector employees (10%)
Contracting with HC providers - mutualized agreements in Thiès M M M
IMF M
Rural and informal sector (80%) M
Linkages of MI schemes
Cadre local de développe-
ment des mutuelles de
Kaffrine in Senegal M M M
Ind.
« Sponsorship », solidarity and equity funds - Wer Werlé Thies
Very poor (10%)

11. Positive contribution of micro-insurance
Improved comprehension of social protection
Improved conditions of access to health care and reduced insecurity
Increased transparency in billing / fee setting and management of healthcare thanks to the contracting process with HC providers

12. Current limits of MIS Weaknesses of the schemes
Size of membership limited  reduced pools
64% of the schemes have less than persons covered in 2003
Some reasons:
Voluntary membership
When membership is automatic, the size is increased; Ex: Mutuelle des volontaires de l’éducation (Senegal), persons covered
Inadequacy of health care  the system is less attractive
Limited financial capacity of the members + no subsidies  limited benefits packages

13. Current limits of MIS Weaknesses of the schemes
Poor management skills and information systems
Voluntary management staff; little number of schemes with computerized MIS (Progressive installation of MAS gestion in Senegal, Benin and Burkina Faso)
Premium collection mechanisms
Per month & direct payment  low collection rates
Weak capacity to negotiate with healthcare providers

14. Current limits of MIS Limitations at a higher level
Lack of coherence at the national level
Poor redistribution
Between +/ - rich members (flat rate premiums)
With other segments of the population (formal sector)
No functional linkages with statutory SS schemes
Weakness of the environment for the development of these schemes

15. National Strategy of Social Protection in Senegal
In that context, the government of senegal decided to move forward in order to boost social security coverage The formalization of the NSSP began in 2005 with

16. Context of NSSP elaboration
Absence of Social Protection in PRSP I
Correlation between absence of social protection and household poverty
Households ( particularly poor households) are vulnerable face to risks such as accident, illness, etc.
Participatory approach
Key actors: government, civil society, international organizations
Big ILO involvment
The NSSP became one pilar of the PRSP II ( )

17. Objectives of the SPSN
Increase the social protection coverage level, specially for health care
Sensitize populations on the importance of social protection as poverty reduction strategy
Train human resources necessary for social protection systems planning and management
More specifically: extend the health insurance level of coverage from less than 20% to 50 % by 2015

18. Nationwide micro-insurance schemes based on socio-occupational groups
Transport operators
( persons to be covered)
SCHEME
Agricultural workers
(5 million persons
to be covered)
SCHEME
Trade
unions
Groups
Groups of farmers
Federations
The groups include cooperatives, GIE, groups of producers, federations of GIEs …

19. Social Protection for agricultural workers in Senegal

20. Context Level of poverty of agricultural workers
Experiences of social protection in rural areas
Government comittment to support social protection of agricultural workers
Law in 2004 (Loi d’orientation agro-sylvo-pastorale)

21. Principes Automatic enrollment
Diversity of financing sources (beneficiaries, taxation, budget allocation)
Innovative financing mechanisms (indirect premium collection )
Outsourcing of technical management and use of computerized MIS
Progressivity in the implementation

22. Services covered Health insurance first step: a priority for all
Coverage system
Health care in the public sector
Primary level (health post, health centre)
Secondary and tertiary level (regional and national hospitals)
Quasi-totality of health care are covered
Level of coverage
70% at the primary level
90% at secondary and tertiary level

23. Cost of coverage
The cost of coverage is estimated to FCFA per person and per year (20 USD)
Beneficiaries will pay 23% (7 USD)
Government will pay 67% (21 USD)

24. Legal framework
The implementation of nationwide HMIS such as the agricultural workers social protection system should help improve access to health care and quality.
It goes with the restructuration of the HMIS environment(laws and regulations, relationships with health care providers)
…………………………

25. Legal framework The structuration is based on:
A legislation on health micro insurance schemes;
A coherent framework for the contracting process with healthcare sector
Since 2004, ILO works with 8 WAEMU (West African Economic and Monetary Union) to elaborate legal framework on HMIS
Health care providers, HMIS and other partners were involved in the process.
Legal framework (rules and regulations) in an adoption procedure at WAEMU.
HMIS will be reinforced in terms of access and quality of care in partnership with health care providers.
A contracting framework aims to improve quality of care and relationships between HMIS and providers. This will allow:
Health care providers face an organized demand;
HMIS to alleviate difficulties such as cautions asked by health care providers or fee setting not adapted to their members.
The contracting framework contains key elements:
Quality of care,
Fee setting and billing modalities,
Information, follow up, control mechanims of the contracting framework

26. Social Protection for agricultural workers in Senegal
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