How is it that, in a region that has lagged behind in many of the global health advances of the past 30 years, one country stands out for its tremendous progress?
In West Africa, Senegal has been making great strides in reducing maternal and child deaths, increasing availability and use of family planning, and building a strong, resilient health system that can repel unexpected threats such as Ebola and Zika virus (the way it has with HIV since the epidemic’s beginning).
Since 1992, vaccinations in Senegal have soared, infant mortality has been cut in half, and the modern contraceptive prevalence rate has rocketed from under 5 percent to 20 percent.
And that last point is crucial, because contraception affects so many other aspects of health. As global use of modern contraceptives rose from 55 percent in 1990 to 63 percent in 2010, global maternal mortality fell by a staggering 45 percent. Countries that embrace family planning and build it into their health systems enjoy not only greater health, but greater gender equality and economic prosperity. And Senegal has made this a priority. As a result, the median age at first marriage for women has risen from 16 to 20, which means more women and girls stay in school longer and have a greater chance of joining the workforce and contributing to their families’ incomes.
But what is Senegal doing right that its neighbors can learn from? Here are a few reasons the country is ahead of the curve in its region:
Early, decisive action on HIV — and Ebola
I was living in my home country of Senegal in 2002 when HIV prevalence rates peaked in parts of Africa. In Botswana, for instance, almost 40 percent of adults were infected. But in Senegal it was only 0.5 percent.
That’s because Senegal mobilized quickly and focused on prevention. They enlisted religious leaders to spread the word, created mass media campaigns, and even treated sex workers, which was a bold move at that time. As a result, HIV rates remain low to this day. And the country’s similar response to the threat of Ebola in 2014 spared Senegal a potentially catastrophic outbreak.
Country ownership and investment
For years, Senegal has benefitted from donors such as the U.S. government, the Bill & Melinda Gates Foundation, and other outside entities that have invested in improving life for its people. And those investments have helped prepare Senegal to invest in itself.
At the 2012 London Summit on Family Planning, Senegal made a commitment, saying, “We're going to double our domestic investment in health.” And they've done just that. In the last two years, for instance, Senegal has increased its health workforce through a mass recruitment campaign. When development donors say they want to see more country ownership, this is what they mean.
Robust national plan
It takes real planning to follow through on ambitious goals. In creating its National Health Development Program, Senegal drew a roadmap to curb the chaos of uncoordinated programming and improve public health for its people.
Senegal also has a new economic plan, called the Plan Senegal Emergent, which goes beyond health to maintaining economic growth and development as Senegal moves toward becoming a middle-income country.
Creative health workforce management
Senegal has a shortage of health workers, but it has done a great job of getting creative with the ones it has. For instance, the government has been working with us at IntraHealth International to rehire some of the huge cohort of out-of-work or retired midwives to help boost family planning throughout the country.
It also instituted the Bajenu Gox Initiative in 2009. Bajenu gox (which means paternal aunt or godmother in Wolof) are traditionally very influential family members. Each community seems to have such a woman who acts as a social leader. So the government came up with a strategy to partner with local bajenu gox across the country and enlist them to provide sound advice for basic health and family planning. And it has worked.
Powerful system for managing contraceptive supplies
6 ways NGOs can speed up progress
Dr. Babacar Gueye, chief of party and country director for IntraHealth in Senegal, offers some tips on how NGOs can speed up progress on family planning efforts, based on his experiences in Senegal:
• Ensure your programs and activities align with the priorities of the government and are high-impact and cost-efficient.
• Offer technical assistance to build capacity throughout the health system.
• Advocate in partnership with both the government and local civil society for greater domestic investments in health.
• Work intentionally to strengthen national systems, rather than create parallel project-based systems.
• Conscientiously work to support sustainable development — not just short-term project results.
• Advocate globally for more long-term investments in health systems and in the health workforce — not just short-term investments in vertical initiatives.
Senegal now has a system for keeping clinics stocked with the contraceptive methods clients want. Through the Informed Push Model, trained logistics operators deliver supplies on a regular schedule, restocking where necessary and recording quantities of products sold. The data are then used to ensure that each site and warehouse is sufficiently stocked, and allows manufacturers to keep pace with demand. This system has reduced contraceptive stockouts to less than 2 percent throughout Senegal.
This has major implications not only for the current population of adults, but for the country’s future — over 50 percent of Senegal’s people are under 20, which means they will grow up with this new system and enjoy a lifetime of health benefits from it.
Senegal has a lot to share with other countries in the region. It already is, in fact, through initiatives such as the Ouagadougou Partnership, an alliance of nine countries that all learn from one another and share expertise to meet their family planning and reproductive health goals.
Many of these countries are starting to see some progress as well. In 2001 in Mali, for instance, a fifth of women (and 9 percent of men) did not know of a single method of contraception.
By 2013, the percentages had fallen to 13 percent of women and 4 percent of men. And most Ouagadougou Partnership member countries have slowly grown their modern contraceptive prevalence rates into the double digits (Ebola-ravaged Guinea is the exception at 5 percent).
NGOs have a role to play in speeding up progress in this region. They also have a responsibility to align their work with local priorities and avoid duplicating efforts or wasting resources.
Senegal’s success comes not only from making commitments but from following them up with implementation plans, working efficiently with its partners (including NGOs), investing and coordinating resources, and doing the day-to-day work necessary to stay on track — precisely the kind of hard work that will help individual countries reach their health targets and achieve the Sustainable Development Goals.
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