Senegal - Elaboration of a national framework for contractual agreements

Within the framework of the Social Security National Strategy (SNPS), STEP in Senegal has engaged a reflexion with social protection actors in Senegal about the adoption of a policy for contractual agreements, more adapted to communitarian schemes of health insurance.

Indeed, contractual agreements with health zone structures constitute an important development issue of healthcare mutual organizations and in general, of social protection schemes of a national dimension. Contractual agreements constitute a major element of technical and financial viability of a healthcare mutual organization.

However, nowadays conventions between mutual organizations and medical services providers are affected by many gaps:

• In the absence of an application decree on healthcare mutual organizations’ law, these do not have a defined status vis-à-vis the offer of medical services;
• Contractual agreements are often isolated actions where the mutual organization is facing alone the service provider;
• Weak institutionalisation of the convention. Signed conventions are relatively bilateral and of interpersonal nature and not from institution (health zone structures) to institution (healthcare mutual organizations);
• The relation established is often unbalanced (information asymmetry) and no constraint besides the medical service provider’s wish obliges this last to meet its obligations vis-à-vis the healthcare mutual organization;
• Due to healthcare mutual organizations development, medical service providers face a multiplication of contractual agreements’ demands that activate technical management and different payment mechanisms and consequently, a growing complexity for health zones structures;
• The deposit, required by some providers to healthcare mutual organizations to be covered in risk of insolvency, constitutes an obstacle in certain cases. The amount of this deposit, sometimes very high, often forces mutual organizations to calculate first an estimate of the amount in order to gather the required money before the actual payment to the health insurance;
• Some structures such as hospitals do not differentiate healthcare mutual organizations from other insurance schemes (such as IPM and private insurance) and apply high invoicing rates.

In addition, it is impossible for the social protection schemes of great scale to rely on case-by-case basis contractual relations with medical service supply, by signing a multitude of conventions with health centres and hospitals across the country.

For all these reasons, STEP-Senegal has introduced to the Ministry of health a reflection project about the insertion of national framework for contractual agreements. This project has incurred in a reflection process and has given place to the constitution of a working group.