The case of Senegal.

Senegal was 1 of the pioneers of health policies in West Africa. However mortality remains high in Senegal and a great difference exists between the privileged urban sector and the disadvantaged rural sector. The only available mortality data come from the civil registration systems of Dakar and Saint Lonis and a few sample surveys. The crude birth rate is about 46/1000 and did not change greatly between 1960 and 1980. Infant mortality did not fall between 1962 and 1977 but mortality and especially childhood mortality has fallen since 1970. Infant mortality on the other hand has been resistant to change. Senegals development plans have emphasized public health including 1) building at least 1 hospital in each region of the country 2) building a network of rural health centers 3) creating nutrition assistance centers and 4) establishing rural drainage projects. Worsening economic conditions mean that less and less has been spent on public health; a disproprotionate share of the budget goes to hospitals. Malaria the chief epidemic disease in Senegal affects virtually the entire population. As immunity against malaria may not be acquired until 6-15 years of age malaria remains an important cause of childhood mortality. A malaria eradication campaign begun in 1953 had limited success because 1) mosquitos did not remain in sprayed houses 2) only 70% of the population received anti-malarial drugs 3) some parasites developed resistance to the insecticides and 4) program administration was inadequate. A 2nd malaria prevention campaign from 1963-1979 using chloroquine was also unsuccessful due to drug costs delays in payment supply problems and inadequate supervision. The youngest age groups however did show a strong mortality decline in the experimental areas. Maternal and child health services increased faster than the population but were concentrated in towns. Vaccinations against measles tetanus and whooping cough have had no discernible effect on mortality as yet; measles caused 1/3 of the child deaths in Dakar from 1973-1980.