Senegal health and population sector assessment.

An outside consultants assessment of the health and population situation in Senegal was done to suggest strategies and activities for USAID/Dakar in the mid-1990s as well as issues to be addressed by the Government of Senegal (GOS) and foreign donors. Demographically Senegal has 7.3 million and is growing and urbanizing rapidly with declining per capita income health indices and opportunities. The main health problems are high infant and maternal mortality due to underlying malnutrition and lack of primary care to manage diarrhea tetanus measles malaria and maternal risks. STDs and HIV are prevalent. The health infrastructure needs to be recognized decentralized and more equally distributed. Pharmaceutical distribution is inadequate. Private sector health care is mainly urban curative and unconcerned with prevention and family planning. Structurally there is a primary care policy but no program; there are no effective population or nutrition policies; the malaria prevention program is not WHO approved and may be producing chloroquine-resistance; immunization proceeds well in campaigns only; anti-diarrhea efforts are faltering because of promotion of both homemade and packaged ORS. Management needs an operational problem-solving focus clear priorities defined central vs. regional roles supervision and monitoring an adequate information system appropriate staff training. It is suggested that family planning should be integrated with maternal/child health and STD prevention that desired family size be addressed that import duties on contraceptives be removed. Donors are left with the burden of supplying all ongoing health funds and managing their use as well as coordinating their respective inputs. For USAID/Dakar population should remain the key objective. USAID should build upon GOS programs where possible; focus on a package of linked family planning/MCH activities emphasizing the operational level; help developed a modern management approach to service delivery; strengthen public and private infrastructure; enhance sustainability of health activities.