The Sustainability of Departmental Health Insurance Units in Senegal

Health Insurance • 2026

Deep Dive Overview

In 2014, two Departmental Health Insurance Units (UDAM) were established in the Koungheul and Foundiougne departments with a EUR 4 million contribution from the Senegalese government and EUR 16 million investment from a Belgian technical cooperation project (Enabel/CTB). The project dissolved fragmented local communal insurance units to create single, professionalised departmental entities with formal accounting procedures.

The rural regions replaced their fragmented communal community-based health insurance units — previously consisting of 676 separate units — with consolidated pools of 46 units. The model remained sustainable even after technical and financial project support ended in 2017. UDAM manages a membership base largely dependent on agriculture, trade, and fisheries, requiring a flexible financing model to handle irregular income streams. Innovative 'collective work' initiatives — including communal farming and fishing — were developed to help villagers afford insurance premiums.

Qualitative Research (Schell Framework)

13 Months of Field Observations

129 In-Depth Interviews

Documentation Review & Focus Group

Policy Recommendations

Plan for sustainability long before the end of a program. Sustainability should be anticipated as an outcome from the start of an intervention. In Senegal, actuarial modelling was used to establish the membership thresholds necessary to ensure ﬁnancial viability beyond donor support
AU Member States should systematically integrate endogenous, community-driven ﬁnancing models to reduce dependence on public and donor resources. In particular, insurance premium structures should be aligned with the livelihood and income cycles of target populations to improve affordability, contribution regularity, and scheme sustainability
Build win-win partnerships with providers and maintain rigorous accountability. The sustainability of insurance depends on a quality care offer and a healthy relationship with healthcare providers. To maintain trust, implement internal controls, invoice validation systems, and complaint mechanisms to prevent fraud and ensure providers are paid fairly and transparently
Anchor programs in national political strategy. Integrated health programs into National health agencies ensuring they are part of the national development strategy. Additionally, the state’s role in subsidising any contributions must be formalised to ensure ﬁnancial stability

Key Numbers

71%

penetration rate achieved in Foundiougne

€2.5M

paid to local healthcare providers

<15%

administrative overhead (vs 25% regional avg)

676→46

communal units consolidated

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Deep Dive Summary

This deep dive analyses how two Departmental Health Insurance Units (UDAM) in rural Senegal achieved extensive penetration and financial sustainability through professionalised management, collective community work, and flat-rate fee structures.

Content Type

Case Study

Region

Western Africa

Author

Research Team

Read Time

10 min

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Key Findings

UDAM penetration rose from less than 4% in 2014 to 71% in Foundiougne and 66% in Koungheul by 2021.
Professional management kept administrative overhead below 15%, significantly under the 25% regional average.
Between 2014 and 2021, the two units paid approximately €2.5 million to local healthcare providers, making them vital financial stakeholders.
Members pay only 500 francs (XOF) per visit under the flat-rate fee structure, dramatically reducing financial barriers.
Sustainability continued even after Belgian project support ended in 2017, demonstrating the model's viability.