The Government of Senegal is committed to the principle of Universal Health Coverage (UHC) and providing essential basic health services to its citizenry. Through the leadership of the Senegal Ministry of Health, we have spent the past couple of years performing important research and planning designed to help the nation scale services with the goal of eventually reaching UHC. This work has included not only ramping up the services the government provides, but also improving the planning, administration and monitoring of the specific health interventions we implement so that we are constantly adapting and improving. This includes providing a free essential health services to all children, providing women and elders with a set of health services at no cost and improving the ability of our health insurance organizations and community based health service providers to help realize our dream of universal health coverage for all Senegalese citizens.

The commitment to UHC represents a large shift for both Senegal and the continent of Africa. For too long, vulnerable and marginalized populations have dealt with crushing disease burdens specifically high rates of maternal and child mortality, an infectious disease crisis and now emerging chronic diseases. On top of that, the health system was complicated, fragmented in places and often very difficult for the average citizen to navigate. As I have written in these pages before, to address these challenges the nation must continue to invest in future generations by providing adequate health care services as part of our UHC goal.

A key aspect of UHC is the focus on health systems strengthening (HSS) and a commitment to improving healthcare from a systematic approach. This means that the government must ensure that providers, patient navigators, counselors, and public health workers all have the resources and training they need to scale up services as part of a UHC regime. Through both private and non-profit partners, our efforts to improve the strength of our healthcare system have increased dramatically in recent years.

Supply chain management strengthening is very key and Senegal : the example of the push model for family planning

The push model is a system of procurement reaching directly the health centers and not them coming to buy at the regional or national pharmaceutical stores. When it was introduced in two districts with the support of our partner Intrahealth, the average monthly contraceptive stock out fell from 83% for implants and for Depoprovera in 2010-2011 to 0% for both methods in 2012. We are expanding the informed push model nationally and to other essential drugs and products, successfully.

Another example is a public private partnership with ADEMAS a Senegalese NGO working with PSI to distribute subsidized nets in the private sector: Fuel stations, mole, big or small stores . This complete the nets sold to individual in public health services after free distribution campaign.

Complementing countries’ push towards UHC is the current discussion around the future of the global health architecture and system. Our nation, along with many others on the continent, have made significant efforts to improve the health of our citizens over the past two decades. This progress has been due both to a political commitment on behalf of countries such as Senegal, combined with generous support from a host of global health stakeholders and organizations. Whether international or domestic, these group of organizations – donors, NGOs, private sector partners, bi-laterals – have help to create a robust, global health system where collaboration has been critical to improving health outcomes globally.

As we look to the future of global health post-2015, adjusting and improving the global health system will be critical. First and foremost, the international community must continue to support vital organizations that help us achieve universal health coverage such as the Global Alliance for Vaccines (GAVI) to help ensure that progress in reducing child and newborn mortality continues. Without support from GAVI, it will be very difficult to continue the progress toward reducing child mortality and broader efforts to expand routine vaccinations. Here we see how GAVI has strengthened the global health system by providing affordable vaccines and addressing a critical gap in the promotion of child health efforts. Likewise, the Global Fund to fight HIV, TB and Malaria (Global Fund) has been very important in providing funding and best practices for countries to address the burden of infectious diseases. This is another key organization of the global health system that must continue to receive strong support from international donors and philanthropists. It is why, I have not hesitated to be one of their champions to help for their replenishment. These large, multi-lateral organizations have helped address specific gaps and strengthened the system as a whole.

While the emergence of these organizations has contributed to the growth of a global health systems, key gaps still remain. There is a need for a systematic method or organization to help developing countries continue to strengthen their health systems to deal with increasing burden of non-communicable diseases (NCDs). To be sure, there are a host of organizations working on this issue including the UICC and the WHO, however many countries still lack an adequate response to NCDs. We as global leaders, need to address this gap and generate innovative ideas for improving the system in this regard and better negotiate the price of too often expensive treatment.

Further, the global system of health financing is complicated, confusing and sometimes duplicative. The international community and major donors must work with developing countries to simplify and improve the financing of health intervention allowing different organizations to own different pieces and ensure global standards and best practices are followed and implemented. We need to determine the proper role for domestic financing and resource mobilization, whether we need some organizations to focus solely on financing and improving service delivery financing models and how we can avoid duplicative efforts and a lack of donor and recipient government coordination. What is the proper global financing system in a post-2015 and post-AID paradigm where countries take on more responsibility for the health of their citizens?

Innovative financing mechanisms to strengthen the health system and universal health coverage are being explored: taxes on tobacco and alcohols, monitory transaction etc. Nations such as Senegal have been incredibly fortunate for the rapid growth and support for global health programs like tuberculosis, HIV/AIDS and malaria over the past couple of decades. This has taken teamwork and collaboration from a variety of organizations and created a global health system that is robust and that it working. New organizations and improved methods of preventing, diagnosing and treating disease have led to real improvements in the human condition especially for the poor and most vulnerable. However, in order to continue to make progress we must continue to refine and improve the system. We must determine what type of system will allow us to continue to make progress while preparing us to address emerging diseases and epidemics. We must look at the system and determine how it is helping (or hindering) our commitment to the goals and strategies of UHC. This will require collaboration among the various players in global health at multiple levels and with a focus on improving the global health architecture. This will also require a community health based care approach. In a time with limited resources and still a large unmet need, improving the system is critical to continuing the progress and addressing the future challenges surrounding global health.