Factors influencing access to healthcare for the indigent in Senegal

Abstract

Equitable access to health services remains a major challenge to achieving universal health coverage (UHC). In Senegal, the National Family Safety Net Program (PNBSF) aims to reduce vulnerability among poor households through cash transfers and free enrolment in community-based health insurance. However, barriers to effective healthcare access persist. This study examines determinants of healthcare utilization among PNBSF beneficiaries in rural Senegal. A mixed-methods study was conducted in the departments of Koungheul and Foundiougne. The quantitative component was based on a cross-sectional survey of 254 PNBSF beneficiaries who reported a health problem in the four weeks prior to the survey and were eligible for the analysis of healthcare utilization. Determinants of healthcare utilization were analyzed using the Andersen behavioral model, including predisposing, enabling, and need factors, and multivariate logistic regression. The qualitative component included 41 semi-structured interviews exploring healthcare experiences and access barriers. Findings were integrated using an explanatory mixed-methods approach. Overall, 69.7% of participants reported seeking formal healthcare services. In multivariate analysis, being a household head was the only factor significantly associated with healthcare utilization (OR = 3.30 (95% CI 1.74–6.45)). Qualitative findings highlighted persistent financial, informational, and geographic barriers, including limited awareness of entitlements, indirect costs (transport and medicines), and distance to health facilities. Healthcare utilization was relatively high among PNBSF beneficiaries, and household head status was the only factor significantly associated with healthcare utilization in the quantitative analysis. Qualitative findings nevertheless suggest that financial, informational, and geographic barriers may continue to affect access to care. Strengthening awareness of health insurance entitlements and reducing indirect costs may help improve access to healthcare among vulnerable populations in Senegal.