article · Discover Public Health
Senegal's National Family Safety Net Programme provides cash transfers and free community-based health insurance to alleviate poverty and advance universal health coverage. An evaluation of healthcare use among beneficiaries across Koungheul and Foundiougne revealed that nearly seventy percent of individuals reporting an illness sought formal medical care. Within statistical models, being a head of household was the sole factor significantly linked to higher healthcare utilisation. Qualitative interviews exposed ongoing obstacles that limit care access, including low awareness of programme entitlements, long travel distances to facilities, and indirect expenses such as transport and medications. While overall service uptake remains relatively high among programme recipients, these findings demonstrate that social and financial hurdles still restrict equitable care. Addressing awareness gaps regarding insurance benefits and mitigating secondary expenses could strengthen healthcare access for vulnerable rural populations.
Social safety net programmes frequently offer free health insurance to vulnerable populations, yet enrolment does not automatically ensure care access. Revealing that household status strongly influences service use, and that indirect travel and medicine costs remain prohibitive, helps policymakers identify structural gaps. Resolving these non-fee barriers is essential for ensuring that universal health coverage initiatives effectively protect the poorest communities.
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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.
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DOI: 10.1186/s12982-026-02882-2
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