Free Access to and Utilization of Health Services in Senegal: Effects on Vulnerable Populations

Adrij Chakraborty, University of Luxembourg
Michel Tenikue, CEPS/INSTEAD

Access to healthcare in Africa is hindered by financial, cultural, and infrastructure barriers, with Senegal being no exception. Out-of-pocket healthcare costs burden much of the population, often forcing individuals to forgo care or rely on informal options like traditional healers. Despite efforts to implement subsidized health insurance and user fee subsidies, uptake remains low, and the most vulnerable are often left out. Senegal's policy environment offers a case for studying implementation effectiveness through its Universal Health Coverage program. It includes two components: Community-Based Health Insurance for the elderly and the poor, and a user fee exemption plan for children under 5 and the elderly over 60. Using a semi-parametric RDD, we investigate the latter component and identify localized causal effects of free access on healthcare utilization and expenditures. We find positive effects across the two age cutoffs, and sub-sampling by urban and rural regions suggests that the positive effects are driven mostly by individuals in urban households. We argue that targeted free access provision of healthcare services in Senegal may help eliminate demand-side issues among vulnerable sub-populations, but greater percolation is needed to engage rural areas.

Keywords: Health and Morbidity, Children, Adolescents, and Youth, Older Adults and Intergenerational Relations, Randomized controlled experiments

See extended abstract.