Health and social action in Senegal: And Gueusseum warns of a system "on its last legs"

The Alliance of Autonomous Health Unions (ASAS) And Gueusseum is once again sounding the alarm about the state of the Senegalese health and social system. In an open letter addressed to the President of the Republic, Bassirou Diomaye Diakhar Faye, the union denounces the structural weaknesses, budgetary shortfalls, and dysfunctions that, according to them, threaten the effectiveness of the health and social protection system.

For And Gueusseum, the current climate in the health and social care sector resembles "heavily charged weather." Strikes, recurring disruptions, and social tensions are, in his view, symptoms of a system facing "a state of advanced decay."

The dismantling of social services is worrying

The union first questions the new institutional architecture of the sector. The transfer from the Ministry of Health and Social Action to the Ministry of Health and Public Hygiene, presented as a refocusing on prevention, conceals, according to And Gueusseum, a major contradiction.

The union particularly deplores the dismantling of the Social Action department, while the first historic Social Action Conference of 2008 had formulated recommendations that contributed to the development of the Social Orientation Law of 2010 and to the ratification, in the same year, of the International Convention on the Rights of Persons with Disabilities.

Another cause for concern is the splitting of the former Regional Directorate of Health and Social Action into two separate structures. On one side, the Directorate of Health, which has reverted to being the Regional Medical Authority; on the other, the Directorate of Social Action, which the union describes as being insufficiently endowed with human, material and financial resources.

And Gueusseum also points to a form of institutional overlap around the Centres for the Promotion and Social Reintegration (CPRS), whose missions are sometimes competed with by other mechanisms under the Ministry of Family.

For the union, this situation creates an "institutional duplication" that could harm the coherence and effectiveness of social policies.

Disability: The low number of equal opportunity cards denounced

The care of disabled people is another major point of the open letter.

And Gueusseum estimates that around 100,000 equal opportunity cards have been issued since 2014, while the potential target is estimated at nearly three million beneficiaries.

The union also denounces the social consequences of the elimination of family security allowances nearly two years ago. According to them, this situation has contributed to further impoverishing many beneficiaries and pushing them into extreme poverty.

The organization draws a parallel between this situation and official discourse on primary healthcare and community health.

And Gueusseum thus recalls a formula attributed to SUTSAS: "SSP, it's too many primary care, too little care, no health." A way of denouncing, according to the union, the persistent gap between the stated ambitions and the realities experienced on the ground.

Health funding at the heart of concerns

For And Gueusseum, the problem is also financial.

The organization believes that the health sector does not receive sufficient resources to meet its needs. It cites funding of approximately 3% of the national budget, or nearly 217 billion CFA francs out of a total budget of 7 trillion.

The union considers this funding insufficient given the stated ambitions regarding universal health coverage, prevention, community health and improving the quality of care.

And Gueusseum acknowledges, however, the efforts undertaken by the State, particularly in strengthening health infrastructure, health coverage, prevention and certain programs aimed at improving access to care.

But for the trade union, investments in infrastructure alone cannot suffice.

“Building or renovating a healthcare facility alone cannot constitute a successful health policy,” she essentially argues. A healthcare facility, she reminds us, must have sufficient staff, functional equipment, available medications, and operational resources adapted to its mission.

"Political ambition cannot replace resources."

The same requirement is made for prevention and community health. And Gueusseum believes that these policies cannot be reduced to slogans, but require investments in human resources, epidemiological surveillance, vaccination, health education, school health and addressing the social determinants of health.

For the union, the real question is therefore not whether actions are being taken, but whether the resources mobilized are truly commensurate with the stated objectives and the needs of the population.

"Political ambition cannot sustainably replace budgetary resources," the organization insists.

Through this open letter, And Gueusseum is asking the head of state for a change of scale in investments devoted to health and social action.

The union is calling above all for more coherence between ambitions, resources and results, believing that the public now expects concrete and lasting improvements, while professionals are demanding better working conditions.

For And Gueusseum, the message addressed to the President of the Republic is unambiguous: to save a health and social system presented as "on its last legs", the time for announcements must give way to that of action and resources.