Paper short abstract:

This paper considers mutual health organisations as sites of contestation in early efforts to implement Universal Health Coverage in Senegal.

Paper long abstract:

Couverture Maladie Universelle (CMU), Senegal's version of Universal Health Coverage (UHC) was launched by President Macky Sall in 2013, the year after his government was elected to power. One of the key pillars of Senegal's vision for UHC rests on health mutuelles. Mutuelles are mutual health organisations that provide health insurance to its members and which are formed on the basis of an ethic of mutual aid, solidarity and collective pooling of health risks. In the context of CMU, mutual health insurance is grounded in the idea that it will work on the 'law of the big number' (loi de la grand nombre), whereby each person contributes a yearly enrolment fee which is matched by the government.

In this paper I draw on PhD fieldwork carried out in the capital, Dakar to consider health mutuelles as sites of contestation amid contemporary challenges posed to health financing. I examine the implications of funding gaps by highlighting strains experienced by mutuelles as well as pointing to the sources that money often ends up coming from, through for example existing modes of distribution like patronage, NGOs and informal associations. I situate the discussion in this paper in the context of a strong tradition of health mutuelles in francophone West Africa as well as within the broader picture of the global organisations which support the implementation of CMU in Senegal.