Health policy and the law in Senegal

Abstract

The improvement of public health facilities in the Republic of Senegal has required elaboration of a legal framework for the articulation of the goals of health policy and the means for its implementation. The foundation for this legal framework has largely been sought in the legacy of French colonial policy in matters of public health. From 1900 to 1960 the purposes of colonial health policy shifted from an emphasis on preventive and curative facilities for Senegal's relatively small European population to mass preventive medicine as the colonial government perceived the importance of mobilising African labour and military forces to meet colonial needs. Within a centralized bureaucratic administration colonial health services in French West Africa relied heavily on African medical assistants to staff rural dispensaries. Only after World War II were these policies codified even in indicative programmes. In contrast, since Senegalese independence in 1960 the ends and means of public health policy have been specified by three successive development plans. Despite the difference in legal framework, post-1960 health policy has been relatively faithful to the colonial legacy in concentrating on the organization and provision of health services, the education of medical personnel, and the organization and regulation of the medical profession. The general result of post-independence legal reforms has been a rationalization of the centralized bureaucratic model established during the colonial period. At the same time the philosophy of public health planning has evolved from a simple means-end calculation to a more realistic, long-term process model aiming at gradual improvements in the provision of medical facilities. However, despite special attention to increasing facilities for mass preventive medicine and to adapting medical education to national needs, the rural areas in Senegal lag far behind urban centres in both quantity and quality of health facilities.