The role of the social and solidarity economy in the extension of health insurance in Senegal

Abstract

In Africa, the social/solidarity-based economy sounds like a promise of overcoming the historical link between social security and wage employment. In Senegal, the legal anchoring of the process of extending health insurance in the logic of the social/solidarity-based economy has been overtaken by conflicts of perception of this form of economy. The normative and institutional commitment to the extension of health coverage has not produced the expected results. The public financing of health insurance is a source of budgetary tension which already shows the fragility of a system vulnerable to endogenous and exogenous shocks. The social anchoring of health insurance, in its extension project, is also supported by administrative decentralisation, which is struggling to find a link with the historical sources of socialisation. Voluntary work would produce a differentiated social dynamic by increasing inequalities. The future of health insurance, in conjunction with the preservation of the bond of solidarity, equality and equity, depends on the willingness to mobilise the contributory capacities of the liberal professions, independent workers in the formal and informal economy.