Viability of Departmental Unions of Mutual Health Insurance (DUMHI) in the Thiès Region (SENEGAL) in 2023: ARTICLE

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<i>Introduction</i>: The promotion of departmental health mutual units (DUMHI) is one of the priority areas advocated by the State of Senegal to access universal health coverage. The DUMHI is a departmental mutual, professionalized with a package of expanded covered services allowing early recourse of beneficiary patients to public health structures. After years of implementation (2017–2021) of this strategy, this work aims to study the viability of DUMHI in the Thiès region. <i>Methodology</i>: A quantitative evaluative study was conducted from August 15 to September 15, 2023 covering all the files of members (2017 to 2021) of the DUMHI of the three (3) departments of the Thiés region. Data collection was carried out using an observation grid developed by the ILO. The data were entered and analyzed using Excel 2010. <i>Results</i>: On the administrative level, the DUMHI of Thiés had a good overall quality score of monitoring of its operation of 85.7%, while the 2 DUMHI of Mbour and Tivaouane had a rate of 51% and 71% respectively. These rates reflect certain shortcomings noted in the operation. Functionally, the annual recovery rates were 38% for the Thiès DUMHI, 29% for the Mbour DUMHI and 93% for the Tivaouane DUMHI. Medium to low penetration rates were noted in the three DUMHI with percentages of 44%, 42% and 8% respectively for Thiès, Mbour and Tivaouane. Technically, DUMHI beneficiaries bore less of the costs of the services covered compared to non-beneficiaries. The 3 DUMHI were subject to the risks of abuse and adverse selection in 2021. Financially and economically, the loss ratios in 2021 were 209%, 166% and 70% respectively for the Mbour DUMHI, the Thiés DUMHI and the Tivaouane DUMHI. The DUMHI of Thiès and Mbour were unable to cover all of their expenses with their own funds, and the amount of contributions was very low to support the total expenses, with the DUMHI Tivaouane being an exception in 2021. The operating cost ratios were 12% for DUMHI Thiés, 19% for DUMHI Mbour and 18.5% for Tivaouane in 2021. The own financing rate was satisfactory for DUMHI Tivaouane with 143% compared to 94% for Thiés and 87% for Mbour in 2021. <i>Conclusion</i>: Apart from administrative and functional viability, the other dimensions of viability: technical, financial were threatened once the state subsidy stops and the partners withdraw. Thus, a revival of communications activities and the provision of additional and innovative financing will strengthen their functionality.