Health Financing Data and a Woman’s Leadership Bring Strategic Change in Senegal
Madame Adja Thiané Guéye Diaw, the head of the Health Economics Unit of the MSAS
Annick Ranirisoa, Health Policy Advisor, Open Development
Kate Steger, Communications specialist, Open Development
In 2018, Senegal was awash in data related to its National Health Accounts but without the means to analyze and use it, leaving policymakers without clarity about who was financing the health sector and where the money was being spent. This data was critical to understanding whether the money allocated for health was aligned with the country’s health priorities. Fast forward to March 2025 when Senegal is expected to present at the African Health Economics and Policy Association conference in Kigali sharing their impressive efforts to address the data backlog, utilize the data for strategic decision-making, and establish routine procedures for future data collection.
This is the story of how Ms. Adja Thiané Guéye Diaw led Senegal’s revival of Health Accounts, and why institutionalizing National Health Accounts matters for keeping countries accountable to their universal health coverage and primary health care commitments.
It’s the first of a blog series by Open Development to recognize underappreciated technocrats who are making governments work better for people around the world.
Addressing Senegal’s need for health financing data
Developed by the World Health Organization, Health Accounts are an accounting framework that allows countries to track and analyze health expenditures from their source (financing arrangements, out-of-pocket, etc.) to their use (health facilities, disease programs, national health insurance accounts, etc.). The data and analysis are invaluable in the development of national financial plans for health, but if the process of gathering the information is not carefully planned, organized, and streamlined, it can be costly and resource intensive.
With Senegal’s Health Accounts in arrears, the Minister of Health and Social Action (MSAS) was urgently looking for someone to turn the situation around, improve Health Accounts management for Senegal, and use the data to urge the government to increase its financial commitment to the health sector. He selected Adja Thiané Guéye Diaw, then Head of the Budget Programming Office where she was managing the annual MSAS budget program. A nurse by training, Thiané also held a diploma in accounting and statistical methods and had recently completed an MBA in health economics. Upon assuming her responsibilities as the Head of the Health Accounts Office, she found an intern and civil servant still struggling with the 2013 accounts. Within 3 months, she had wrapped up the 2013 accounts and, within 11 months, had completed the 2014, 2015, and 2016 accounts as well.
This brought the country some well-deserved attention and many wanted to know how they had achieved this feat. Thiané, who was promoted to lead the Ministry’s Health Economics Unit when the position became vacant in 2019, modestly shares the credit with others saying, “I think it’s important that we received support from the authorities and the technical and financial partners who really pushed us to be up to date.”
Among the technical partners Thiané is referring to are USAID’s Building Resilient Health Systems (BRHS) project, led by Chemonics, and their partner organization, Open Development. BRHS is supporting the MSAS to build its capacity to collect NHA data efficiently and analyze the data produced, as part of an effort to institutionalize Health Accounts. At the same time, Open Development’s Senior Health Financing Advisor, Dr. Farba Sall, has worked with Thiané ’s staff to develop and translate three policy briefs to share findings for informed decision-making.
Using NHA data for resource mobilization and allocation
The Health Economics Unit’s work on the NHA was supervised by two MSAS committees: a steering committee, chaired by the Secretary General of the Ministry of Health, and the Technical Committee, chaired by the Director of Planning, Research, and Statistics. These committees advised Thiané to use the policy briefs to highlight the major take-aways from the NHA data. Particularly, they saw from the NHA that the amount the country was spending on treating non-communicable diseases (NCDs) was very high while the amount spent on NCD prevention was very low. In addition, they saw that most of the funding covering primary health care (PHC) was coming from households and technical and financial partners, which raised equity and sustainability concerns. They also realized that the State, particularly at the local level, was not fulfilling its commitment, as recommended by the Abuja Declaration, to increase health expenditures to 15% of the national budget. As a result, the country's progress toward achieving universal health coverage (UHC) was hampered.
The three policy briefs that Thiané ’s staff developed, with Open Development’s support, helped them address these take-aways. They have also increased understanding and mobilization of domestic resources not just within the MSAS, but also with the Ministry of Finance and Budget (MFB) and even with the general public through civil society actors.
Dr. Serigne Mamadou Loum, Head of the Division of Primary Health Care, is a public health specialist in charge of coordinating the PHC needs of communities at the national level. Thiané ’s brief showed that almost 90% of the essential health services required as part of the universal health coverage package are provided through primary health care in communities. It also showed that 55.9% of PHC costs were borne by households. Loum says this helped his division understand that, in order to make universal health care more equitable and accessible, they needed to vastly increase the domestic funding funneled to PHC at the community level. Loum is also using the findings to inform community health resource mapping which will support the development of a comprehensive plan for financing and resource mobilization and advocate for the inclusion of a budget line for community health in the state budget. Loum believes the briefs “make it easier to mobilize resources and determine the distribution of funds.”
His colleague, Dr. Malick Hann, Head of the Division of Noncommunicable Diseases, has used Thiané ’s brief on NCDs to great benefit as well. He says that the NHA data showed that, on average, CFA 233 billion (USD $372,334,000) a year was being spent on the management of NCDs and that less than 1% of that was put into prevention. The data also showed that a large portion of funding for NCDs was coming from families through out-of-pocket expenses. With a public commitment to universal health coverage, this reality was alarming. “Really, it troubled us,” Hann says. “Something had to be done.” He credits Thiané’s brief with triggering the rapid release of funding for a nationwide survey on NCDs that has confirmed that 37% of the cost for treating NCDs was coming from out-of-pocket expenses. Hann has also used the brief to advocate within the government for higher taxes on products like tobacco, alcohol, and unhealthy foods that have a negative impact on NCDs.
The third brief is a blunt plea to the Ministry of Finance to increase the overall budget for the health sector. It lays out a full overview of the gaps between predicted and actual financial commitments from State and local governments to the MSAS and the impact of shortfalls in achieving strategic national goals. It also goes further to make a data-based case for how health expenditures prevent impoverishment, increase longevity, and contribute to the overall health of the national economy.
Thiané says these briefs were not only circulated within the Ministry of Health, but were also taken up by civil society organizations, one of which, the Pan-African Institute for Citizenship (CICODEV Africa), organized dialogs and public discussions via television, radio, and other platforms. Another NGO, 3CAP Santé, utilized the policy briefs to support advocacy for additional resources at the local level. As an immediate result, 3Cap Santé successfully signed an agreement with locally elected officials to bolster advocacy efforts aimed at increasing health resources. Furthermore, the organization is finalizing an agreement with the Ministry of Health to strengthen the role of civil society organizations in advancing public health. These activities enhance general understanding of the costs, benefits, and barriers of the government’s efforts to achieve universal health coverage. 3CAP Santé’s Secretary General Karim Diop says that by ensuring that this type of information is accessible, available, and up-to-date, leaders will be better equipped to make informed decisions. Researchers from other countries have also made inquiries related to the briefs, and Thiané herself will be presenting the briefs at the African Health Economics and Policy Association conference in Kigali in March 2025. This success not only ensures that Senegal has a voice regarding the NHA, but also has a leadership role in advancing health financing in the region.
Institutionalizing the NHAs to reduce costs and add sustainability
The WHO requires participating countries to regularly produce NHA reports. In Senegal, the production of the last accounts (2017-2021) cost over CFA 245 million (approximately USD $420,000). To reduce the costs associated with the process, Sall and the BRHS project are further supporting the MSAS to integrate financial data collection into Senegal’s health information system, DHIS2. Thiané, who is currently leading the Health Economics Unit to produce the 2022-2023 accounts, says that adding a financial tracker to DHIS2 will allow every health facility to input financial data themselves requiring only a quarterly review by MSAS staff. This will save time and money because the Ministry will not need to hire researchers to obtain the quality data needed for the NHA. Obtaining private sector data remains a challenge since their data collection process is completely different and follows its own timeline. The BRHS project is conducting two pilots with the private sector in Dakar and Thies to address interoperability between systems. With these and other continued efforts, the NHA process will gradually become more comprehensive, more routine, and less costly.
Celebrating women champions in health financing
Thiané ascendancy to the head of the Health Economics Unit was not straightforward and few women hold this position within Health Ministries across Africa. As a young woman, Thiané had an affinity for accounting, but her educational options led her to a nursing degree instead. After graduating from the National School of Nursing in Senegal, she worked in hospitals and health centers in and around Dakar until she was eventually assigned to a nursing position at the MSAS where her vocation and her original interests began to merge. In her spare time, she pursued post-graduate education through the Management Development International program at Illinois State University and was then assigned to lead the drafting of the annual budget for the MSAS from 2012 to 2018. Her successful management of the annual budgeting process combined with her deep understanding of health care resource needs gained from her years of nursing made her the ideal candidate to take the helm as Coordinator of the Health Economics Unit when the position became vacant.
In addition to her role in the MSAS, Thiané also teaches at the African Center for Graduate Studies in Management and mentors future health financing administrators across the region. Today many countries in West Africa want to set up health economics units like the one in Senegal which is uniquely predominantly staffed by women. “It’s a source of pride for us,” she says, but she’s not one to rest on her laurels. Not only is she the president of the Women's Association of the Ministry of Health and the focal point for the P4H Network, a global consortium that advances universal health coverage, but she also wants to see the Health Economics Unit elevated to a Directorate within the MSAS. The unit is currently attached to just one directorate, but its work cuts across all directorates each asking for convincing data to mobilize the resources needed to achieve universal health coverage in Senegal. “To advocate for funding, you need to have evidence,” Thiané says. She’s ready to lead the charge.
The Future of Health Accounts in Senegal
The adoption of key concepts in health accounts and the understanding of related issues by health program managers represent encouraging progress for future budgetary decisions at the Ministry of Health. These managers are now better equipped to support their arguments for prioritizing the fight against NCDs and strengthening PHC in resource allocation.
The BRHS project and Open Development will continue to support the MSAS in its advocacy efforts with the new authorities, the recently established Health Committee of the National Assembly, and local officials who bear direct responsibility under laws and regulations for addressing the health needs of the population. Furthermore, BRHS and Open Development will facilitate efforts to mobilize resources from the private sector and other ministries in line with the multisectoral approach of the national strategy for UHC and health in all policies to help reduce the health sector's funding needs.