A first for Senegal, as social health insurance is extended to artisans
Informal sector workers often earn low and irregular wages, lack protection and face difficulties in accessing adequate basic services. As part of Senegal’s labour reforms, Germany is supporting a social protection pilot which could be extended to cover the whole informal sector
This article is also available in French.
Extending social protection to Senegal’s informal sector: a systemic and systematic approach.
Produced by: the International Labour Organisation, Senegal;
Summary of content: German Development Cooperation is supporting, together with the ILO, a pilot project to extend social health protection to the informal sector in Senegal, starting with the country’s artisans. In this short video, artisans explain why having access to social protection is so important for them.
Madame Madjiguène Diop is a self-employed artisan working in the food processing business in Dakar, Senegal, and has many responsibilities. Not only is Mme Diop her family’s main breadwinner, she must also look after her young apprentices. Health care in Senegal is expensive and often unaffordable for those on low-incomes. The risk of someone in her small circle falling ill is never far from Mme Diop’s thoughts.
Last year, she was informed by her professional association about a new insurance scheme called the MSNAS (Mutuelle Sociale Nationale des Artisans du Sénégal) designed specifically to extend social protection to Senegal’s low-wage artisans. Mme Diop was one of the first to sign up and now she, together with her family members and employees, can access the health care they need at a fraction of the usual cost.
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Mme Diop describes her relief on joining the MSNAS,
In financial terms, the health insurance provided by MSNAS has made a huge difference. I used to pay all my own health care costs, as well as those of my family and my apprentices – this is too much. Now I am a member of the mutual, it’s much more bearable.
In fact, Mme Diop has already taken advantage of the highly subsidised services when she visited the Nabil Choucair de Patte D’oie health centre in Dakar, and one of her apprentices recently gave birth at a health centre using the new scheme.
Providing social protection for the missed ‘working poor’
Informal sector workers are generally poorer than employees in the formal sector. They tend to earn low and irregular wages, lack social and labour protections, and face greater difficulties in accessing adequate basic services, including health services. Strengthening access to health services and ensuring financial protection for informal sector workers are enduring challenges in low- and lower-middle income countries, such as Senegal.
The lack of protection for Senegal’s low-paid workers poses a serious risk for the country’s economic growth. Over 90 percent of the total workforce, or to put it another way 40 percent of the non-agricultural workers in the country, are employed in the informal sector. With urbanisation, this proportion will likely continue to grow.
Health coverage is particularly low among the working poor, who account for the greater part of informal sector workers and who aren’t eligible for interventions targeted at the poor. As a result, they may fail to seek the healthcare they need, preferring instead to keep on working and earning for as long as they can.
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Senegal’s artisans play an important economic role
The MSNAS aims to offer social protection to entrepreneurs and workers in small businesses who are effectively excluded from compulsory social security schemes due to the informal nature of their work. It is a pilot project of the Government of Senegal’s flagship labour reform, Access to Social Protection for the Informal Economy: Implementation of the Simplified Scheme for Small Taxpayers (RSPC).
The choice of artisans for this pilot was not accidental. Technical studies supported by the ILO reveal important criteria for the success of such a scheme, including the size of the workforce – there are 122 different artisanal trades in Senegal, the existence of strong organisational dynamics and the place of the sector within the national economy.
As Madame Marie Odile M. Faye Diedhiou, Director of Social Protection in the Ministry of Labour, explains,
The informal sector contributes more than half of our GDP in Senegal and is considered an obvious choice for job creation initiatives. Before RSPC, there was an alarming lack of social protection coverage, with the exclusion of these workers, who nonetheless occupy an important place in our national economy.
A ‘shot in the arm’ for Universal Health Coverage
Mutual health insurance in Senegal is not new, dating from at least the 1980s, but schemes have mostly targeted those in government service or other registered employment. And, as in many countries, the take-up of voluntary community-based health insurance has been low.
In 2022, the Government of Senegal re-committed to scaling up community-based health insurance (mutuelles de santé, as they are known in the country) as a key means of delivering on its policy of Universal Health Coverage. As a pilot of the RSPC scheme, the MSNAS, together with the free health care policies (e.g., for children under five and the very poor), will support the expansion of universal health care coverage to all sectors of the population.
A flexible and modular design
The design of the MSNAS is purposefully modular and flexible. It starts with social health insurance and then, as lessons are learned through the implementation of this pilot, there are plans to extend the scheme to provide old age pensions, maternity cover, and insurance against workplace accidents and occupational diseases for artisans. Over time, it will also be scaled up to new informal sector groups, such as small traders. This step-by-step approach will help to improve the scheme based on first-hand experience, as well as to control the costs.
Dame Diaw, Social Protection Coordinator and lead for the RSPC project at the ILO, explains that this is the start of something much bigger,
The creation of the Mutuelle is extremely important for Senegal, which is leading the field in this regard. The fact that the adaptable and flexible design can be extended to new professions is a critical factor.
What does the scheme offer?
The scheme is specially designed to provide access to affordable health services for artisans. Each artisan must register together with a minimum of 5 other persons, who may be family members and/or members of their workshop.
The artisan pays a once-only joining fee, equivalent to around Euros 3, and an annual fee which provides access to one of two defined healthcare packages – a basic minimum package and a specialised package. When seeking health services through MSNAS, members pay only 20 percent of the usual service fees, making healthcare much more affordable.
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In order to access health services under the MSNAS, artisans must pay an annual fee for the basic package of CFA 3,500 or around Euros 5 per person, which is currently in line with the fees charged by the Agency for Universal Health Coverage (ANACMU). A more extensive care package which also covers private medical care, will be available for the craftsmen and women in the near future.
Truly multi-sectoral approaches are challenging but worth the effort
Launching a new health insurance scheme is a complex endeavour and there have been many challenges along the way. The MSNAS is a collaboration between the Chambers of Trades and the Ministry of Labour, while other ministries and agencies such as the Agency for Universal Health Coverage (ANACMU), the Ministry of Health and the Ministry of Artisans are also involved. The MSNAS is being supported technically and financially by ILO and by German Cooperation, and is being implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH as part of the project Together Towards Labour Reform.
For a truly multisectoral enterprise, coordination and planning are never simple, and time is needed to achieve consensus. Getting the scheme to the starting point has been a long and hard journey, but above all a multisectoral one, involving many different ministries and institutions. At the same time, this has laid stronger foundations for future growth.
Important institutional milestones have been achieved
In the course of setting up MSNAS, a number of important milestones have been achieved in establishing the institutional foundations for the scheme. The legal foundations for MSNAS were laid in 2021 by Senegal’s General Assembly, and the scheme is supervised by the Administrative Council along with technical committees. A Technical Management Unit has been established with the support of German Cooperation and is staffed by three people who are responsible for the day-to-day work.
A digital information management system has been purchased and installed, and the technical and operational parameters for the expansion of the scheme to new areas have already been set out and agreed. These are important achievements which will support the sustainable operations of the MSNAS.
It’s early days but the scheme is gaining in popularity
A widespread communications campaign ran throughout 2022-23 aimed at informing potential members about the benefits, prior to its launch in February 2024. By the end of April 2024, close to 10,000 artisans had signed up and paid their joining fees. More than 200 of these members had also paid the annual fees for themselves and for their family member(s) and/or apprentices, resulting in over a thousand MSNAS beneficiaries who are now eligible to use the MSNAS health services. A campaign is currently underway to encourage all MSNAS members to pay their annual fees, as well as to attract new members.
Contracts have so far been signed with 138 health services providers, comprising 19 hospitals, 53 health centres, 29 health posts, and 31 pharmacies, and a further 295 contracts are in the pipeline. These facilities, where fully paid up MSNAS members can go to obtain health services, are to be found throughout Senegal’s 14 regions.
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Mme Diedhiou explains that these developments could not have been achieved without the support of partners, such as ILO and German Development Cooperation. ‘The GIZ contribution has enabled us to make great strides in the implementation of the project through two key areas: the operationalization of MSNAS; and the extension of social protection to other social risks and other sectors of the informal economy’.
The expansion of the scheme
Priorities for 2024 are to increase the number of artisans accessing health services through the MSNAS and to continue working towards the full operationalisation of the scheme. Once the scheme has been extended so that artisans also have maternity cover, support in their old age, and insurance against workplace accidents and illnesses, it will be extended to other informal sector groups, such as small traders, and those working in the fisheries and agriculture sectors. There are also plans to make the scheme obligatory, but for now it will remain voluntary.
Senegal’s craftsmen and women not only play an important role in the national economy, they are a fundamental part of the country’s culture. Assane Gueye, Chairman of the MSNAS Administrative Council and himself an artisan, explains why the scheme is such good news,
Health care in Senegal is very expensive. When artisans fall ill, they can’t access services and they can’t work. MSNAS is providing a real benefit for them – it enables our valued craftsmen and women to look after themselves.
With its modular design, with targeted technical and financial cooperation from ILO, GIZ and other partners, and with the strong political and cross-sectoral support, there is a palpable energy to make MSNAS work.
Corinne Grainger
June 2024