Los desafíos de la reforma de la política sanitaria en Senegal: análisis cualitativo de la departamentalización de las mutuas de salud
Contenido principal del artículo
Resumen
Introducción: En Senegal, los planes de seguro médico comunitario (SMC) han sido durante mucho tiempo el principal instrumento para lograr la cobertura sanitaria universal (CSU). Históricamente gestionados por voluntarios comunitarios, estos planes han enfrentado dificultades relacionadas con la sostenibilidad financiera y la eficacia de su cobertura. En respuesta, Senegal inició una reforma en 2022, transformando los planes comunitarios en departamentales para mejorar la gestión y la prestación de servicios. Este estudio tiene como objetivo explorar los desafíos asociados con la implementación de esta reforma en el país.
Métodos: El estudio cualitativo se llevó a cabo entre 2020 y 2023, utilizando 27 entrevistas en profundidad con partes interesadas de cuatro regiones para explorar los roles de los actores sociales, las ideas, las dinámicas de poder y el contexto en la reforma. Las entrevistas se enfocaron específicamente en captar la dinámica de apoyo y resistencia a la transición de SMC comunal a departamental. Los datos se analizaron mediante un enfoque de análisis temático.
Resultados: Los hallazgos revelan una resistencia significativa entre los gerentes de los SMC comunales existentes, quienes temen perder autonomía y control financiero. Las partes interesadas expresaron preocupación por el enfoque apresurado y vertical del proceso de reforma, que muchos sintieron que se les impuso sin la consulta adecuada. A pesar de estos desafíos, algunas participantes reconocieron los beneficios potenciales de una gestión profesional y operaciones optimizadas para mejorar la accesibilidad y eficiencia de la atención médica.
Conclusión: La investigación muestra que, a pesar de la resistencia debido a ideas, valores y dinámicas de poder arraigados, la reforma ha sido aceptada y se está implementando actualmente. El papel que desempeñarán los seguros médicos departamentales en el proceso de reforma en curso aún está por determinarse.
Detalles del artículo
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