[The extension of national health insurance in Senegal: progress and obstacles]

This article analyzes the progress and the difficulties in the expansion of the Senegalese national health insurance scheme. The methodology is based, on one hand, on institutional data and documents, and on the other hand, on interviews with various actors in the health system. We present the health insurance extension scheme and place it in the context of the experience of other poor countries in sub-Saharan Africa. Mutual health insurance has a particularly important place in this extension. We then assess the state of progress of the extension of this mutual health insurance to show the uncertainties in the achievement of the reforms. Finally, we discuss the structural limitations and the conditions of the program's success. We underline in particular the necessity of a more systemic approach.