A man in a lab coat pointing to "Article 9" on a poster hung on a wall.

Strengthening Health Systems and Access in Senegal .

January 10, 2019

To improve health systems, the government of Senegal is creating tools, policies, and processes to ensure quality health service delivery.

Standard processes are vital, whether they’re for a supply chain that delivers quality medicines or for health workers who deliver quality services. With processes and policies in place, health systems can ensure quality of care, health workforce retention, and sustainable operations that reach communities in need. But creating these processes from the ground up is no small feat, especially in Senegal.

Senegal faces major human resources for health challenges, including a critical shortage of health workers in hard-to-reach areas. These shortages are more prominent in remote and rural areas and can weaken health systems and patients’ access to health services. In addition, retaining health workers in remote areas remains an obstacle to providing health services. These issues are exacerbated by the limited availability of safe, quality medicines to treat Senegalese patients.

What tools, policies, and processes will it take to address systemic barriers to sustainable health systems and improve service delivery?

Chemonics is partnering with Senegal’s Ministry of Health and Social Action (Ministère de la Santé et de l’Action Sociale, or MSAS) and other relevant government ministries to tackle this challenge head-on. Working alongside the USAID HRH2030 (Human Resources for Health in 2030) program and the USAID Global Health Supply Chain – Technical Assistance Francophone Task Order (GHSC-TA Francophone TO), the government of Senegal is developing tools that address this pressing question.

Stronger Job Descriptions for Stronger Systems

Nene Sory Binda Ba is a nurse at Grand Yoff General Hospital in Dakar. Given Senegal’s health workforce shortage, it’s especially important for health workers like Nene to understand their role, who they report to, and the services they provide. The lives of patients depend on it, and so does the health system at large. At Grand Yoff General Hospital, Nene understands her responsibilities and the resources needed to fulfill them. She can pinpoint the skills needed for her role and the hierarchies that surround it. HRH2030 and Senegal’s Directorate of Human Resources at the MSAS are working together to ensure other health workers — and stakeholders within the ministry — can say the same. Job descriptions help make that possible.

With a template created by the Office of Organization and Methods under the Presidency of the Republic, MSAS is developing job descriptions across its health institutions. Along the way, staff better understand the tasks in their purview while decision-makers in the institution recognize why positions exist in the first place.

To build the capacity of MSAS staff in developing job descriptions, HRH2030 trained 122 human-resource managers and human-resource focal points at the central, regional, and hospital levels. In addition, HRH2030 supported the General Directorate of Social Action, the Directorate of General Administration, the Kaffrine Medical Region, and the Directorate of Planning, Research, and Statistics to develop 277 job descriptions for their staff.

"The job descriptions allow for staff to understand their career path ... The goal in all the hospitals is that every agent has their job description read, validated, and accepted and that this can be a source of motivation."

Dr. Mor Diaw, director of Hospital Services at the MSAS

One unforeseen benefit of drafting and implementing these job descriptions: the process allowed different stakeholders in health facilities to analyze available resources. For Dr. Mor Diaw, director of Hospital Services at the MSAS, this process enabled facilities to take a step back and map out all the tasks that needed to be done, identify who was currently carrying out those tasks, and determine if the current organization of staff was set up in a way that delivered the most appropriate care to patients.

After understanding any gaps in their staffing plan, Dr. Diaw said that facilities are now empowered to find “the right person for the right job.” He explained, “The job descriptions allow for staff to understand their career path … The goal in all the hospitals is that every agent has their job description read, validated, and accepted and that this can be a source of motivation.”

These job descriptions are just one of the human-resource policies and practices that HRH2030 and the government of Senegal are embracing in their journey toward a more stable health workforce and, in turn, a more resilient health system.

Standardizing Supply Chain Management Processes

With support from HRH2030, job description templates are creating a more consistent path for health workforce development. But pharmaceutical management is another aspect of Senegal’s health system that needs more clearly defined processes to better serve patients. The USAID GHSC-TA Francophone TO, also implemented by Chemonics, is working with MSAS counterparts to improve management processes in Senegal’s health supply chain

The GHSC-TA Francophone TO is helping the Department of Pharmacy and Medicine develop a compendium of standard operating procedures for managing pharmaceuticals and health supplies, which will serve as a reference document for different stakeholders. The compendium includes a compilation of best practices applicable to pharmaceuticals management — from the moment the pharmaceutical product is selected, quantified, ordered, and shipped to Senegal all the way to distribution to patients at medical centers and pharmacies around the country.

This tool — which has been adapted from the World Health Organization/USAID DELIVER tool Guidelines for the Storage of Essential Medicines — provides precise details on every step of pharmaceutical management. It covers testing medicines to safeguarding quality and even defines how the medicines should be stored and prescribed to patients. The tool also establishes consistent safety protocols.
“When someone goes to the north of Senegal, [pharmacists and storekeepers] do the tasks in the same manner, and medicines are handled just as safely,” explains Dr. Aline Kane, the GHSC-TA Francophone TO Senegal country director. This type of standardization helps ensure that patients receive high-quality pharmaceuticals in any part of Senegal.

In addition, the GHSC-TA Francophone TO assisted the National Supply Pharmacy to revise and disseminate a procedure manual for the informed push distribution model, known as Yeksi Naa, and to develop a communications plan for it. Implementing these two documents will help improve the availability of health commodities at health facility service-delivery points in Senegal.

"When someone goes to the north of Senegal, [pharmacists and storekeepers] do the tasks in the same manner, and medicines are handled just as safely."

Dr. Aline Kane, the GHSC-TA Francophone TO Senegal country director.

Stepping Stones Toward Better Access and Service Delivery

Whether its job descriptions or standardized supply chain management procedures, process improvement is an important aspect of health systems strengthening in Senegal. Job descriptions help standardize the work being done by health-care workers, making certain that they know how to do their jobs and how to do them well, leading to better retention rates. In addition, procedural standards for pharmaceutical management ensure that medical commodities reach patients in the safest condition.

Setting clear standards and processes for Senegal’s health system is a critical step in ensuring that patients have access to the lifesaving services and commodities they need. While these tools are only a small part of the changes that are taking place to strengthen Senegal’s health system, they are stepping stones toward better health access and stronger quality of care for the Senegalese population.