What causes inequity in access to publicly funded health services that are supposedly free at the point of use? A case of user fee exemptions for older people in Senegal

Philipa Mladovsky and Maymouna Bâ

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: Plan Sésame (PS) was launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. As in many countries, this user fee exemption is marred by inequitable implementation. This study seeks to identify underlying causal mechanisms to explain how and why some people were relatively less likely to have access to publicly funded health care. Explanations identified in focus group and interview data are organised into four themes: (i) PS as a poorly implemented and accessed “right” to health care; (ii) PS as a “privilege” reserved for elites; (iii) PS as a “favour” or moral obligation to friends or family members of health workers; and (iv) PS as a “curse” caused by adverse incorporation. These results are analysed through critical realist and social constructivist epistemological lenses, in order to reflect on different interpretations of causality. Within the critical realist interpretation, the results point to a process of social exclusion. However, this interpretation, with its emphasis on objective reality, is contradicted by some local, subjective experiences of inequality and corruption. An alternative social constructionist interpretation of the results is therefore explored; it is argued this may be needed to prevent relatively powerful actors’ versions of the truth from prevailing.

Keywords: Social exclusion; older people; universal health coverage; user fees; Senegal; critical realism (search for similar items in EconPapers)
JEL-codes: E6 (search for similar items in EconPapers)
Pages: 40 pages
Date: 2016-05
New Economics Papers: this item is included in nep-afr, nep-age and nep-hea
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