Community Health Financing in Senegal: Strategic Purchasing as a Lever for Health Sovereignty in the Face of Partner Disengagement

Problem: Senegal is undertaking a transformation of its health system, driven by its Vision Senegal 2050 and its demand for national sovereignty. Community health constitutes the first level of contact between the population and the care system. Yet, its financing remains structurally dependent on technical and financial partners (TFPs), at a time when these partners are scaling back their commitments. Strategic purchasing of health services is examined as a lever that can simultaneously increase domestic revenue and optimise expenditure. Methods: The study draws on the national mapping of community health investments carried out in 2025, covering the years 2023 and 2024. Financial data from seven regional health directorates and the main TFPs were consolidated by source, cost category, and region. The analysis, restricted to the 2023-2024 period, addresses the structure of financing, budget execution, allocative efficiency, and the gaps between the planned costs of the National Community Health Strategic Plan (NCHSP) and the resources mobilized. Results: In 2023-2024, 10.99 billion FCFA was mobilized, of which 62.8% came from TFPs, 27.6% from local governments, and 9.6% from the State. Partner disengagement is evident: the total envelope contracted by 24.1% between 2023 and 2024, and the TFP contribution fell by 13.7% in absolute terms, while its share of annual financing rose from 59.2% to 67.4%, with the State failing to offset this withdrawal. Execution rates remained above 95%, with no correlation between the level of spending and programmatic results. Marked territorial inequalities persist, with Kolda and Sedhiou combining the lowest per-capita investment and the highest mortality. Conclusion: Strategic purchasing of services, coupled with strengthened domestic resource mobilisation and effective fiscal decentralisation, represents the most promising path to reduce external dependence, optimise spending that is currently weakly linked to results, and ensure territorial equity in the implementation of the NCHSP 2025-2029.