Challenge
Senegal has a population of around 17 million (as of 2020), with 48 percent living in urban areas. Despite improvements in national disease surveillance systems and epidemic responses since the West African Ebola Outbreak in 2014-2016, it is critical to strengthen Senegal’s capacity to provide for a more effective and efficient response to outbreaks. Senegal is still vulnerable to transmission of COVID-19 due to porous national borders, densely populated urban areas, few handwashing facilities in homes, and limited access to quality health services (with only 0.54 health centers per 100,000 population1). In addition, the country has an uneven geographic distribution of qualified healthcare workers, as well as frequent shortages of essential medicines. Moreover, the country has been experiencing a third wave of the COVID-19 pandemic since July 2021, with over 1,765 deaths as of August 31, 2021. The shortage of COVID-19 vaccines is not just a Senegal phenomenon, but a continent-wide problem, resulting in insufficient and unequal access.
Approach
The Government was proactive in preparing and responding to the COVID-19 pandemic. Prior to the first case in early March 2020, the Ministry of Health and Social Action (MoHSA) had developed a contingency plan following the World Health Organization’s declaration of an international public health emergency. Soon after, the Government requested World Bank financing to support their short-term action plan. As a result, $4 million was provided to procure equipment, medicines, and personal protective equipment for healthcare workers.
The Senegal COVID-19 Response Project, which aims to prevent, detect, and respond to COVID-19, was developed in record time. In its first phase, it provided $20 million to support the implementation of the National COVID-19 Response Plan, thus filling critical health system gaps. For example, case detection and confirmation, contact tracing, reporting, and maintaining essential health services were critical activities. This project also ensured cross-sectoral collaboration with the water, sanitation and hygiene (WASH), education, and social protection sectors. Regarding the project’s second phase, $134 million was approved in June 2021. It enabled the country to procure additional equipment/medicines, as well as to acquire COVID-19 vaccines through various mechanisms such as the COVAX Facility and the African Vaccine Acquisition Trust (AVAT), as well as directly from manufacturers. The vaccination campaign began on February 23, 2021 in all regions of the country and is currently ongoing.
Results
Although the project is still ongoing, there are several early results (April 2020-August 2021):
- A cumulative total of 72,805 cases have been confirmed, of which 9,025 are under treatment; a total of 1,765 deaths have occurred as of August 31, 2021.
- Eighty-five percent of confirmed COVID-19 cases have recovered as of August 31, 2021.
- One hundred percent of patients who come to health facilities with COVID-19 symptoms are tested and treated free of charge, nationwide.
- The acquisition of 332,118 Sinopharm vaccine doses have been financed by the project, and the project expects to finance additional vaccine doses from AstraZeneca (COVAX), Johnson and Johnson (AVAT), and Moderna (COVAX) in the next 6-9 months (for a total of approximately 13,997,400 doses).
- Three hundred fifty healthcare workers have been recruited to support the COVID-19 treatment centers.
- A total of 901 point-of-entry/border officers and 6,267 healthcare workers have been trained in COVID-19 prevention, control, and contract tracing; a total of 17,261 community health workers were trained in community-based disease surveillance as of July 28, 2021.
- Equipment and supplies — including masks, gloves, face shields, and gowns — were procured for laboratories and healthcare facilities. Other items provided include monitors, microphones, reagents and other supplies for laboratories, and 10 equipped ambulances for emergency medical services. Finally, subscriptions to online meeting applications were also made available to all regions.
- A total of 95.41 percent of district health centers/hospitals have received PPE and other infection control supplies as of July 28, 2021.
- A total of 4,482,863 people have been reached through hygiene promotion activities.
- An Epidemiological Treatment Center at Fann Hospital was established.
- Additional thermal scanners have been installed at points-of-entry (shipping ports and airports).
- A public access webpage with the COVID-19 situation in the country was created and is updated at least once per day.
- The private sector (hotels and other centers) was engaged to reduce the capacity constraints in healthcare facilities by providing lodging for confirmed positive cases with little or no symptoms.
- Call centers were equipped to process the COVID-19 calls from the toll-free national number.
World Bank Group Contribution
The International Development Association (IDA) has provided $154 million to support the Senegal COVID-19 Response Project. With financial support from the Global Financing Facility, the Bank is also providing technical support to maintain essential health and nutrition services during the COVID-19 pandemic. The Regional Disease Surveillance Systems Enhancement (REDISSE) and the COVID-19 Response Plan were critical factors that allowed Senegal to co-host, with the Institut Pasteur, one of the two World Health Organization (WHO)-accredited COVID-19 testing centers in Africa. It also facilitated training programs for staff from 30 other laboratories in Africa.
Development Partners
The Project is being implemented in close coordination with Agence Française de Développement (French Development Agency), Enabel (the Belgium Development Agency), the Clinton Health Access Initiative, the European Union Emergency Trust Fund for Africa, the Japan International Cooperation Agency, the Korean International Cooperation Agency, the Luxembourg Agency for Development Cooperation, PATH (a global health organization), the United Nations Children's Fund (UNICEF), the United Nations Population Fund, the United States Agency for International Development (USAID), the United States Centers for Disease Control and Prevention (CDC), and the WHO.
Looking to the Future
The results are tangible and sizeable and came about at unprecedented speed when compared to the challenge. However, there remains unfinished business. More emphasis will be placed on communications and community engagement to address: (i) the stigmatization of populations that have tested positive for COVID-19, as well as frontline healthcare workers/emergency workers responding to the pandemic; and (ii) vaccine hesitancy driven by widespread misinformation and concerns about safety and side effects. Moreover, the Bank and the Global Financing Facility’s assistance will ensure support for the continuity of essential health services for maternal, child and adolescent health. Sustainable financing of the health sector is also critical to improving the availability and utilization of essential health services during and after the COVID-19 pandemic.
Beneficiaries
This Project benefits all Senegalese, with all COVID-19-related testing and treatment offered free of charge for the population. Healthcare facilities and laboratories are well-equipped. They also have well-trained healthcare personnel, which benefits all citizens, including the most vulnerable groups. As of August 31, 2021, compared to neighboring countries in West Africa, Senegal ranked first in the number of COVID-19 tests performed (with 750,135 people tested), as well as in the number of vaccine doses administered.