Source: French to English Tester Published on: 2026-04-08
Source: The Conversation – in French– By Ibrahima Thiam, teacher-researcher, Iba Der Thiam University of Thiès
Senegal and the United Stateshave signed, on March 13, 2026, a five-year agreement protocol (2026-2030) valued at 135 million dollars. This bilateral cooperation mainly aims at strengthening the Senegalese health system.
However, it takes place in a particular context marked by a strong will for deep restructuring of public finances by the Senegalese authorities following the audits of 2024-2025, and by the projection of the “Senegal 2050” agenda towards economic sovereignty.
As a researcher, I have studied health economics and the implementation of public policies in Senegal. In my opinion, the analysis of this agreement, beyond a medico-technical reading, must be structured around two perspectives: the capacity to transform the health system and the Senegalese economic and budgetary context.
Implications for the health system
The agreementtargetsTo strengthen several key dimensions of the Senegalese health system, namely: epidemiological surveillance, laboratory capacities, digitalization, human resources and the fight against priority diseases, particularly those related to maternal and neonatal health, and the fight against infectious diseases (HIV, malaria, tuberculosis).
More concretely, the medico-technical component of the agreement aims to establish a break with the current palliative care model towards a preventive approach and better use of digital technology.
Thus, the effectiveness of this protocol does not rely solely on the injection of funds, but on its ability to structurally transform the healthcare supply through three major strategic levers.
The first lever is the digital transition through the digitization of the health information system (HIS). This pillar should enable a more rational allocation of resources, limiting waste and optimizing the management of medicines. Indeed, while medicines represent 52.1% of the direct health expenditures of Senegalese people, optimizing the distribution chain is more than necessary to transform the management of pharmaceutical products, which accounts for68.5%in the costs of healthcare facilities.
Thus, the memorandum of understandingplansthe interconnection of health structures, allowing real-time monitoring of the availability of inputs and better traceability of funding.
The second lever is epidemiological sovereignty through the standardization of regional laboratories.
The memorandum of understanding aims to strengthen rapid diagnostic capacities to effectively ensure national health security. This involves providing regional laboratories that meet the required standards to handle diagnostic requests within the deadlines. Furthermore, it will be about enabling the different regions of Senegal to reduce their dependence on the capital’s infrastructures.
Indeed, Dakar still concentrates more of60% of specialists.
The third lever is the optimization of human capital and the promotion of social equity. Among the targets of the agreement is the drastic reduction of maternal and neonatal mortality, a fundamental human development indicator. According to the National Agency for Statistics and Demography (ANSD), in Senegal,per 1000 live-born children, 48 do not reach their first birthday and 66 die before their fifth birthday. Infant mortality is estimated at 30.5‰.
The maternal mortality rate is estimated at 26 maternal deaths per 100,000 women aged 15-49, with regional disparities. To this end, the program plans to strengthen investments in the ongoing training of healthcare staff and the deployment of midwives and specialized nurses in rural areas. This allows Senegal to improve theUniversal Health Coverage (UHC). Indeed, UHC guarantees that everyone, without distinction, can access essential quality health services (prevention, treatment, rehabilitation, palliative care) at the right time, without facing financial difficulties.
Between consolidation and sovereignty
The main interest of this $135 million agreement protocol lies in its financial structure, which differs from the usual traditional models. Indeed, Senegal contributes more than half of the financing, that is, $72 million through the State budget. This majority contribution reflects a desire to transition towards domestic financing and, consequently, towards health sovereignty.
This direction is consistent with the new public policies, notably with theEconomic and Social Recovery Plan of Senegal, which emphasizes economic sovereignty and the reduction of external dependence.
However, like other departments, the budget allocated to the Ministry of Health and Public Hygiene remains under pressure. Although health expenditures increase in absolute value (around USD 444 million in 2025, then about USD 460 million in 2026), they struggle to reach the 15% of public expenditures recommended by theAbuja Declaration.
They revolve around5 to 6 %in these latest finance laws2024-2025.
The integration of this memorandum of understanding into the national budget, despite its importance, must contend with a complex financial reality.
Audits commissioned by the new authorities in 2024 revealed that the average budget deficit over the period 2019-2023 amounted to 10.4% of GDP, more than double the previously announced figures and exceeding the community standard. Thebudget 2026, stopped at 12.46 billion USD, marks a willingness to take control again, with a projected deficit at 5.3% of GDP (with a goal to bring it back to the community standard of 3%).
The financing of this agreement, which is based on a domestic contribution of 53% of the total amount (i.e., 72 million dollars), forces the State to increase tax revenue mobilization, with atax burden objectiveset at 23.2% of GDP.
At the same time,public debtrevalued has increased sharply, exceeding 100% of GDP, thus significantly surpassing the convergence threshold of the West African Economic and Monetary Union (WAEMU) set at 70%.
This considerably reduces Senegal’s budgetary leeway. Thus,the debt serviceabsorbs more than 1,190 billion FCFA (approximately 2 billion USD) in 2026. The health agreement must succeed in the challenge of efficient allocation. It is a matter of transforming a social expense into a growth investment.
In addition, the improvement of the health of populations through, in particular,life expectancyAt birth, which is currently 68.9 years at the national level against a global average of 73.8, it will need to contribute to achieving the targeted growth objectives, necessary to reduce the country’s debt in the long term.
Moreover, beyond the financial and economic implications, this agreement constitutes a seal of trust in a context where the country is trying to emerge from a zone of financial turbulence. This partnership, supported by the transparency exercises of the new authorities and the ambitious orientations of public policies (Vision Senegal 2050, Economic and Financial Recovery Plan…), is a signal of credibility sent to international investors and bilateral and multilateral partners.
A bet on the future
Ultimately, the Senegal-United States health protocol agreement goes beyond simple development aid. It is also a test of effectiveness and viability for the country’s new policy of economic and financial sovereignty, in a context of limited budgetary room for maneuver.
However, the success of this program depends on Senegal’s ability to transform these resources into measurable health outcomes (reduction in mortality, full digitalization, control of emerging diseases…) while maintaining fiscal discipline in the face of public debt, which remains the main constraint of the Senegalese economy.
Ibrahima Thiam works for Iba Der Thiam University of Thies in Senegal.
–ref. Agreement protocol with the United States: Senegal is testing a new health financing model –https://theconversation.com/protocole-daccord-avec-les-etats-unis-le-senegal-teste-un-nouveau-modele-de-financement-de-la-sante-279386