Exploring individual and structural factors influencing healthcare seeking behavior in the context of the Senegal’s Universal Health Coverage program: a multilevel analysis from the ANRS-12399 Soignants Sénégal study

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BACKGROUND: Although Senegal's Universal Health Coverage (UHC) program has improved access to care, it has sometimes led to overuse of health services. Moreover, the program's substantial financial debt to health facilities (HFs) has exposed them to organizational and financial problems, making it difficult to renew drug stocks and pay salaries on time. The multiple effects of the UHC program, both on individuals and on HFs, may discourage individuals from seeking for care in HFs. This study analyzed structural and individual factors associated with healthcare-seeking behavior in the context of Senegal's UHC program. METHODS: We used data from six HFs in the mostly rural Fatick region that participated in two different two surveys: ANRS 12399 Soignants Sénégal and CMUtuelleS. We performed a multilevel logistic regression model to identify individual and structural factors influencing healthcare-seeking behavior. RESULTS: Among the 313 individuals included, 63.3% were female and median age was 52 years (IQR [41⎯63]). Half the participants (50.5%) sought health services after experiencing a health problem in the two months prior to the survey. HFs, which the National Agency managing the UHC program (33.3%) owed most to, were better equipped and staffed, but also the most negatively affected by UHC implementation. Despite this, individuals sought care in these facilities just as frequently as in others, suggesting that being better equipped and staffed helped them to be more resilient to the negative effects of the UHC program. Individuals were less likely to seek care in smaller HFs. Instead, they were more likely to seek care in HFs providing HIV and tuberculosis care. Voluntary (i.e., paying) members (vs. other members) of community-based health insurance organizations, and individuals with a chronic illness (vs. without), were more likely to seek care. Persons with a disability (vs. without) and those experiencing food insecurity (vs. no food insecurity) were less likely to seek care. CONCLUSION: Both the financial support provided to individuals by the UHC program and structural characteristics of the healthcare system were associated with seeking healthcare. Taking greater account of these structural aspects when implementing UHC could enhance the program's effectiveness and help achieve its objectives.

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