"Good intentions are not enough": analysis of a health policy for the elderly in Senegal

In 2006, the Senegalese government introduced the "Plan Sésame", an unprecedented policy in West Africa aimed at reducing social vulnerability among the elderly (i.e. people aged over 60 years). This paper examines the process of implementation of the "Plan Sdsame': Using a qualitative approach, the study was based on a unique case study authorized by the Senegalese Ministry of Health. Three methods were used: i) individual interviews (n = 19), ii) discussion groups (n = 24), and iii) documentary study. Despite its social objective, the "Plan Sésame" was ultimately limited to free health care. However, even the health component of the plan has suffered from under funding. Political obstacles, inadequate accompanying measures and short staffing have resulted in late reimbursements at a local level, thus limiting the implementation of the plan. While both health professionals and elderly people are in favor of free healthcare, they are also critical of the implementation issues surrounding the "Plan Sésame": Although it appears to be a viable solution, these issues may spell the end of the plan. The task of designing solid technical foundations and developing appropriate accompanying measures should not be overlooked because of the limited interest of international partners in the "Plan Sésame" the national dimension of the plan and its electoral importance.