The question
The Global Fund finances the fight against three diseases in Senegal — HIV, tuberculosis and malaria. But money is not enough: the grant cycle itself, from the initial funding request through to implementation, must not undo along the way what it claims to build. The Prospective Country Evaluation observes that cycle in real time, in eight countries including Senegal, to understand which investments change, when and why.
Two themes served as a lens: diagnostic capacity for the three diseases, and the DHIS2 national health information system.
How we worked
Eighty-one documents analysed — grant agreements, detailed budgets, national strategic plans, performance reports. Twenty-five key informant interviews across national programmes, principal recipients and the Global Fund country team. Seven fact-checking interviews. Ninety-three meetings observed. All of it systematically triangulated: no finding rests on a single source.
Budgets were tracked intervention by intervention, with activities linked to each theme identified through keyword search. Every health-system activity was coded independently by two evaluators according to whether it supported the system or strengthened it.
What we found
Diagnosis loses ground just when it is most needed
Between the funding request and signature of the tuberculosis grant, the budget for diagnostic capacity fell from €3.4 million to €2.2 million, a 34 % drop. Over the same period the health information and M&E module rose from €432,427 to €613,711, a 42 % increase.
Twenty-four machines, five regions with none
Senegal acquired twenty-four GeneXpert machines with Global Fund support. They were placed on the basis of 2016 tuberculosis mortality data, across six regions accounting for 82 % of deaths. The result: Louga, Matam, Tambacounda, Kolda and Sédhiou have none, even though multidrug-resistant tuberculosis is more evenly spread and HIV is more prevalent in the south. Utilisation of the installed base sits at around 45 %. In October 2020, six machines were out of service.
Chronic stock-outs
Seventy-five per cent of the National AIDS Council grant goes to buying medicines, reagents and devices. Even so, in the first half of 2020, 80 % of screening and treatment centres reported HIV test stock-outs. Failed tenders, lengthy procurement, suppliers turning away from small orders.
COVID-19 erased a year of screening
The state of emergency and the suspension of field activities cut tuberculosis screening by 80 % between February and May 2020. Average performance on tuberculosis indicators fell to 63 %, and HIV to 60 % for ANCS and 65 % for CNLS — their lowest levels since implementation began.
DHIS2 is installed but not adopted
In use since 2014, the national health information system remains under-used. On-time data transmission fell from 79 % of facilities in 2019 to 63 % in 2020. The barriers are technical — indicators that cannot be extracted, incomplete interoperability — but also political: no leadership imposes DHIS2 as the national reference tool.
System strengthening remains an intention
Total allocation rises from €64.97 million to €69.62 million for the 2020-2022 cycle, up 7.2 %, with the health-system strengthening budget increasing by nearly 25 %. But our analysis shows that 77 % of those investments are support — purchases, commodities, per diems — rather than durable capacity building.
The vast majority of RSSH investments continue to be supporting (77 % in NFM3) rather than strengthening the health system.
What we recommended
- Think in systems, not programmes, when acquiring and deploying GeneXpert machines
- Transfer management of the network from the tuberculosis programme to the Directorate of Laboratories
- Make DHIS2 the national reference tool, and fund its harmonisation meetings
- Revive the multisectoral system-strengthening platform, which never became operational
- Strengthen the national procurement pharmacy rather than bypassing national purchasing
How to cite this study
Faye A., Ka A., Tine A., Ndoye B., Sall D., Gaye I., Leye M., Badji M., Tine R., Ndoye T. (ISED/UCAD) ; Ndione I., Sene B. N. (PATH Sénégal) ; Hernandez Prado B., Schneider M., Rios Casas F., Huntley B. (IHME) ; Osterman A., Nawaz S., Shelley K. D. (PATH), 2021. Prospective Country Evaluation — Senegal: Annual Report 2020-2021. 31 mars 2021, 52 p. Commandité par le Groupe technique de référence en évaluation (TERG) du Fonds mondial de lutte contre le sida, la tuberculose et le paludisme.