Prospective Country Evaluation — Senegal: 2021 extension report

Why an extension

The annual report published in March 2021 left several questions open, because the final budgets for the new funding cycle were not yet available. The Technical Evaluation Reference Group therefore commissioned a three-month extension phase, from April to June 2021, to address them.

Four questions precisely: how do national actors understand the distinction between supporting and strengthening a health system? Why do so few strengthening indicators appear in results frameworks? What do the final budgets of the new cycle reveal? And what can be learned from grant revisions, both in ordinary times and under COVID-19?

What we found

Eighteen months for one revision, five for another

Grant revisions are experienced as an administrative burden. The National Malaria Control Programme took eighteen months to complete a revision, unable to assemble the required financial data. The National AIDS Council and the National Alliance of Communities for Health managed it in five months. Six factors explain the weight: templates provided late, questions duplicating the funding request, manual transfer of data between platforms, exchanges with response times of three to nine months, and successive approval procedures.

The pandemic proved it could be done differently

In response to COVID-19, USD 2.2 million of savings were reprogrammed, alongside USD 4.9 million of additional funding. And this time everything moved fast. Simplified forms, a single centrally coordinated submission across all programmes, continuous consultant support — and above all, removal of the requirement for country coordinating mechanism and grant approval committee sign-off.

The contrast is instructive: it is not the procedures that are incompressible, it is the level of trust granted to national teams that varies.

Strengthening progresses, slowly

Our updated analysis of the final budgets shows the share of investments amounting to genuine health-system strengthening rising from 26 % to 38 % between cycles. That is real progress, and not enough. The three-year grant horizon structurally favours immediate needs over long-term capacity.

Indicators imposed, and contested

The number of system-strengthening indicators rose from four to ten, including five procurement indicators requested by the technical review panel. Senegal is an exception among the countries evaluated. But the Ministry of Health sent an official letter contesting them: the country does not control procurement, since it runs through an international platform.

At this rate, you will see us forced, in the near future, to only buy from their platform, which will further weaken the national medicine supply system.

Budget movements no one can explain

Between the funding request and signature, the system-strengthening budget rises 18 %, from €11.4 million to €13.5 million, while the human rights, gender and equity budget falls 2.5 %. Storage and distribution capacity at the national pharmacy gains 84 %. Yet the removal of the intervention on reducing HIV-related gender discrimination could not be explained by any of the stakeholders interviewed — and appears in no document.

What we recommended

1. Allow budget carry-over from one grant cycle to the next, as was done for COVID-19 funds
2. Set clear review and response deadlines, to reduce the time demanded of national teams
3. Leave micro-planning to national experts and reserve the country team for strategic questions
4. Let countries choose indicators accessible from their own information system
5. Settle principal recipient decisions earlier, and document budget trade-offs

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