Long Way to Universal Health Coverage (UHC): Are Policy Dialogue Processes Appropriate to Negotiate Trade-Offs in Africa? The Cases of Benin and Senegal

The numerous stakeholders involved in the development of universal health coverage (UHC) policies are likely to have diverging interests about which dimensions to prioritize, hence the importance of ensuring an effective and transparent policy dialogue. This paper aims to investigate whether or not UHC policy dialogue processes are functioning well in Benin and Senegal. Based on a literature review, we have identified a number of characteristics guaranteeing the quality of policy dialogue processes, which we have integrated into an analytical grid. The quality criteria identified were classified along four dimensions: stakeholder participation, dialogue/negotiation process, quality of situation analysis and decision criteria, and results from the negotiation process. Based on data collected through documentary review, interviews, an electronic survey and the authors’ own experience, we applied that analytical grid to the cases of Benin and Senegal. In both countries, the policy dialogue processes are largely imperfect in terms of many of the quality criteria identified. Decisions were made under strong political leadership, ensuring government coordination and ownership, and strong emphasis has been put on expanding financial risk protection. Yet, both countries perform poorly in a number of dimensions, especially with regards to conflicts of interest, transparency and accountability. None of them has really institutionalized a UHC policy dialogue process, and the UHC policymaking processes have actually bypassed existing health sector coordination mechanisms. The two countries perform well regarding the quality of situation analysis. A small (in the case of Benin) or broader (in the case of Senegal) governmental coalition managed to impose its views, given insufficient stakeholder participation. Policy networks were particularly influential in Senegal. Overall, there are important gaps that reduce the quality of UHC policy dialogue processes, hence explaining the weaknesses in their results in terms of transparency and accountability. Our analytical framework enables usto identify rooms for improvement with regard to country-led negotiation processes relating to UHC.