A qualitative study of healthcare workers’ living and working conditions in rural and urban areas of Senegal in the context of Universal Health Coverage: the ANRS-12399 Soignants Senegal study

Background Healthcare delivery in Senegal is hindered by a limited, unequally distributed healthcare workforce, and by inadequate infrastructure which negatively impact access to quality care and good health outcomes. Despite efforts to improve healthcare delivery through Universal Health Coverage (UHC), progress remains insufficient. We investigated the living and working conditions of Senegalese healthcare workers (HWs), specifically their representations and experiences of the implementation of UHC programs. Methods The ANRS-12399 Soignants Senegal study focused on HWs, including community HWs, working in health posts, health centers, regional and national hospitals, located in urban, sub-urban and rural areas. Individual semi-structured interviews were conducted with doctors and with new (preceding 12 months) arrivals (any HR type). Instead, separate semi-structured focus groups were conducted for non-doctor HWs who had graduated in a chosen technical field (e.g., nurses) and non-graduate HWs (e.g., community HWs). Results The sample comprised 60 HWs; median age was 34 years (IQR [29.5–37.5]). Those with administrative responsibility were more likely to have an understanding of the UHC’s various programs. UHC implementation had led to debt for care structures, poorer working conditions because of a deterioration of the patient-HW relationship through unexpected out-of-pocket costs for supposedly free services, delayed salary payment, and drug stock-outs. Moreover, job tenure was shorter in rural areas and for doctors, indicating the attractiveness of urban workplaces and greater doctor mobility, respectively. Reasons for leaving rural positions included dissatisfaction because of poor recognition, limited opportunities for career development, equipment and training infrastructure shortages, distance from one’s family, and the absence of financial incentives. HWs working in urban settings faced more equipment maintenance issues, but were less likely to leave their position. Different knowledge acquisition desires drove mobility to and from rural areas; seeking stable contracts motivated HWs to work in rural areas. Conclusion HWs working in rural Senegal face greater challenges. Deciding whether to work there entails more than financial considerations. Although UHC is not the origin of HWs’ poor working conditions in the country, it exacerbates them. Addressing difficulties HWs face in rural Senegal is essential to ensure retention and better implementation of the UHC’s various programs.