Search

Les personnes immigrées originaires d’Afrique subsaharienne traversent fréquemment des épisodes de grande précarité à leur arrivée en France. L’absence d’hébergement stable ou de titre de séjour peuvent notamment se traduire par une plus grande exposition aux risques sexuels et au VIH en particulier. Cette population représentait ainsi plus du tiers des nouveaux diagnostics d’infection par le VIH en 2018, infections par ailleurs acquises pour plus de la moitié après l’installation en France. Cet état de fait plaide pour une politique de prévention spécifique. C'est dans ce contexte que trois équipes de recherche et deux associations ont proposé une intervention innovante visant à renforcer la capacité d’agir (empowerment en anglais) en matière de santé sexuelle dans cette population, dans une démarche d’aller-vers. Nous présentons ici les coûts de l’intervention Makasi – la première du genre à être mise en place en France – dans le but d’informer les organisations souhaitant mettre en oeuvre ce type d’intervention.

Au Sénégal, comme ailleurs, l’accès à l’information semble déterminer l’intérêt porté par les individus aux systèmes d’assurance maladie, influençant ainsi leur comportement d’adhésion. En nous appuyant sur des données collectées en 2019-2020 dans la zone rurale de Niakhar au Sénégal, cette étude apporte un nouvel éclairage sur le rôle de l’accès à l’information et des facteurs géographiques comme déterminants clés d’une adhésion effective aux Mutuelles de Santé Communautaires par les habitants des zones rurales. Dans l’ensemble, nos résultats visent à aider les décideurs publics à mieux définir la feuille de route de la couverture de santé universelle, afin qu’ils adaptent leurs politiques de sensibilisation à l’assurance maladie et améliorent l’accès aux mutuelles ainsi qu’aux structures sanitaires qui leurs sont affiliées.

L’accès aux services de santé est un élément clé pour atteindre l'Objectif de Développement Durable n° 3, qui consiste à promouvoir une vie en bonne santé pour tous à tout âge grâce à une couverture maladie universelle (CMU). Cependant, dans le contexte des pays à revenu faible ou intermédiaire, la plupart des études se concentrent sur la protection financière mesurée par les dépenses de santé catastrophiques, ou sur l'utilisation des services de santé parmi des populations spécifiques présentant des besoins de santé (comme une grossesse récente ou une maladie).Cette étude vise à construire un score individuel d’obstacles perçus à l’accès aux soins (OPAS) afin de prédire l'utilisation des services de santé.

Mis en œuvre au Sénégal en 2013, le Programme National de Bourses de Sécurité Familiale(PNBSF) est un programme de transferts monétaires pour les ménages indigents. Outre la réduction de la pauvreté des ménages et l’incitation à la scolarisation des enfants, un objectif du PNBSF est d’améliorer la couverture sanitaire en garantissant aux ménages bénéficiaires une adhésion gratuite à une mutuelle de santé communautaire. Nous présentons dans cet article la première évaluation au niveau local de ce programme d’assurance santé entièrement subventionné par l’État sénégalais.

International audience; Limited access to information is one of the main health insurance market imperfections in developing countries. Differential access to information may determine individuals' awareness of health insurance schemes, thereby influencing their probability of enrollment. Relying on primary data collected in 2019-2020 in rural Senegal, we estimate the uptake of community-based health insurance using a Heckman-type model to correct for awarenessbased sample selection bias. Besides showing that health insurance awareness is a precondition for effective enrollment in community-based health insurance schemes, we also bring new evidence on the roles which geographic factors and individual risk preference play in health insurance uptake by rural dwellers. We show that geographic distance prevents individuals from accessing information on health insurance schemes, and discourage those who are informed from enrolling, because of the additional distance they must travel to benefit from covered healthcare services. Results also show that individual risk preference influences health insurance uptake, but only when information barriers are taken into account. Overall, our results could help decisionmakers better shape the universal health coverage roadmap, as policies to improve health insurance awareness differ substantially from policies to improve the features of health insurance schemes.

Additional file 1: Table S1. Description of variables. Table S2. Descriptive statistics according to survey year. Table S3. Propensity score model: inferior bounds and number of untreated and treated individuals in each block. Table S4. Average treatment effect of the free ART program on catastrophic health expenditure. Table S5. Inverse probability of treatment weighting: covariate balance. Table S6. Results of the inverse probability of treatment weighting probit model for catastrophic health expenditure.

International audience; Sub-Saharan Africa's hepatitis B virus (HBV) burden is primarily due to infection in infancy. However, data on chronic HBV infection prevalence and associated risk factors in children born post-HBV vaccination introduction are scarce. We estimated hepatitis B surface antigen (HBsAg) prevalence and risk factors in Senegalese children born during the HBV vaccination era. In 2018-2019, a community-based cross-sectional survey was conducted in Senegal among children born between 2004 and 2015 (ie after the three-dose HBV vaccine series was introduced (2004) but before the birth dose's introduction (2016)). HBsAg-positive children were identified using dried blood spots. A standardized questionnaire collected socioeconomic information. Data were age-sex weighted and calibrated to be representative of children living in the study area. Risk factors associated with HBsAg positivity were identified using negative binomial regression. Among 1,327 children, 17 were HBsAg-positive (prevalence = 1.23% (95% confidence interval [CI] 0.61-1.85)). Older age (adjusted incidence-rate ratio [aIRR] 1.31 per one-year increase, 95% CI 1.10-1.57), home vs healthcare facility delivery (aIRR 3.55, 95% CI 1.39-9.02), stitches (lifetime) (aIRR 4.79; 95% CI 1.84-12.39), tattoos (aIRR 8.97, 95% CI 1.01-79.11) and having an HBsAg-positive sibling with the same mother (aIRR 3.05, 95% CI 1.09-8.57) were all independently associated with HBsAg positivity. The low HBsAg prevalence highlights the success of the Senegalese HBV vaccination program. To further reduce HBV acquisition in children, high-risk groups, including pregnant women and siblings of HBsAg-positive individuals, must be screened. Vital HBV infection prevention measures include promoting delivery in healthcare facilities, and increasing awareness of prevention and control procedures.

Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06331-5.

International audience

International audience; We analyse the influence of financial openness on the level of aggregate consumption, a research question that has been left surprisingly unexplored by the previous literature. We construct a complete and balanced panel data set of 88 countries for the period 1980–2010, and then differentiate between four groups of countries. Models for non-stationary heterogeneous panels, as well as panel threshold regression models, are used to estimate the determinants of aggregate consumption. The core finding of the paper is that the financial openness effect on consumption changes in the course of economic development, with the level or per capita income acting as a threshold which is consistently estimated within the model. The openness effect is non-homogeneous across groups, stronger for low levels of per capita income and diminishes as income rises. These findings provide new insights into the welfare effect of financial liberalization.

We analyse the influence of financial openness on the level aggregate consumption. We construct a complete and balanced panel dataset of 88 countries for the period 1980-2010, and then differentiate between four groups of countries. Models for non stationary heterogeneous panels, as well as panel threshold regression models, are used to estimate the determinants of aggregate consumption. The core finding of the paper is that the financial openness effect on consumption changes in the course of economic development, with the level or per capita income acting as a threshold which is consistently estimated within the model. The openness effect is non homogeneous across groups, stronger for low levels of per capita income, and diminishes as income rises, providing novel insights about the welfare effect of financial liberalization.