Senegal has offered free care to children under five since 2013, and to adults 60 and above through Plan Sésame since 2006. Drawing on national household survey data collected between 2018 and 2022, researchers compared people just below and just above each age threshold to see whether these entitlements translate into increased healthcare utilization and reduction in healthcare expenditure.
The findings tell two very different stories. For children, losing free-care status does not reduce how often families seek treatment — but it does raise what they pay, with out-of-pocket costs climbing sharply for specialist care. The exemption, researchers conclude, has been quietly protecting household budgets rather than driving demand for care.
For seniors, the picture is starkly different: becoming eligible for Plan Sésame changes nothing. Consultations and payments remain the same before and after the cutoff. Low awareness appears to be a key factor — only 6.5% of eligible seniors know the programme exists, compared with nearly half of caregivers familiar with the child exemption — compounded by reported delays in reimbursement and cumbersome referral procedures.
Rather than call for an overhaul, the study's authors recommend a more measured first step: diagnose before redesigning. That means tracking who is still being charged, measuring real awareness and uptake, and examining where delivery breaks down. Only then, they argue, can a legal right to free healthcare become a lived reality for Senegal's older population.
