No Money, No Care: Women And Health Sector Reform In Senegal

Abstract

The author uses the case of Senegal to analyze how the effects of global health reforms are mediated by social relations and the micropolitics of a given place. The article examines the past two decades of reform and how they have been shaped by the interface of international health policy, their implementation nationally, and the local structures of power in the city of Saint Louis, Senegal. First the article highlights the three main reforms that have been carried out in Senegal: decentralization, privatization of the health sector, and the institutionalization of participatory management structures for health facilities. The author then addresses women's exclusion from local politics, civil society, and the local health committees in Saint Louis. A key problem is that elected officials and health sector personnel have failed to engage with women as potential leaders and participants in the community health structures, instead viewing them only as family health managers and the targets of health education messages. The article ends with some considerations for the future of health sector reform and the kinds of changes that will have to occur to ensure women's equity and full participation in the process of community health care management.

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