CSO Budget academy / Fighting for domestic funding commitments to epidemic preparedness in Senegal

Fighting for domestic commitments to epidemic preparedness in Senegal

Civil Society Advocacy for Domestic Investment in Epidemic Preparedness

From 2018 to 2025, Resolve to Save Lives, the Global Health Advocacy Incubator and more than a dozen civil society organizations from nine countries—Ethiopia, Ghana, Kenya, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zambia—partnered to increase domestic investment in epidemic preparedness.

Activities spanned coalition building and toolkit development, advocacy and media training and targeted engagement with political and financial leaders to make the case for investments in epidemic preparedness. The program is a testament to civil society’s potential to change policy, catalyze change, bolster domestic resources and safeguard communities.

Country context

In the early 2000s, Senegal had limited ability to respond to epidemics. A weak sanitation and health system enabled regular cholera outbreaks and lengthy, deadly episodes. In a major 2004-2005 epidemic, 32,000 people were infected and over 450 died.¹ Government action produced progress: no cholera outbreaks have been declared in recent years. During the 2014-2016 West Africa Ebola outbreak, Senegal was prepared. An infected person returning from neighboring Guinea was quickly identified and monitored, preventing widespread transmission of the virus. Senegal’s outbreak surveillance measures also ensured there were no other cases. The Ebola crisis prompted Senegal to establish a public health emergency operations center—le Centre des Opérations d’Urgence Sanitaire (COUS)—to prevent, detect and respond to health emergencies in collaboration with international partners.

Timeline and key achievements

Jun 2018	Advocacy work begins in Senegal
Jan 2019	GHAI holds workshop on epidemic preparedness for parliamentarians
Feb 2019	GHAI holds workshop with government ministries on sustainable financing for epidemic preparedness
Sep 2019	ONG 3D joins as CSO partner
Oct 2019	COSPEC CSO coalition formed
Feb 2020	Proposal for US$10M epidemic preparedness included in Ministry of Finance Public Investment Program for 2021-2023
Mar 2020	Meeting between ONG 3D and President Macky Sall
Aug 2020	Tripling of budget for the Public Health Emergency Operations Center from CFA 100M (US$180K) for the Directorate of Prevention for COVID-19

Senegal’s advances demonstrated that investing in preparedness prevents human and economic devastation. Its progress was recognized during the December 2016 Joint External Evaluation (JEE), which assesses a country’s ability to prevent, detect, and respond to epidemics. The JEE team noted that: “Major efforts undertaken indicate that the country is able and willing to further strengthen and sustain its capacities in order to act more quickly, more efficiently and more effectively in the area of health security.”

While Senegal’s JEE noted improvement in laboratory capacity, surveillance, workforce strengthening, and response—including establishment of the COUS— domestic funding remained a significant shortcoming. The report concluded: “The high level of donor funding seriously threatens the sustainability of the progress realized by Senegal.”² As a result, the JEE recommended that Senegal increase overall domestic funding and highlighted the COUS’ specific needs.

In 2017, the government created a budget line for the COUS. But in 2018 and 2019, allocations were below US$100K, and eventually much of the committed funding was reallocated. This left the COUS operating budget dependent on donor support, severely limiting its capacity and undermining its sustainability. The institution also faced political challenges. While the U.S. CDC and some government officials supported establishment of the COUS, the Ministry of Health’s Directorate of Prevention raised concerns and eventually ensured that surveillance and other activities returned to its purview.

Launching the campaign

Senegalese President Macky Sall expressed strong support for epidemic preparedness, and advocates were eager to leverage this enthusiasm for the domestic budget. When a new increase in tobacco excise taxes was planned, The Global Health Advocacy Incubator (GHAI)— a spinoff of the Center for Tobacco Free Kids which operated in Senegal— saw an opportunity. Because the increase was in part justified on public health grounds, a clear case could be made for allocating a portion of the revenue to epidemic preparedness.

In June 2018, work began to realize sustainable increases to domestic funding . GHAI prepared a landscape analysis of the context and major players to guide the campaign. They also hired a knowledgeable and well-connected Senegalese consultant to kickstart activities. With support from Resolve to Save Lives, the team sought to identify the meaningful entry points in the budget process and to sensitize decision makers to the importance of preparedness, as many were unfamiliar with the COUS activities.

Building support for preparedness funding

The team began testing the idea of allocating tax revenue to preparedness with health committee members of parliament, who supported the government mobilizing its own resources and not being solely reliant on external partners.

As the campaign picked up steam, regular meetings were organized with the COUS and other public health officials to understand preparedness gaps and to strategize how to support increased allocations. The team also identified and advocated for the activation of budget lines to support both the COUS and other components of epidemic preparedness under the Ministry of Health’s Directorate of Prevention. An early win secured a small increase to COUS’s 2019 budget.

To gain further buy-in, a January 2019 workshop was organized for 35 parliamentarians; the meeting offered an opportunity to present COUS activities and emphasized the urgency of increased epidemic preparedness funding. Many deputies expressed concern that something as important as epidemic preparedness remained so dependent on foreign assistance and urged the Ministry of Health and Social Welfare to request a funding increase during the 2019 budget amendment process. Local media covered the meeting.

At the start of the program, we had a big meeting with a large portion of the parliamentarians. And this meeting was televised so the Senegalese people were informed about the establishment of this program that would work to improve the management of health emergencies. I was contacted by many people because they knew that epidemics like COVID would come.³
Prof. Oumar NdaoGHAI consultant, Senegal

The following month, a similar workshop was organized with a cross-section of government ministries to gain additional buy-in for epidemic preparedness. A working group comprised of CSO staff and government officials began developing a sustainable financing proposal for the Ministry of Finance. The Ministry of Health and Social Welfare requested that the Ministry of Finance increase epidemic preparedness funding, in line with the request made at the earlier workshop with parliamentarians.

In October 2019, ONG 3D, a public health, development, and human rights CSO, joined as an advocacy partner and took steps to extend the campaign’s profile.

ONG 3D convened over ten CSOs to create a civil society alliance–Coalition des Organisations de la Société civile pour la Prévention des Épidémies et la gestion des Catastrophes (COSPEC). COSPEC sought to mobilize support for long-term domestic funding for epidemic preparedness. ONG 3D organized education workshops with COSPEC members about the importance of epidemic preparedness and led regular meetings to coordinate advocacy efforts. The workshops were attended and supported by COUS officials, showing their integral role in supporting the advocacy work.

The work started with the support of the COUS. There was the creation of this grouping, COSPEC, because there were CSOs who worked in health, but ONG 3D trained them on how health crises should be managed. They also trained health journalists. The COUS greatly supported us in the training.
Prof. Oumar NdaoGHAI consultant, Senegal

ONG 3D also engaged the media to build public support for the campaign and keep it in front of decision-makers. The team held trainings for journalists with COUS leaders who provided health security information, increasing the journalists’ capacity for accurate reporting. This work generated important coverage that bolstered the campaign.

ONG 3D and partners also produced a series of video reports.⁴ These features community and religious leaders and were shown on the national television program “Focus”, which reached five million viewers across Senegal. The reports highlighted the need for political leaders to support domestic funding for epidemic preparedness and brought the urgency of domestic epidemic preparedness into homes across the country

Engagements with parliamentarians and government officials were ongoing throughout the campaign and played a central role in advancing campaign goals. These relationships created opportunities for officials to speak publicly in the media and in the “Focus” video reports, demonstrating their support and leadership to the constituencies that had brought them to power.

ONG 3D recognized the power of engaging elected politicians through their constituencies to build genuine political buy-in for epidemic preparedness. By connecting the issue directly to the needs and concerns of the people they represent, the campaign translated awareness into concrete support—demonstrating how grassroots engagement can shape policy and drive change.
Marine BuissonnièreSenior Advisor, Prevent Epidemics, Resolve to Save Lives

The arrival of COVID-19 both aided and complicated efforts. While it gave a clear and immediate example of why increased domestic epidemic preparedness funding was essential, officials were often distracted by the pandemic. Nonetheless, advocacy efforts secured an in-person meeting between President Sall and the head of ONG 3D. ONG 3D presented its case, and the president pledged support for increasing budgets of the COUS and related Ministries, Departments, and Agencies (MDAs). Collectively, these efforts raised the critical issue of epidemic preparedness across the government and among parliamentarians.

The path was not linear. Budget requests did not always translate into increased funding because of competing priorities and political dynamics. The campaign team’s evidence-based proposals, primarily focused on two budget lines that were constrained and dependent on allocations from the general budget rather than funds earmarked for health. In response, advocates shifted gears and focused on finding resources for the COUS and the Directorate of Prevention from the Ministry of Health and Social Welfare’s well-funded Public Investment Program.

The proposal to access these funds was called the “Project to Support the Management of Health Crises and Emergencies in Senegal” (PAPCCUSS); the campaign team developed the proposal through a multistakeholder process that included a wide array of government MDAs, who created a common, expansive vision of for domestic preparedness funding. The proposal enumerated the human and economic costs of outbreaks across Senegal and West Africa and examined the work of the COUS, its partners, and their attendant strengths and weaknesses. It examined budget gaps preventing preparedness activities, the feasibility of funding those costs, and the positive economic benefits. In total, PAPCCUSS proposed a five-year investment of CFA 5.9B (US$10M) in preparedness activities and was submitted to government MDAs. The team met with a long list of government health actors, including cabinet-level officials, to ensure ownership, which was facilitated by their participation in the proposal’s creation. Despite the team’s efforts, the Directorate of Prevention, a major political player, was not closely involved in the proposal and showed little buy-in.

Achieving increased investment

In August 2020, the COUS received a significant funding increase for the first time since its 2014 creation, tripling government spending from CFA 50M to CFA 150M (US$87K to 271K) plus an additional CFA 100M (US$180K) for the Directorate of Prevention’s COVID-19 response efforts. These gains were the results of strategic campaigning which primed leaders to recognize both the importance of this well-targeted investment and its relevance to their constituents’ needs. The PAPCCUSS proposal was included in the Ministry of Health’s Public Investment Program for 2021-2023. Proposed seed funding was, unfortunately, below expectations and was struck from the budget after initial inclusion. Because of competing priorities and political divisions between the Directorate of Prevention and the COUS, the task of securing sustained resources for preparedness remained unfinished.

The Directorate of Prevention which plays a big role in the prevention of epidemics in Senegal wasn’t very involved [in the development of PAPCCUSS]. That was due to a personnel problem. They should have been involved. I contacted them many times. But they preferred to be on the sidelines. It’s truly a big regret.⁵
Prof. Oumar NdaoGHAI consultant, Senegal

Lessons learned and legacy

In advocacy, close engagement with government is a key enabler of success. Regular meetings and joint work on proposals created a common understanding of the problem and vision of how to fix it. Officials shared critical information, supported trainings, and appreciated the team’s support. Many officials became public advocates themselves, speaking to the media, often via opportunities created by the advocacy team such as the “Focus” series..
Even when government players are involved, political tensions can create acute challenges. On several occasions, advocates were assured that funding for the COUS and seed funding for PAPCCUSS were secured, but the money did not make it into final budgets. While some funding was eventually secured, circumstance and ideological differences about the role and responsibilities of MDAs in preparedness prevented larger gains.
Outside events such as COVID-19 can change advocacy dynamics for better and worse, and advocates must respond nimbly. The pandemic provided a clear case study for domestic funding, but government officials who had supported proposals became completely consumed by the pandemic. While maintaining their goal, the team adjusted its messaging and used COVID-19 as an example, to demonstrate the urgency of their message.
Credibility is critical to success. Because GHAI’s on-the-ground consultant had a long career at the ministry of health, trust was immediate. The consultant, ONG 3D, COSPEC, and others involved in the campaign created compelling funding proposals that were backed up by data and other evidence. The entire team showed their ability to listen, integrate input, and move projects forward, cementing their place as a trusted partner.

Conclusion

When the COVID-19 pandemic hit, COSPEC members continued to support the campaign. They also coordinated with government and engaged with community and religious leaders through education events, where leaders promoted epidemic preparedness as part of their messaging about the virus. These events empowered leaders to spread the word, gave them an opportunity to make their voices heard, and built trust in communities.

There are no more resources because the Americans left. The COUS still exists because Senegal funds part of the activities, but it is not as it was.⁶
Prof. Oumar NdaoGHAI consultant, Senegal

The campaign’s budget advocates—as well as media and political decision-makers—will continue to have a lasting impact on Senegal’s epidemic preparedness and response. Their inputs are as important as ever as the sudden withdrawal of U.S. support early 2025 has had a major impact on Senegal and the COUS given its heavy dependence on foreign aid. Strategic advocacy targeting well-informed policymakers is critical as officials weigh funding priorities in the months and years ahead. Senegal’s 2020 investments amount to a down payment on the country’s health security, but a common vision and sustained political support are required to safeguard the country’s people from future outbreaks.

Footnotes

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC3432123/#:~:text=In%202004%2D2005%2C%20as%20part,(CFR)%20of%201.44%25)
2. Il faut noter que le haut niveau de financement de l’extérieur menace sérieusement la pérennité des pro- grès réalisés par le Sénégal
3. Au début du programme, on a eu beaucoup de rencontres avec les parlementaires. Et ensuite il y a eu une grande reunion avec une grande partie des parlementaires. Donc on a discuté avec eux. Cette rencontre a été télévisée et s’est sortie à la television donc les Sénégalais étaient déjà informés sur la mise en place d’un programme qui va s’occuper de la gestion des crises et urgence sanitaire. Moi-même, j’ai été contacté par beaucoup de personnes parce qu’il savait que des épidémies allait venir comme le COVID.
4. https://www.facebook.com/ong3dSN/videos/643336392890377/?refsrc=https%3A%2F%2Fm.facebook.com%2Fwatch%2F&_rdr
5. Mais la Direction de la prévention qui auraient un grand rôle dan la prévention des épidémies au Sénégal n’était pas très impliqué. Ça, c’était dû a un problème de personnel. Mais normalement ils devraient être impliquées. Moi, je les ai contactés à plusieurs reprises. Mais ils ont préféré se mettre à côté. C’est vraiment un grand regret.
6. Il n’y a plus de moyens parce que les Américains ont parti. [Donc c’est même le COUS qui avaient des moyens des états Unis parce que c’était une création Américaine. C’est la Direction de la prévention maintenant, qui va faire le travail.] Le COUS existent toujours parce que, en partie, le Sénégal finance une partie des activités. Mais le COUS n’est plus comme il était.