Resumen Objetivo: Evaluar los determinantes en la financiación del acceso a la atención médica y el papel de una clase particular de financiación informal propia, denminada tontina, para el acceso a la atención médica en la población de migrantes de origen senegalés. Método: Los datos fueron recogidos mediante técnicas cualitativas, entrevistas semiestructuradas (n=14) y grupo de discusión (n=10) en una población de migrantes senegaleses residentes en Granada, entre octubre y noviembre de 2019. Los participantes clave provenían de una tontina. Resultados: La falta de trabajo o de recursos económicos, así como la condición de migrante indocumentado, constituyen barreras para la adhesión a los seguros de salud públicos y privados. Asimismo, los participantes consideran que la asistencia sanitaria pública no tiene en cuenta la importancia que puede tener para ellos seguir un tratamiento cerca de sus familiares o tener la alternativa de las medicinas tradicionales. La tontina permite proteger a las personas más vulnerables, como las indocumentadas, y financiar las prácticas de importancia cultural para las personas migrantes senegalesas. Conclusiones: Este estudio es el primero en proporcionar una comprensión de un mecanismo de financiación propio de un colectivo de migrantes bastante desconocido por la sociedad española. Las tontinas continúan una larga tradición en la que las comunidades desfavorecidas y vulnerables resisten múltiples fuentes de discriminación y desigualdad mediante la autoayuda, la confianza y la solidaridad.

Abstract Objective: To evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants. Method: Data were retrieved through qualitative techniques, semi-structured interviews (n=14) and discussion group (n=10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine. Results: The lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance. Conclusions: This study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity.

Resumen Objetivo: Evaluar los determinantes en la financiación del acceso a la atención médica y el papel de una clase particular de financiación informal propia, denminada tontina, para el acceso a la atención médica en la población de migrantes de origen senegalés. Método: Los datos fueron recogidos mediante técnicas cualitativas, entrevistas semiestructuradas (n=14) y grupo de discusión (n=10) en una población de migrantes senegaleses residentes en Granada, entre octubre y noviembre de 2019. Los participantes clave provenían de una tontina. Resultados: La falta de trabajo o de recursos económicos, así como la condición de migrante indocumentado, constituyen barreras para la adhesión a los seguros de salud públicos y privados. Asimismo, los participantes consideran que la asistencia sanitaria pública no tiene en cuenta la importancia que puede tener para ellos seguir un tratamiento cerca de sus familiares o tener la alternativa de las medicinas tradicionales. La tontina permite proteger a las personas más vulnerables, como las indocumentadas, y financiar las prácticas de importancia cultural para las personas migrantes senegalesas. Conclusiones: Este estudio es el primero en proporcionar una comprensión de un mecanismo de financiación propio de un colectivo de migrantes bastante desconocido por la sociedad española. Las tontinas continúan una larga tradición en la que las comunidades desfavorecidas y vulnerables resisten múltiples fuentes de discriminación y desigualdad mediante la autoayuda, la confianza y la solidaridad.

Abstract Objective: To evaluate the determinants of healthcare access financing and the role of a particular class of informal financing known as tontine, a community-based health insurance among Senegalese immigrants. Method: Data were retrieved through qualitative techniques, semi-structured interviews (n=14) and discussion group (n=10) in a population of Senegalese migrants residing in Granada between October and November 2019. Key participants were from a tontine. Results: The lack of work or economic resources, as well as the condition of undocumented immigrant constitute barriers to adherence to public and private health insurance. Participants consider that public health care does not take into account the importance of following treatment close to their relatives in their country of origin or having the alternative of traditional medicines. The tontine helps to protect the most vulnerable people such as undocumented immigrants and allows financing services of cultural importance. Conclusions: This study was the first to provide an understanding of a financing mechanism typical of an immigrant community quite unknown to Spanish society. Tontines continue a long tradition whereby disadvantaged and vulnerable communities resist multiple sources of discrimination and inequality by self-help, trust and solidarity.

This blinded field safety study was conducted in Senegal to assess safety and immunogenicity of administration of the registered dose of Rift Valley fever virus (RVFV) Clone 13 vaccine (Onderstepoort Biological Products) to sheep and goats of West African breeds under natural conditions. A total of 267 small ruminants (220 sheep, 47 goats) were included; half received RVFV Clone 13 vaccine at the recommended dose and half received the diluent (as placebo) only. The study was performed on three commercial farms in the northern and eastern region of Senegal in accordance with veterinary good clinical practices. The animals were observed daily for 3 days after vaccination, and then weekly for 1 year. In both sheep and goats vaccinated against RVFV seroconversion rates above 70% were recorded. No seroconversion related to RVFV was observed in placebo-treated animals. No statistically significant differences were determined between placebo and vaccinated groups for mean rectal temperatures for the first 3 days after administration (p > 0.05). No abnormal clinical signs related to treatment were noted, and only one slight injection site reaction was observed in one vaccinated animal for 2 days after vaccination. Out of 176 births assessed over 1 year (93 from the vaccinated group, 83 from the placebo group), 9 were abnormal in the placebo group and 3 in the vaccinated group (p > 0.05). The frequency of adverse events was similar in the placebo and vaccinated groups. RVFV Clone 13 vaccine administered according to the manufacturer's instructions was safe and well tolerated in West African breeds of sheep and goats, including animals of approximately 6 months of age and pregnant females, under field conditions in Senegal. Antibody levels persisted up to 1 year after vaccination.