Dakar’s Low-Cost Sea-Based Aquagym Boosts Mobility and Health Access for Older Adults

In Dakar’s surf, a low-cost path to movement – and a test for health systems

Before sunrise on Dakar’s Ngor beach, dozens of older adults wade into the Atlantic wearing bright life jackets and foam noodles. The aquagym class they’ve formed has become an unlikely rehabilitation hub for people living with pain, stiffness and limited mobility from chronic conditions. One retired civil servant in her late 60s recalled the aftermath of a spinal problem that left her barely able to stand. “The shock was enormous,” she said. “I stayed at home for almost a year, doing nothing.” Then one morning she wandered down to the beach in Dakar’s Ngor neighborhood and saw people exercising in the water. “I asked what they were doing, and they told me to try,” she said. “I’m still walking.”

What’s happening on this shoreline speaks to a widening gap across many African health systems: noncommunicable diseases and the disabilities they leave behind are rising, while affordable rehabilitation remains scarce. Global estimates suggest more than a third of the world’s population could benefit from rehabilitation at some point in their lives, underscoring why many countries are moving to integrate rehab within primary care and universal coverage agendas. Those global estimates are detailed by the World Health Organization’s analysis of rehabilitation need based on the Global Burden of Disease study, which places the figure at 2.41 billion people and notes the rapid growth in need since 1990. That work now feeds into the WHO “Rehabilitation 2030” initiative and its push to embed rehab inside national health benefits packages.

What this community-run program provides

On Ngor, that global agenda lands in a very local form: a volunteer-led program that tries to keep people mobile at a fraction of the cost of formal therapy. Sessions unfold in view of passing fishing pirogues and morning commuters, turning a public beach into an improvised health facility.

Health access pressures behind the popularity

Participants describe the classes as a lifeline in a system where diagnostics, surgery and specialist care are often unaffordable or hard to reach, especially for those outside formal employment. “That’s when I started losing hope,” the retired civil servant said. “Some mornings, a blocked vertebra or swollen ankles would leave me unable to move all day.” Another participant, 76-year-old Khadija Wade, recalled: “I became very sedentary. I could spend an entire month at home without walking,” Wade said. After joining on a doctor’s recommendation, she added: “I came to my first session with a cane, but now I can walk without it.”

Clinicians point to delayed care-seeking – frequently when pain and disability are already advanced. “A lot of people don’t come to us until things get really bad, and by then it’s much harder and more expensive to treat them,” said Dr. Seydina Ousmane Ba, director of the National Orthopedic Prosthetics and Rehabilitation Center in Dakar. In his view, community-based programs can help decompress referral hospitals if they are linked into formal pathways and basic safety standards.

System capacity, coverage and equity – where Senegal stands

Senegal’s health reforms over the past decade have focused on expanding coverage, but financing and workforce gaps remain pronounced for rehabilitation, especially for older people living with chronic disease.

• Insurance footprint
  • Community-based health insurance (mutuelles) registered 4.48 million beneficiaries in 2022, with a gross coverage rate of 25% through these schemes and 1.05 million up to date on contributions that year.
  • Broader national efforts to digitalize and consolidate schemes report that overall health coverage surpassed 50% by 2022, with a multi-year aim to approach three-quarters of the population by the end of the decade. For now, however, many rehabilitation services still sit outside guaranteed benefits or require co-payments.
• Rehabilitation workforce
  • Physiotherapy density remains below 1 practitioner per 10,000 people, reflecting a wider regional shortage of rehabilitation professionals and bottlenecks in training and deployment.
• Access barriers cited by patients and providers
  • Out-of-pocket costs for diagnostics and procedures, including imaging and post-operative rehab.
  • Limited geriatric and specialty rehabilitation services outside major urban centers.
  • Inaccessible transport and public spaces for people with disability, which can turn a simple clinic visit into a full-day and costly effort.

National planning documents are beginning to acknowledge these gaps. The government’s universal health coverage drive is framed by Senegal’s Health and Social Development plan and by its commitment to the African Union’s Agenda 2063, but implementation on the rehabilitation side is still catching up with rhetoric.

What the evidence says about aquatic exercise

Water’s buoyancy unloads joints while providing uniform resistance; the result is a low-impact environment that can enable movement when land-based exercise is painful. “Aquagym has benefits you don’t always get on land,” Ba said. “The water supports your body, reduces pain and makes movement easier, so patients can exercise more comfortably.” That makes the ocean, when safely managed, a powerful but often overlooked public asset for health.

• Osteoarthritis (knee/hip)
  • Systematic reviews indicate small-to-moderate short‑term improvements in pain and function versus control after structured aquatic exercise programs, with few serious adverse events reported.
  • Swimming is a form of aerobic exercise; a recent network meta-analysis found aerobic activities – including swimming – consistently ranked among the most effective modalities for improving knee osteoarthritis pain, function, gait performance and quality of life over short and mid‑term follow‑up, compared with minimal intervention.
• Stroke recovery
  • Meta-analyses report improvements in balance and gait speed when aquatic therapy is delivered alone or alongside land-based rehabilitation, though study quality and heterogeneity vary and longer-term effects are less certain.
• Cardiovascular conditions
  • Small trials in chronic heart failure suggest supervised warm-water training is generally well tolerated and may improve exercise capacity and cardiorespiratory measures, but patient selection and clinical supervision are critical, especially where emergency response infrastructure is limited.

Experts caution that not all patients are good candidates for open-water exercise – particularly those with uncontrolled blood pressure, severe heart failure or epilepsy – underscoring why some form of clinical triage or referral system matters even in community programs.

How this local initiative maps to global public‑health goals

For policymakers, Ngor’s aquagym program sits at the intersection of two agendas: universal health coverage and healthy ageing. It illustrates how cities can stretch limited budgets by backing safe, low‑cost community solutions rather than relying only on hospital‑based services.

• Population need
  • One-third of the world’s population now lives with a condition that may benefit from rehabilitation, with the total rising to 2.41 billion in 2019. The burden is highest in regions where formal rehab systems are least developed, making community programs a de facto extension of the health system.
• Policy direction
  • UN member states have endorsed integrating rehabilitation into universal health coverage and primary care through a 2017 World Health Assembly resolution, and requested baseline reporting and targets to 2026 – a timeline relevant for national planning and for community programs seeking formal referral pathways.
  • In Senegal, that discussion now runs through the Ministry of Health and Social Action and its commitments under the national strategy for universal health coverage, which sets the parameters for which services could eventually be reimbursed.

As national benefit packages evolve, programs like Samb’s could either remain informal add-ons – dependent on volunteerism and municipal goodwill – or be recognized as accredited, referral-based partners. That choice will rest with health authorities and local governments weighing cost, safety and equity.

Safety and quality considerations for sea‑based therapy

For now, the Ngor initiative operates in a regulatory grey zone: neither a formal medical service nor a casual swim club. That makes safety protocols and basic governance central to any discussion of scaling or replication.

• Program governance
  • Clear training standards for volunteer coaches and documented supervision by certified lifeguards.
  • Protocols for screening participants, documenting underlying conditions and coordinating with clinical providers for those with complex or unstable health issues.
• Environmental and operational safeguards
  • Daily assessment of surf conditions, currents and water quality; heat/cold stress plans; emergency response and evacuation drills rehearsed with local rescue services.
  • Regular equipment checks for life jackets and flotation aids; attention to crowding when sessions approach peak numbers, with caps on class size if needed.
• Equity and accessibility
  • Accessible entry points to the water and beaches; transport support or group transport options for participants with limited mobility.
  • Fee policies that preserve affordability while sustaining staffing and equipment, including possible sliding scales for those unable to pay.
• Data and learning
  • Routine, privacy‑protected tracking of attendance, basic functional outcomes and any incidents to inform quality improvement and potential reimbursement within national benefits packages.

If Senegal were to formally integrate such programs into its health offer, they would likely need to align with the country’s obligations under the Convention on the Rights of Persons with Disabilities, which commits states to equal access to rehabilitation and community-based services for people with disabilities.

For many, recovery is also about community

Participants repeatedly describe the mental boost that comes with exercising together in the ocean – the shared jokes before dawn, the chorus of encouragement as someone manages a new movement. The founder notes how word of mouth has drawn people from across the city – and even from abroad – as the program has scaled.

The model is not a replacement for clinical rehabilitation, but it is a pragmatic bridge where specialist services are thin, and a reminder that inclusion and movement can begin in the most public of places. For city officials and health planners, it also serves as a live demonstration of what can happen when policy commitments to universal health coverage meet the realities of an ageing population on a working beach.

As one regular put it: “What keeps me coming back is seeing other people not giving up,” she said.

This report draws on WHO global estimates of rehabilitation need and a BMJ network meta-analysis of exercise modalities for knee osteoarthritis to situate Ngor’s community initiative within broader evidence and policy debates.