Authors : Dêlidji Eric Degila, Barikissou Georgia Damien
Site of the publication : Geneva Graduate Institute
Type of publication : Policy Brief
Date of publication : 2024
Description of Current Health Care System
Organisational structure
Currently, the Benin health care system is decentralized. However, it is highly centralized in terms of implementation and operationalization of the decision and intervention.
According to the institutional organization described into the Decree No. 2022 – 148 of 2nd March 2022, the health sector is organised in a three-tier pyramid, based on territorial division:
- a peripheric level, represented by the health zones (ZS), which provide primary health care to the population including (Zone Hospital (HZ), University Zone Hospital (CHUZ), Health Centre (CS), HIV/AIDS care site, Private/church health facility, Tuberculosis screening and treatment centre, Leprosy and Buruli ulcer screening centre, Buruli ulcer, HIV voluntary testing centre (VCT)
- an intermediate or departmental level, which provides technical support to the health zones including Departmental University Hospital Centre, Departmental Hospital Centre, Centre for Information, Prospective Studies, Listening and for Advice (CIPEC), Leprosy Treatment Centre, Regional Buruli Ulcer Treatment Centre, Regional Pneumo-Phthisiology, Departmental Blood Transfusion Centre;
iii. a central or national level, which provides strategic support to the departments. This level includes:
» National Hospital and University Centre (CNHU-HKM)/Armed Forces Training Hospital (HIA)
» SAMU
» Mother and Child University Hospital Lagune (CHU-MEL)
» National Pneumo-Physiology Centre
» National Psychiatry Centre
» Centre for Integrated Medical Care for
» Infants and pregnant women with Sickle Cell Disease
» National Agency for Primary Health Care (ANSSP)
» National Agency for Quality Control of Health Products and Water
» Benin Pharmaceutical Regulation Agency (ABRP)
» Health Infrastructure, Equipment and Maintenance Agency (AISEM)
» Medical Aid and Emergency Agency
» National Blood Transfusion Agency (ANTS)
» National Agency for Quality Control of Health Products and Water (ANCQ)
» National Council for Primary Health Care
» National Council for Hospital Medicine
» National Ethics Committee for Health Research
» Associations of health professionals
» Beninese Society for the Supply of Health Products
» The main responsibility for health care is assumed by the central government (Ministry of Health), which takes almost all decisions in terms of policy, planning, implementation, monitoring, evaluation and outlook.
» Health care system segmentation: Upper-classes can access Insurance or civil servant social protection. The poor are enrolled as indigents, most vulnerable people in ARCH project or used self-medication.
» Since 2016, the government of Benin has been successfully rolling out the Insurance for Human Capital Strengthening (ARCH) program, a project with several social components whose implementation will eventually allow vulnerable groups to be protected from poverty. This project consists of an integrated package of four services: health insurance, credit, training and retirement insurance. The first pilot phase of the Health Insurance component of Project ARCH began in July 2019
Coverage
Population groups entitled to receive services in the system: Citizens and the most vulnerable groups, civil servants, military, workers/employees of regular private companies and organizations.
Eligibility criteria: Civil servants and workers/employees of regular private companies and organizations have access to health insurance after their probationary period. The vulnerable groups have access to health care as long as they were registered with the national agency of person identification.
Provision
Health Personnel
Benin has 7.8 qualified health personnel per 10,000 inhabitants, instead of the 25 required by international standards.
Infrastructure
In Benin, a total of 5,011 beds are available in public health centres and 800 in not-for-profit institutions in 2021, with a ratio of 2,151 inhabitants per bed. A total of 397,155 hospitalization recorded in 2021 with 1,498,861 days spent in hospital. The outpatient sector exists but is a very informal activity.
Service package
The service package has evolved considerably over time. The most recent will provide 100 % free care for the extremely poor and 50% free care for the poor for a basic package. Before effective implementation of the new policies, the services package varied according to beneficiaries (vulnerable groups, civil servants or defence forces, supplementary insurance).
For tuberculosis control, all the services with drugs and a part of hospitalization are included.
For HIV, only diagnosis and antiretroviral drugs are included. For the vulnerable groups (government project ARCH), consultation and hospitalization for simple and severe malaria, acute respiratory disease, diarrhoea, and delivery are included in the package.
The referral from the health facilities to the hospital are reimbursed for all those diseases. For indigents, 100 % of the available services are delivered if the patient met the criteria. For the civil servants: 80% of all eligible services are included in the package without access to drugs. For insurance and mutual, the package depends on the agreement between 80-100% of the eligible services.
Concerning the private scheme, self-medication by using pharmaceutical medicine or phytotherapy depends on the wealth index of the patient. Currently it seems that around 20% of health care services needs are covered.
Financing
In 2020, the current health expenditure (CHE) as a percentage of the Gross Domestic Product (GDP) was 2.6. In terms of shares of health care expenditure, individuals, families, friends, and diaspora contribution is estimated to 80% of total health spending (51.4% domestic out-of-pocket spending, 12.7% of foreign origin distributed by the government, and 17.6% direct foreign spending). Central government (9.1%), private insurance (5.4%), technical and financial partner (PTF) contribution is estimated to almost 20%.
Regulation
Only government institutions and agencies are responsible for the regulation and/or organization of the health care system (Republic of Benin, 2019). These are listed below:
The National Agency for Health Regulation (ARS) is linked to the Presidential Office and was officially established on 12th September 2022 by the President of the Republic. It is an autonomous institution. Its mission is to ensure that the right to health for all is realised through continuous improvement in the supply and quality of care.
The Ministry of Health: The role of the Ministry of health is to:
» Define and monitor the national health strategy and ensure its implementation
» Coordinate operational implementation of politics and strategies
» Insure access to quality health
» Design and implement regulatory roles
» Promote the contribution of Benin Diaspora in the health sector
» Facilitate the implementation of the universal coverage
» Coordinate the finance of the health sectors
The National council for the fight against aids, tuberculosis, malaria, hepatitis and epidemics:
The CNLS-TP is the national coordinating institution acting as the interface between the ECOWAS Regional Centre for Disease Surveillance and Control and Benin. Then, it is the only institution responsible for coordinating interventions in terms of detection, prevention, surveillance and response to epidemics in Benin. It ensures the national coordination of surveillance, alert and laboratory activities, training, and research activities and those of the “One Health” platform.
The Benin Pharmaceutical Regulatory Agency regulates the acquisition and distribution of pharmaceutical products.
» Regulation of health providers: The Ministry of Health and ARS gives private practice authorization, authorization to open private hospitals or pharmacies and Orders of physicians and pharmacists accept the nominations for members.
» The Ministry of Health, ARS, CNLS-TP and insurance companies are responsible for deciding the services available in the basket of benefits.
Role of global actors
Global actors are active in health care in the county, through the supply of medicines, consumables and equipment, deployment of interventions (mosquito nets, vaccinations, etc.), training and skills transfer for health workers, health promotion, rehabilitation of health centres.
Additionally, global actors are involved in health care reform processes and decision making for some aspects. The most important global actors operating in the country are the World Health Organization (WHO), UNICEF, the Global Fund, the Global alliance for vaccine and immunizations (GAVI), the European Union (EU), the U.S. Agency for International Development (USAID), the President’s Malaria Initiative (PMI), the Agence Française de Development (AFD), the Belgian Development Agency (ENABEL), the German Development Agency GIZ, Swiss co-operation and the Bill and Melinda Gates Foundation. The list is not all-inclusive.
Churches and other charitable organizations also play a role in providing and financing health care, by building health centres and offering health services, as well as by donating and financing health promotion.