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. 2020 Sep 5;10(1):28.
doi: 10.1186/s13561-020-00286-9.

Budgeting challenges on the path towards universal health coverage: the case of Benin

Elisabeth Paul  1   2 , N'koué Emmanuel Sambiéni  3 , Jean-Pierre Wangbe  4 , Fabienne Fecher  5 , Marc Bourgeois  5
Affiliations

Budgeting challenges on the path towards universal health coverage: the case of Benin

Elisabeth Paul et al. Health Econ Rev. .

Abstract

Background: In its pursuance of universal health coverage (UHC), the government of Benin is piloting a project of mandatory social insurance for health entitled "ARCH".

Methods: We analysed budget data and ARCH documents, and conducted four observation missions in Benin between March 2018 and January 2020. Results are presented in terms of the three classical objectives of public expenditure management.

Results: The government of Benin faces important budgeting challenges when it comes to implementing the ARCH social insurance project: (i) the fiscal space is quite limited, there is a limited potential for new taxes and these may not benefit the ARCH funding, hence the need to prioritise fiscal resources without jeopardising other areas; (ii) the purchasing of health services should be more strategic so as to increase allocative efficiency and equity; (iii) the efficiency of the expenditure process needs to be improved, and more autonomy needs to be devoted to the operational level, so as to ensure that health facilities are reimbursed in a timely fashion in order to meet insured people's health costs, in such a way as to avoid jeopardizing the financial equilibrium of these facilities.

Conclusion: The important budgeting challenges faced by Benin when it comes to implementing its UHC policy are also faced by many other African countries. It is important to avoid a situation in which the resources dedicated by the government to the social health insurance system are at the expense of a reduction in the financing of preventive and promotional primary healthcare services.

Keywords: Benin; Budgeting; Health financing; Public expenditure management; Strategic purchasing; Universal health coverage.

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Conflict of interest statement

EP and ES received funding from the Belgian Development agency (2016–2019) to support its health programme in Benin, notably in the context of switching from performance-based financing to strategic purchasing. EP, ES and MB received funding from the Belgian Cooperation, through the ARES-CCD (2019–2020), to support its policy of support to mutual health insurance in the context of the Beninese governmental policy of mutual health insurance. However, this paper has been written in total independence from those projects.

Figures

Fig. 1
Fig. 1
Key health financing indicators, Benin, 2008–2017. Global Health Observatory Data Repository [http://apps.who.int/nha/database/ViewData/Indicators/en ], consulted 23 December 2019
See this image and copyright information in PMC

References

    1. World Health Organization. Primary Health Care on the Road to Universal Health Coverage (conference edition): World Health Organization; 2019.
    1. Présidence de la République du Bénin. Assurance pour le Renforcement du Capital Humain (ARCH). Fiche de projet. 2019.
    1. Ministère de la Santé . Stratégie Nationale de Financement de la Santé pour la Couverture Sanitaire Universelle du Bénin 2016–2022 (SNFS) 2015.
    1. République du Bénin, Présidence de la République, Commission technique chargée des réformes dans le secteur de la santé (CTRSS) Rapport général de la commission technique chargée des réformes dans le secteur de la santé. 2018.
    1. République du Bénin, Présidence de la République. Décret No 2019–432 du 02 octobre 2019 portant approbation des statuts de l’Agence nationale des soins de santé primaires. 2019–432 Oct 2, 2019.