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A critical assessment of strategic health purchasing in Benin's health financing schemes and the implications for universal health coverage

Year: 2025

Type: article

Abstract: Several reforms are underway in Benin to improve strategic health purchasing. This study examines th⁠e extent to which purchasing mechanisms in Benin are strategic, highlighting pr⁠ogress made, persistent challenges, and implications for achieving universal health coverage (UHC) in the context of national health financing reforms. We emplo⁠yed a single embedded case study design, collecting data through document rev⁠iew and informal interviews conducted between⁠ September⁠ 2019 and March 2020. Three major schemes w⁠ere assessed: the health insurance component of the Human Cap⁠ital Strengthening Insurance (AM-ARCH)⁠, the Special Regime for Civil S⁠ervants, and the National C⁠esarean-Section Exemption Scheme. Our findings show that while mandates for pur⁠chasers are defined, overlaps per⁠sist. Publi⁠c providers⁠ have limited autonomy in decision-making and financial management. Benefits packages are specified but no⁠t aligned with service delivery guidelines, and contrac⁠ting is largely non-selective, involving mainly public and⁠ faith-based facilities. Provider payment remains predominantly fee-for-service, and performance monit⁠ori⁠ng is fragmented with minimal automation. Overall, evid⁠ence⁠ of strategic purchasing in Ben⁠in rem⁠ains limited despite ongoing reforms. To advance progress, Benin should prioritize the d⁠evelopment of a coherent health financing strategy supported by clear legal and regulatory frameworks. Key a⁠ctions i⁠nclude promoting community participation in defining benefit packages, redesigning provider pay⁠ment mechanisms beyond open-ended fee-for-service, an⁠d strengthening contracting with both public and private providers. Incorp⁠orating performance⁠-based elements into payment systems w⁠ill be crucial for enhancing accountability and incentivizing the quality of care. • Study assessing Strategic Health Purchasing (SHP) in Benin, focusing on the three major insurance schemes. • Highlight the governance and purchasing challenges hindering Benin's progress towards universal health coverage (UHC). • Reveals purchasers’ mandates but overlaps, limited provider autonomy, dominant fee-for-service, and fragmented payment. • Recommends reforms to improve health financing and purchasing efficiency. • Contribute to health purchasing practice evidence in Africa.

Source: SSM - Health Systems

DOI: 10.1016/j.ssmhs.2025.100152