Budgeting challenges on the path towards universal health coverage: the case of Benin
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RESEARCH
Open Access
Budgeting challenges on the path towards universal health coverage: the case of Benin Elisabeth Paul1,2* , N’koué Emmanuel Sambiéni3, Jean-Pierre Wangbe4, Fabienne Fecher2 and Marc Bourgeois2
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: Universal health coverage, Health financing, Budgeting, Public expenditure management, Strategic purchasing, Benin
Introduction Like many other African countries, Benin is confronted with important problems with regard to accessibility to healthcare. According to the recent Global Monitoring Report on universal health coverage (UHC), the service * Correspondence: [email protected] 1 Université libre de Bruxelles, Campus Erasme, Route de Lennik 808, CP 594, 1070 Bruxelles, Belgium 2 University of Liège, Tax Institute, Quartier Agora, Bat. B3, 4000 Liège, Belgium Full list of author information is available at the end of the article
coverage index (SDG-UHC indicator 3.8.1) was at 39.6% in 2017 (down from 40.2% in 2015). Data on the incidence of catastrophic expenditure (SDG-UHC indicator 3.8.2) date back to 2011, when it was 10.9% (respectively 5.4%) and 10% (respectively 25%) of household total consumption or income [1]. More recent survey and census data indicate that only 8.4% of the population is covered by some form of health insurance. While about 40% of the population is poor, more than half of them (23% of the total population) are extremely poor [2].
© The Author(s). 2020 Open Access This article is li
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