Itinéraire thérapeutique des malades indigents au Bénin (Pauvreté et soins de santé)

Abstract

There is great risk of excluding the poor in a system where patients are charged for medical care. Our objective was to identify the stages of the therapeutic itinerary of poor and nonpoor patients in case of illness. Prospective study over 12 months, in 16 sites selected randomly after dividing the territory of Benin into four strata. The sample included 1312 households (668 poor and 644 nonpoor) and 9554 people. Those who were ill during the study period were interviewed on the therapeutic itinerary chosen. A total of 1959 (20.5%, of whom 1091 were poor) of the 9554 people in our sample experienced at least one episode of illness. The nonpoor chose the health centres in the first instance more frequently than the poor (26.3%vs. 20%; P < 0.001); but the first choice of most patients (66.4% of poor and 63.9% of the nonpoor patients) was modern or traditional self-medication. Within the strata (regions), indigents and nonpoor in the urban region and the north chose different treatments in the first instance (P < 0.001). Apart from the first treatment chosen, no significant difference was observed between the therapeutic satisfaction of both groups. Patients unsatisfied with the first step of treatment were essentially those who used traditional or modern self-medication. Despite this, modern and traditional self-medication remain the most frequent second step choice for both poor and nonpoor patients. The main difference between poor and nonpoor people's therapeutic itinerary is that nonpoor people more often use state health facilities first than the poor.