Abstract
The closure of illegal health facilities and the elimination of dual membership of health professionals have been part of health reforms since 2016 in Benin. This research was intended to deeply analyze the immediate effects of new reforms in hospitals and assess governance implications. Methods: The research was a retrospective analysis conducted by a mixed method, using both qualitative and quantitative primary data from three public hospitals and one confessional, from the national public health office and of administration and finances office. Health human resources and their complaints, attendance at health care units, monthly hospital revenues and corrupt practices were used as variables. The research covered the first semesters of 2018 and 2019. The sample was made by reasoned choice. Results: Attendance increased at public hospitals from 12% to 80% and their monthly revenues up to 200% in 2019 and hospitals staffs were present with overload of work. The private hospital suffered a drop of-33% in attendance and-5% in monthly revenues, followed by a staff shortage. Discussion: The reforms have given confidence to public health facilities users and revealed the weak hospitals capacity and difficulties in managing patient flows and staff. Conclusion: There’s a start in improving practices for better hospital performance. Government involvement and technical platforms strengthening are crucial for sustainable results and private hospitals must recruit their own staff.
Highlights
IntroductionThe spatial distribution of hospitals of Benin’s health system is pyramidal [1]
The spatial distribution of hospitals of Benin’s health system is pyramidal [1]. This organization is inspired by the health district model seen as relevant and robust [2,3,4] as recommended by the world bank. This pyramidal distribution is characterized by a large number of hospitals at the peripheral level that offer mainly general medicine, and a small number of hospitals at the central level that include a larger set of special health care
With the various reforms undertaken in the health sector since 2001 and despite a health infrastructure coverage of 95%, the attendance rate is estimated at 45% [6] and health indicators have deteriorated over the past ten years
Summary
The spatial distribution of hospitals of Benin’s health system is pyramidal [1] This organization is inspired by the health district model seen as relevant and robust [2,3,4] as recommended by the world bank. This pyramidal distribution is characterized by a large number of hospitals at the peripheral level that offer mainly general medicine, and a small number of hospitals at the central level that include a larger set of special health care. This deterioration is reflected in infant, child, and neonatal mortality rates, respectively dropping from 70 deaths per thousand live births, 42 deaths per thousand and 23 deaths per thousand in 2011 to 96 per thousand, 55 per thousand and 30 per thousand births alive in 2018 [7]
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