Benin on Its Way to Universal Health Coverage
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BP 1673 Abomey-Calavi Tel. +229 21 361 724/60 40 01 11 Adresse mail : [email protected] Site web : sante.gouv.bj Benin on its way to universal health coverage Dr Rodrigue KOHOUN, MD, MPH Plan 1. Introduction 2. Context 3. Health indicators 4. Reforms in health sector 5. Main programmes implemented 6. Significant strategies to attend SDGs 7. Benin National Health Insurance 8. Challenges 9. Conclusion 07/11/2019 Benin walking toward SDG 2 Introduction (1) • Financial barriers are major obstacle for health care accessibility in low-income countries • In subsaharian Africa, if users fees establishment by Bamako Initiative in 1987 reinforce health system and essential drugs availability, it also introduced barriers for using health care by the poor and the disadvantaged households. • The last two decades main policies have been implemented: user fees exemption, vouchers. 07/11/2019 Benin walking toward SDG 3 Introduction (2) • All those policies revealed not efficacy. That why several low –income countries are developing an holistic policy to attend universal health coverage • In Bénin, after the implementation of several user fees exemption by 2000, a new national health insurance policy is adopted. • This Health Insurance, a flagship of the social Insurance Programme for the Strengthening of Human Capital began three months ago. 07/11/2019 Benin walking toward SDG 4 Introduction (3) • The objective of this programme is to attend Universal Health Coverage and Sustainable Development Goals • It needs an important domestic found mobilization but also external financing support. 07/11/2019 Benin walking toward SDG 5 Geographic context (1) NIGER BURKINA FASO Karimama ALIBORI Malanville Banikoara Kandi Tanguiéta Kérou Sègbana Gogounou Matéri Cobli Toucountouna Sinendé Kalalé Boukoumbé Natitingou Péhunco Bembèrèkè Kouandé Nikki Copargo T O G O O T N’Dali Djougou IA ER G I N Ouaké BORGOU Pèrèrè DONGA Parakou Bassila Tchaourou Ouèssè Département du Zou 1 Abomey Bantè 2 Djidja 3 Agbangnizoun COLLINESGlazoué 4 Covè Département du Plateau 5 Za Kpota 6 Zogbodomey Savè 1 Kétou 2 Ifangni 7 Bohicon Savalou 8 Ouinhi 3 Pobè 9 Zangnanado 4 Adja Ouèrè Dassa-Zoumè 5 Sakété assa Département du Couffo Djidja Kétou 1 Aplahoué 2 2 Klouékanmè 4 9 1 Département de l’Ouémé 3 Lalo 4 Toviklin 1 Porto-Novo 1 1 7 5 5 Djakotomè 3 2 Adjara 3 8 6 Dogbo 2 6 3 Adjohoun 4 4 Aguégué 4 3 7 5 AkproMissérété Département du Mono 5 7 3 6 5 6 Avrankou 3 3 1 Lokossa 1 2 2 7 Bonou 2 Athiémé 2 8 6 8 Dangbo 3 Bopa 6 8 5 1 6 4 1 2 9 Sèmè Podji 4 Comé 4 4 5 9 5 Grand Popo 5 Porto-Novo 6 Houéyogbé Département de l'Atlantique 1 Abomey Calavi 5 Ouidah Département du Littoral 2 Allada 6 Sô Ava - Cotonou 3 Zè 7 Toffo 4 Kpomassè 8 Tori Bossito 07/11/2019 Benin walking toward SDG 6 Demographic and socio economic context • Area: 114763 km² • Population: 11 884 127 inhabitants Sex ratio: 1,03 woman for 1 man Density: 103 inhabitants/km² Life expectancy: 60,5 years for man and 63,3 years for women • Gross domestic product per capita: 788 $ US Extreme Powerty rate 59,9% (2015) Gini Index 47,8 (2015) • National Health expenditure 3,6% GDP OOPS 43% 07/11/2019 Benin walking toward SDG 7 Health indicators the last decade (1) Indicateurs DHS 2006 DHS 2017 Use of Health services 0.45 0.55 Maternal mortality (per 100000 life birth) 410 391 Infant mortality (per 1000) 76 55 Under five year mortality (pour 1000) 121 96 Planning familial (%) 20 Immunization (%) 57 71 Prenatals care coverage (%) 78 84 Assisted delivery (%) 78 07/11/2019 Benin walking toward SDG 8 Health indicators: main causes of death (2) • Malaria • Pneumonia • Diarrhoea • Anemia • Malnutrition • Non communicable desease • Injury 07/11/2019 Benin walking toward SDG 9 Reforms in health sector in Benin • The aim of reforms is to : reduce maternel and child mortality in Benin ; build a strong health system ; Waranty universal health coverage by reducing inequity, protecting disadvantaged household and the poorest. • Reforms focused on the six WHO pillars 07/11/2019 Benin walking toward SDG 10 Main programmes implemented • Integrated management of childhood illness; • Emergency obstetric and neonatal care; • User fees exemption (free caesarean section, free malaria in pregnant women and under five years children; • Package of high-impact interventions in community • Pilot phase of a national Health Insurance 07/11/2019 Benin walking toward SDG 11 Significant strategies to attend SDGs (1) • Enhancing health human resources to increase health care availability and quality Task shifting for maternal and neonatal care has been officially introduced in the health facilities, particularly in the rural non covered services deliveries; Capacity building and health workers recruitment • Scaling up of the integrated maternal, neonatal and nutrition health plan; • Systematization of the audit of maternal and neonatal death; 07/11/2019 Benin walking toward SDG 12 Significant strategies to attend SDGs (2) • Policy commitment to monitor maternal and neonatal deaths; • Control and regulation of the private health and pharmaceutical sectors; • Public-Private-Partnership in Health Sector : Involving private sector in national politics; Quality of care in health private facilities; 07/11/2019 Benin walking toward SDG 13 Significant strategies to attend SDGs (3) • Reinforce health centres and hospitals medical equipment: Wide programme to increase the technical capacity of hospitals and health facilities; Building national and regional hospitals of great reference • Improving quality of care and increase the governance and leadership in health sector. 07/11/2019 Benin walking toward SDG 14 Benin National Health Insurance • A national revolution in health sector • Flagship of the social Insurance Programme for the Strengthening of Human Capital Health Insurance; Training of the poor; Microfinancing access Retirement insurance 07/11/2019 Benin walking toward SDG 15 Benin National Health Insurance • Pilot phase targed the poorest • The package of health care: malaria, diarrhoea, visceral surgical interventions, injuries, under five year disease, delivery and caesarean section, main maternal death causes • Poorest are exempted for fees when using public health facilities for this package • It’s planed to be scaling up in less than 9 months. • This policy is financed exclusively by National income 07/11/2019 Benin walking toward SDG 16 Challenge • Scaling up national health insurance policy in less than 9 months • Community involvement • Technical capacity • Competent and motivate health wolkers 07/11/2019 Benin walking toward SDG 17 Conclusion • Benin is accelerating its walk towards SDGs by implementing relevant policies and strategies • It focused efforts on health accessibility and improving the quality of health care • This implies massive investments and a significant mobilization of ressources (humans, technical and financing) 07/11/2019 Benin walking toward SDG 18 Thank you 07/11/2019 Benin walking toward SDG 19.