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Budgeting challenges on the path towards universal health coverage: the case of Benin

Elisabeth Paul, N'koué Emmanuel Sambiéni, Jean-Pierre Wangbe, Fabienne Fecher and Marc Bourgeois

ULB Institutional Repository from ULB -- Universite Libre de Bruxelles

Abstract: Background: In its pursuance of universal health coverage (UHC), the government of Benin is piloting a project ofmandatory social insurance for health entitled “ARCH”.Methods: We analysed budget data and ARCH documents, and conducted four observation missions in Beninbetween March 2018 and January 2020. Results are presented in terms of the three classical objectives of publicexpenditure management.Results: The government of Benin faces important budgeting challenges when it comes to implementing theARCH social insurance project: (i) the fiscal space is quite limited, there is a limited potential for new taxes andthese may not benefit the ARCH funding, hence the need to prioritise fiscal resources without jeopardising otherareas; (ii) the purchasing of health services should be more strategic so as to increase allocative efficiency andequity; (iii) the efficiency of the expenditure process needs to be improved, and more autonomy needs to bedevoted to the operational level, so as to ensure that health facilities are reimbursed in a timely fashion in order tomeet insured people’s health costs, in such a way as to avoid jeopardizing the financial equilibrium of thesefacilities.Conclusion: The important budgeting challenges faced by Benin when it comes to implementing its UHC policyare also faced by many other African countries. It is important to avoid a situation in which the resources dedicatedby the government to the social health insurance system are at the expense of a reduction in the financing ofpreventive and promotional primary healthcare services.

Keywords: Universal health coverage; Health financing; Budgeting; Public expenditure management; Strategic purchasing; Benin (search for similar items in EconPapers)
Date: 2020-09-05
New Economics Papers: this item is included in nep-ias and nep-mac
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Published in: Health Economics Review (2020) v.10 n° 1

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