A critical assessment of strategic health purchasing in Benin's health financing schemes and the implications for universal health coverage

Several reforms are underway in Benin to improve strategic health purchasing. This study examines th⁠e extent to which purchasing mechanisms in Benin are strategic, highlighting pr⁠ogress made, persistent challenges, and implications for achieving universal health coverage (UHC) in the context of national health financing reforms. We emplo⁠yed a single embedded case study design, collecting data through document rev⁠iew and informal interviews conducted between⁠ September⁠ 2019 and March 2020. Three major schemes w⁠ere assessed: the health insurance component of the Human Cap⁠ital Strengthening Insurance (AM-ARCH)⁠, the Special Regime for Civil S⁠ervants, and the National C⁠esarean-Section Exemption Scheme. Our findings show that while mandates for pur⁠chasers are defined, overlaps per⁠sist. Publi⁠c providers⁠ have limited autonomy in decision-making and financial management. Benefits packages are specified but no⁠t aligned with service delivery guidelines, and contrac⁠ting is largely non-selective, involving mainly public and⁠ faith-based facilities. Provider payment remains predominantly fee-for-service, and performance monit⁠ori⁠ng is fragmented with minimal automation. Overall, evid⁠ence⁠ of strategic purchasing in Ben⁠in rem⁠ains limited despite ongoing reforms. To advance progress, Benin should prioritize the d⁠evelopment of a coherent health financing strategy supported by clear legal and regulatory frameworks. Key a⁠ctions i⁠nclude promoting community participation in defining benefit packages, redesigning provider pay⁠ment mechanisms beyond open-ended fee-for-service, an⁠d strengthening contracting with both public and private providers. Incorp⁠orating performance⁠-based elements into payment systems w⁠ill be crucial for enhancing accountability and incentivizing the quality of care. • Study assessing Strategic Health Purchasing (SHP) in Benin, focusing on the three major insurance schemes. • Highlight the governance and purchasing challenges hindering Benin's progress towards universal health coverage (UHC). • Reveals purchasers’ mandates but overlaps, limited provider autonomy, dominant fee-for-service, and fragmented payment. • Recommends reforms to improve health financing and purchasing efficiency. • Contribute to health purchasing practice evidence in Africa.