Results-Based Financing: A Promising Approach for Benin’s Health Sector

BANIKOARA, September 22, 2016 ─ Alexandrine Same Ibrahima arrived in Banikoara in northern Benin with her husband in 2014. As she was pregnant, the first order of business was to seek prenatal care at a private clinic in order to have access to better health services. “During the first visit, I was seen by the midwife. However, the midwife wasn’t there for the two subsequent follow-up visits and the health workers who attended to me didn’t inspire me with confidence,” she recalls.

Heeding the advice of a friend, Ibrahima decided to go to the public hospital. “I was pleasantly surprised by the quality of the care and by the service provided by the midwife. She attended to me on each of my visits and that was reassuring. My view of public hospitals has changed significantly. Everything is clean and the costs of the consultations and medicines are posted, so I know exactly how much I have to pay,” said a delighted Ibrahima.

Since 2012, Benin has been making noteworthy efforts to enhance the quality of health services, particularly with regard to maternal and neonatal health care and disease control. With support from the World Bank through the Health System Performance Project (HSPP), Benin has adopted a new approach to managing its health facilities—Results-Based Financing (RBF)—which uses a system of bonuses to motivate hospital facilities and health centers to improve the efficiency of their services.

Under the project, a matrix of indicators is used to conduct regular assessments of the quality of services in several areas provided by the centers. These include patient services, hygiene and sanitation, consultations, immunization, family planning, HIV control, surgery, and financial management. If the center receives a good score, it is rewarded with a bonus to be used to improve technical equipment, purchase medicines, implement awareness-raising strategies, hire specialized workers, and motivate staff.  

“I was assigned to the Gomparou health center in 2014 and I am very happy. I earn CFAF 40,000 francs, but every three months, whenever we perform well, I receive a bonus that can be as much as CFAF 135,000. This motivates me to always strive to do a better job to provide the services for which I am responsible,” explained Bio Titan Rabiatou, head of the pharmacy in Gomparou, in northeastern Benin.

Significant progress was also observed during visits to three of the eight health districts piloting the RBF program—Banikoara in the north, and Zogbodomey-Bohicon-Zakpota and Covè-Zagnanado-Ouinhi in central Benin. Between 2012 and 2016 in the Zogbodomey-Bohicon-Zakpota district, the number of births at public health centers jumped from 7,679 to 11,047, prenatal consultations increased from 6,404 to 10,936, and curative consultations soared from 91,666 to 145,463. The number of children who received full immunization increased from 10,797 to 17,292 during the same period.

These improvements are also due in great part to the efforts of community health workers, who are trained to detect diseases in communities and raise awareness among pregnant women, whom they refer to the health centers. These individuals play a critical role in communities as they encourage people to seek care as soon as possible.

“Prior to project intervention, individuals did not go to the health centers because the quality of care was unsatisfactory. Our awareness-raising efforts have led to a sharp drop in the mortality rate and we are now able to diagnose diseases before it is too late,” stated Winto André, a community health worker from Towe, a village in the commune of Zogbodomey.

In order to promote the general rollout of the RBF approach, innovative initiatives are being piloted to involve private facilities. According to Dr. Prisque Bah Nangbe, the head of Saint Perpétue, a private clinic in Bohicon, “RBF strengthens the public-private partnership in Benin’s health sector and requires that all stakeholders comply with the norms and procedures in effect in our country. It will pave the way for standardizing services and especially for instilling greater discipline in service delivery.”

Although use of maternal and neonatal health services remains uneven, local authorities are convinced of the usefulness of this approach. Dr. Blaise Guezo Mevo, a doctor-coordinator in the Zogbodomey-Bohicon-Zakpota district, said “we want to transform our health district into a reference laboratory for good practices and promote the quest for excellence through education so that each health worker can serve as a model. We are going to assess each worker individually to motivate them to improve their performance. Our mayors also welcome the RBF approach and we are counting on their support to mobilize community resources to continue our work.” 

While the World Bank project will close in June 2017, other institutional donors are assisting with the development of the RBF approach in Benin. This approach is being rolled out across the country with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization (GAVI), and the Belgian Cooperation.