Before the establishment of the ‘assurance pour le renforcement du capital humain’ (ARCH - Insurance for Strengthening Human Capital) in 2019, the national health insurance scheme in Benin was characterized by a user fees policy which had adverse effects on the demand for health services. This led to the poorest being unable to access and/or pay for health services when they needed them most. To combat this, the ARCH programme was set up with the ultimate goal of stimulating socio-economic growth. The programme entails a package of four integrated services including training, credit, and retirement insurance, along with health insurance which forms the main part of the programme. WHO Benin supported the national authorities to design a more holistic approach for social insurance by assessing the one-year pilot phase of the health insurance component and formulating recommendations for the scale up phase. As of December 2022, a total of 867 944 individuals from the poorest strata have been identified and enrolled into ARCH and now benefit from free treatment in public health facilities in Benin. The state subsidizes up to 100% of the contributions for this population.

How did Benin, with the support of the WHO Secretariate, achieve this?

Health insurance is a mechanism by which individuals can access a range of quality health services without incurring serious financial hardship. This is a critical element for Universal Health Coverage (UHC). Every country has a different path towards UHC and each needs to consider which health services to cover based on the needs of the populations along with the available resources. However, the importance of access to health services as a basic human right is universal.

In Benin, prior to development of the ARCH, the health financing system was severely fragmented and not yielding the expected outcomes. Contributary schemes for salaried formal sector coexisted with voluntary community-based health insurance, with such practices shown to be non-synergistic. Before 2016, only 8.4% of the population was covered by health insurance, mainly for civil servants and other salaried staff, but was shown to be inefficiently managed by the state with often exorbitant transaction costs [1]. There were no compulsory practices for the private sector and no large scale operational social protection mechanisms in place for the informal sector. Although the informal sector contributes about 68% towards gross domestic product, it is characterised by the lowest socio-economic strata who have difficulty accessing basic social services [2].

In 2020, WHO Benin country office and the Regional Office for Africa, supported the national authorities by conducting a review of the pilot phase of the health insurance component of ARCH programme. This was done by screening key UHC aspirations and targets in collaboration with the Regional Public Health Institute (Institut Regional de Santé Publique - Comlan Alfred Quenum -IRS CAQ).  This assessment pointed out key challenges and formulated recommendations as prerequisites to effectively scale up the health insurance component including (i) the importance of extending the access to health insurance benefit to the most vulnerable groups such as the extremely poor and reducing the out-of-pocket costs as a significant barrier for care seeking by the poor, (ii) the necessity of expanding fields of service to be included in the healthcare basket, (iii) the need to put in place timely and responsive reimbursement mechanisms for health facilities as well as (iv) improving communication on the health assurance component at the community and grassroots levels.