Blanche Waouwa (right), 41, and Pulchérie Oza (left), 57, are midwives at a hospital in the Lokossa commune of southwest Benin, 200 kilometers from the capital, Cotonou. The hospital’s dilapidated facilities handle birth after birth: Benin’s fertility rate was 4.8 children per woman in 2013. Gynecologist Solange Houedjissin heads the obstetrics department at the hospital, which receives subsidies tied to the quality and quantity of services delivered to patients. “Pregnant women often come here in terrible shape, because so many of them have no sense of the importance of prenatal care,” she says. “And it’s important to educate them about the fact that when there are complications, a caesarean is not inevitable some women flatly refuse to get into the ambulance to go to the hospital,” she adds. Since 2009, caesareans have been free in Benin, but some hospitals try to make patients pay CFAF 30,000 to 50,000 for “incidental expenses.” The rate of childbirth by caesarean in this hospital is 27.8 percent (554 out of 1,989 births).
In Benin, with help from the World Bank, the Ministry of Health provides financing to health centers based on their results, aiming to improve the quality and quantity of the care they administer. Thanks to the results-based financing (RBF) approach, notable improvements in the quality of care were recorded in all the establishments the program covered. For example, the rate of standard-quality prenatal visits topped 30 percent (compared to 5 percent in the reference year, 2010, and surpassing the program’s target rate, 25 percent). One of the most significant challenges is to reduce the still inordinately high rate of maternal deaths in childbirth. According to the World Health Organization (WHO), maternal mortality is decreasing very slowly in Benin, from 497 per 100,000 births in 1996 to 350 per 100,000 in 2012, even though many more births take place in the presence of qualified health care providers (an estimated 84 percent in 2012). Photo: © Stephan Gladieu / World Bank