This study is a continuation of theprevious sector review, conducted in 2004. The 2008 reviewhad two main objectives. This review is primarily an updateon the situation. In its development strategy, Benin gaveconsiderable importance to the health of its population.This effort is part of the long-term vision of the country.Improving health status, especially for the poor, is one ofeight strategic directions for that vision. Similarly, on amore operational level, this objective is reflected in thecurrent Growth Strategy for Poverty Reduction (GPRS2007-2009). Benin is particularly committed towards theMillennium Development Goals, including 3 on the healthsector. This review was also an opportunity to furtheranalyze the constraints in the health system, consistentwith the new strategy Health Nutrition and Population WorldBank, Strategy adopted in 2007. But this exercise was notintended merely to be analytical. It also aimed to enrichthe political dialogue between, on one hand, the actors inhealth and, secondly, the World Bank and other developmentpartners. This effort relates more specifically to somethemes such as governance, private sector involvement andalignment of partners' efforts (called technical andfinancial partners in Benin or PTFs). From this perspective,the journal is also a contribution to Benin's effortsto advance the IHP (International Health Partnership Plus).This initiative is now the main tool for implementing theParis Declaration. In practice, the journal has sought tocontribute to the consensus between the Ministry of Healthand the donor group on the diagnosis of the health systemand the changes needed to strengthen it. Several guidelineshave emerged stronger from this discussion, particularly inthe area of governance of the health system. Beyond thereinforcement of the various components of the healthsystem, two fundamental principles should guide thetransformation of this system: 1) A principle of corporategovernance: through decentralization of the health system,health facilities must have their basic needs better takeninto account (hence the need for bottom-up planning) andespecially as more independent financially administrative;and 2) A principle of individual governance: health workersshould be strongly encouraged to improve their performance(competence, productivity and compliance of patients). Giventhe limited success of measures to strengthen inspectionsand other controls "top-down, this incentive can onlycome from clients, either directly (i.e., bonuses based oncost recovery), or preferably indirectly with a mechanismfor payment by results funded by the state and possibly partners.
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