Private medical practice in Benin: dynamics of a growing sector

In Benin, like in many countries in sub-Saharan Africa, the setting up of structural adjustment programs forces, in the middle of eighties, the government to limit the recruitment in civil service. As they were systematically hired by the State, most of health professionals are unemployed from 1986. Henceforth, private health sector grow progressively, without any legislation, through the development of many formal and informal private surgeries and clinics.
The article will focus mainly on the development of private profit-making medical practice in Benin. It will be based on three empirical researches about medical profession in this country, from March 2009 to April 2011. In this paper, we will refer to qualitative interviews on the one hand with actors from both private and public medical structures, mainly doctors, paramedical staffs and patients, and one the other hand, with representatives of professional organizations, public policies in Ministry of Health and international organizations.
First, the article will briefly describe the historical development of private medical practice in Benin, and consider governmental responses to this process. Thus we will address to the belated drawing up of a regulatory framework and the lack of control by the profession consequences, notably in terms of qualification, ethics and quality of health care. We will also examine recent reactions aimed at remedying to these different pitfalls.
In this context, the paper will interest secondly in new entanglements between the public medical sector and the private medical structures emerging at local level. We will examine doctors’ practices and strategies, with only private practitioners and with doctors working in both private and public sectors.
Finally, the article will give attention to how these private medical surgeries and clinics and the access conditions to these structures are perceived by health providers and patients. In this part of the paper, we will also address to tactics worked by patients regarding the different medical facilities. As a conclusion, we will wonder whether this medical private sector would contribute to reproduce some mechanisms of inequality in health sector.