Fee Variability and Equity in Primary Health Care Facilities in Benin, 2025

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Introduction: In Benin, where out-of-pocket payment constitutes the primary healthcare financing mechanism, the fee-setting practices of First Contact Health Facilities (FCHFs) directly condition financial access to care for the population. This study aims to document the regulatory framework and pricing practices in Beninese FCHFs and to analyse their relationships with the socio-economic characteristics of health districts. Methods: A descriptive and analytical cross-sectional study was conducted in 2025 using fee schedules from 28 of the 34 health districts. Four categories of services were analysed: clinical and technical procedures (n=59), biological laboratory investigations (n=74), medical imaging examinations (n=4), and specialist procedures (n=17, Cotonou only). Tariffs were stratified by area type (urban/rural) and triangulated with departmental poverty rates, FCHF attendance rates, and the share of community-based financing. A Pearson correlation coefficient was calculated between poverty and fee levels. Results: No legal instrument governed FCHF fee-setting. Childbirth exhibited the highest dispersion (CV=94.46%; range: 885–15,000 FCFA). The mean fee for a medical consultation was 1,571 ± 535 FCFA in urban areas versus 1,118 ± 402 FCFA in rural areas, a differential of 40.5%. Certain highly impoverished rural districts maintained fees above the national average. A moderate but statistically significant negative correlation was observed between the departmental poverty rate and the medical consultation fee (r=−0.651; p=0.001). Own revenues of FCHFs accounted for 97.4% of their resources. Conclusion: Fee-setting in Beninese FCHFs relies on informal mechanisms that generate inequities in access to care. The ongoing reforms in the health sector represent an opportunity to establish equitable fee schedules, grounded in the socio-economic realities of the population, the principles of primary health care, and coupled with social protection mechanisms for vulnerable households.

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