Abstract

Introduction: In 2012, Belgian Development Agency (BTC), at the request of Benin Authorities, introduced a Results-Based Financing (RBF) mechanism in two Regions to improve health system performance. The purpose is to grant subsidies to providers and managers of care and services on a performance basis. Two regional steering committees (SC) chaired by mayors have been set up with health care and civil society representatives. Mayors were given the position of buyer of performances on behalf of beneficiaries. The aim is to study the institutional arrangements for the management of BTC's RBF at the decentralized level in relation to its effectiveness in the context of supply/demand dialogue, community empowerment, better coordination between local Governments and Health, and improving care quality.

Methods: This is a cross-sectional study with retrospective and prospective data collection. The study population is made up of players involved in the RBF. Data collection was carried out through the documentary review of the RBF experiences in Benin. The analysis was conducted by identifying the strengths, weaknesses, opportunities and threats of the SC at the decentralized level.

Results: Regular meetings of the SC focuses henceforth on the resolution of concrete problems through a constructive dialogue between supply and demand; Community participation has shifted from information to co-decision making; Enhanced accountability: providers and managers report on their performance to the reporting line, mayors and the Civil Society; The presence of the Civil Society and the mayors ensures compliance with the principle of performance-based payment and contributes to the fight against fraud and impunity; Complaints management data and community verification feed into the supervision of the Health zone management team; Progressive financing of the SC functioning by the municipalities and; Improving satisfaction of health services users.

Conclusions: SC at the decentralized level promotes stakeholder engagement for people's access to health care; It shows the need for a permanent framework of exchanges among players at the decentralized level to improve the provision of care; Involvement of mayors in a process of improving care quality and at a decision-making level is a guarantee of responsibility and community involvement.

Keywords: RBF, decentralized steering committee, community empowerment, sustainability