District health systems: users' preferences for services in Benin

The function of district health systems in Benin Republic wascritically assessed, and special consideration was given tothe acceptability of available health services from the users'point of view. Using a representative household survey, servicerecords, a survey amongst service users, participant observationand qualitative interviews, we obtained data on the use of differentservices offered by the modern public health system, as wellas on reasons for non-use and preference for treatment by traditionalpractitioners or within the family. Although in the last 15 years accessibility to health serviceshas improved remarkably, services are not fully accepted. Under-utilizationof services seems to be due to their low quality, and users'reluctance to consult them. Users are faced with prohibitivecosts, and staff attitudes have further decreased confidence.A major reason for this seems to be staff incompetence in counsellingpatients and clients. Health systems research studies focusing on the clients' viewsmay provoke a critical reflection of everyday practices, providea review of the objectives of district health systems, and leadto discussions on how to improve the performance and qualityof district health teams. This paper gives an account of thepositive experience with participatory workshops at differentlevels of the health system, which constitute a way of ensuringthat study results will be discussed and used at district andnational level.