Wednesday, April 8, 2009


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Decision welcome with mitigation

Due to be effective on April 01, 2009 in forty-three (43) hospitals in the rural area, the measure of free caesarean had its first day of implementation in Benin amidst a situation of shortage of basic material supplies and qualified personnel, on the ground.

Boni Yayi made this promise during the 2006 presidential and since in office, has been finding out a way to implement the measure. After three (03) years of rule and two (02) years ahead of the next presidential elections schedule to take place in March 2011, he has finally made it although there are serious reservations about the way the decision is being implemented.

Taken during a Cabinet Meeting in March 2008 and reactivated again a year later on the sidelines of the celebration of International Women's Day in March 2009, the measure of free cesarean delivery was effective on April 01, 2009 but only in hospitals which are eligible to receive deliveries that can not be made naturally. In most of these eligible hospitals, which are located in rural areas, the implementation of the measure is effective but causes a lot of rush and a sharp increase in the average number of women who undergo cesarean section before giving birth.

At Suru-Léré Hospital, a suburb hospital, the unique medical center eligible in Cotonou city, at 6 p.m. four (04) cases of women who gave birth by caesarean section have already been recorded while two others emergency cases have been waiting to undergo surgery. Questioned, the Head of this suburb hospital stated that the daily average number of women who undergo cesarean section to give birth is three (03).

The measure is unanimously welcome but most of the professionals in the healthcare sector show a mitigated reaction. Most of them expressed dissatisfaction about the way the measure has been implemented in the different medical centers. They complain that the Government has not considered their demands before making this decision.

On the eve of the day when the decision was due to be implemented, the healthcare Union in a communiqué, commends what it calls «…the noble and praiseworthy Government’s initiative which is an important step towards maternal and neonatal mortality reduction…. » However, it deplores that the implementation of such an important decision, in a context marked by the lack of medical equipments and related supplies as well as by the shortage of quailed professionals, raises doubt about its success. Moreover, there are many demands of wage increase which remain until now unanswered.

Benin healthcare system has regularly been hit by strikes because of poor work conditions in the sector. The Government has promised to do all it could to improve work conditions in healthcare sector but the workers think that this improvement was a prerequisite to the success of this decision regarding free cesarean.

In addition to this lack of human, financial, and material resources, health professionals emphasized the need for a clearly outlined policy in an official manual of instructions, which can serve as guideline in the implementation of this decision as well as an executive ministerial order defining the framework in which the decision has to be implemented. According to them, the actors involved in the implementation of the decision are not sensitized enough since there is no clarification about the beneficiaries and about the care of the child born under cesarean section.

Critics in the media also blame the Government for implementing such a decision without planning, method, proper sensitization of the public, and the prerequisites, which it has to meet foremost. In fact, the measure has triggered a lot of confusion in public since many are not aware that the measure does not involve all the medical centers.

Furthermore, the Government only subsidizes part of cesarean related charges. The Government pays one hundred thousands (100.000) f CFA for each cesarean section leaving the remaining charges to the patient. One columnist, Jérôme CARLOS who is also known as a historian, raises doubt about the credibility of the Government by asking, « is there gratuity or can one talk about gratuity if the initiative of the Government, yet praiseworthy, is nothing but the payment of a part of the cesarean cost? In fact, what is gratuity? The dictionary answers: characteristics of something that is given without payment or that one enjoys without payment as counterpart»

Criticisms over the Government’s handling of the measure regarding free cesarean are similar to ones that have already been voiced about other several decisions. Opposition, ordinary citizens, and analysts, all agree that, although there is on the part of the Government, the willingness to confront the challenges facing the nation, the precipitous manner, in which these problems are being taken on, aims at impressing rather than really solving them. Whether it is about free education, Government response to workers’ demands, micro finance, fight against corruption, agriculture policy, and many different issues, public as well as analysts voiced the same criticisms, which can be summarized in one word: hastiness.

Alfred Cossi Chodaton

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