Championing inclusive dialogue to support health system reforms

The success of Benin’s health insurance scheme, known as AM-ARCH, like any social policy, requires the buy-in of all stakeholders to discuss the challenges of implementing and delivering high quality health care services to beneficiaries. As such, the authorities in charge of health insurance reforms understood the necessity to adopt a collaborative approach and continuous dialogue.

To this end, the African Collaborative for Health Financing Solutions (ACS), in its support to Benin, facilitated the engagement of stakeholders for an inclusive dialogue around UHC.

A theory of change to support the culture of results

In November 2019, ACS supported the National Agency for Social Protection (ANPS) in the organization of a learning agenda workshop for the AM-ARCH project. Beyond establishing a learning agenda, the workshop aimed to initiate dialogue between stakeholders and foster the establishment of a climate of trust. Indeed, this workshop brought together for the very first time all AM-ARCH stakeholders to discuss and reflect on the main areas of assessment of the success of the pilot phase. This opportunity for collaboration on AM-ARCH was greatly appreciated by all stakeholders and ANPS was reinforced in its commitment to “work together” with key players around a shared goal. The openness of powerholders and the climate of trust created among stakeholders made it possible to set up a high-level consultative platform.

The consultative platform is a space for strategic reflection on various topics related to the AM-ARCH implementation process. It promotes dialogue between the different stakeholders and constitutes a melting pot of exchanges and emulations for the participants. Although the consultative platform is not a decision-making framework at this stage, it makes it possible to guide the decision-making and the implementation of AM-ARCH by providing information, clarifications, and formulating recommendations for decision-makers. The consultative platform is made up of policymakers (UGP-ARCH, ANAM, Ministry of Health, Ministry of Social Affairs and Microfinance), service providers (Health Zones, Social Promotion Centers, etc.), representatives of civil society, private sector organizations (mutual health organizations), trade unionists, and beneficiaries of health insurance.

And the strengthening of the collaboration took place gradually. The first step consisted of facilitating the development of the Theory of Change that underpins such a consultative platform for inclusive dialogue. Thus, the definition of the objectives and the chain of expected results, the identification of key actors and their roles and responsibilities were carried out in a participatory approach.

Access to information to forge interactions and alignment among stakeholders

To support the dynamic of interactions and ensure its functionality, the members of the consultative platform meets quarterly to promote reflections around AM-ARCH. A WhatsApp discussion forum connects members for rigorous joint monitoring of the progress of AM-ARCH implementation. This forum constitutes a space where each member has the freedom to ask questions and obtain an answer even from the authorities present on the platform. Discussions of the consultative platform are guided by the learning themes of the pilot phase of AM-ARCH (quality of services offered to beneficiaries, management of their complaints at the point of service, reimbursement of services to health facilities, communication around of the reform) which constitute the objective basis on which the implementation of the pilot phase is monitored by the consultative platform.

Increased inclusive political dialogue for enhanced accountability climate

At the beginning of the collaboration, ANPS and ACS agreed on the fact that a drastic change was needed to ensure the success of the AM-ARCH project. The required change consisted of bringing in all critical stakeholders to the decision making table. As such, ACS started by carrying out a mapping of the stakeholders having to work together on AM-ARCH in a context of mistrust and weak interactions among actors. The results of this mapping made it possible to broaden the consultative platform to new parts essential for a successful implementation of AM ARCH, namely Civil Society Organizations, Labors, Community Based Health Insurance.

The consultative platform was quickly identified as the appropriate environment for dialogue and validation ACS work plans to ensure that the support provided by the project is perfectly suited to the country’s priorities relative to UHC, per ACS’s continuous demand assessment core function. The multisectoral dialogue allowed the members of the consultative platform to jointly monitor the difficulties recorded in the implementation of the ARCH-AM, the sharing of experiences and good practices both among the participants in the dialogue and with other countries supported by ACS. The consultative platform remains an area of accountability that demands answers from ANPS-ARCH and those responsible for implementing AM-ARCH at all levels of the Beninese health system. As reported by a political decision-maker, “now everyone is accountable for the success or failure of this important social project.”

Members of the platform freely ask all kinds of questions and get answers to their queries. There is an openness and frankness among actors which is appreciated by all. “Every time I attend a consultative platform meeting, my enthusiasm for the success of AM ARCH increases. There is no taboo subject and I can see the commitment and humility of those responsible for the implementation of the project ”said a deployment operator in a pilot area. The consultative platform created the conditions for better involvement of the Beninese civil society in the deployment of AM-ARCH. Indeed, the House of Civil Society and the Coalition of CSOs for UHC are now privileged interlocutors of the ANPS since the contacts were made thanks to the political dialogue initiated.

Ingredients for the consolidation of multisectoral dialogue around Health Insurance in Benin

First, we learned that in order to engage in dialogue around UHC issues, it is more effective to get stakeholders to understand the implications of such a dialogue rather than mere exhortations. Indeed, instead of simply recommending inclusive dialogue around AM-ARCH in Benin, ACS’s approach allowed stakeholders, particularly the ANPS, to experiment with what such a dialogue could look like and advantages that could derive from it. This was decisive in the decision to set up the consultative platform. The systematic and rigorous approach used by ACS, with developing a theory of change and defining objectives and roles for everyone, has increased the chances of success in putting this framework in place.

Then, the use of the learning agenda as a compass for the follow-up of the AM-ARCH by the consultative platform made it possible to align the actors around a common objective and to have a concrete basis for discussion, thus allowing constructive exchanges.

Finally, the multisectoral nature and the inclusion of the main stakeholder groups of AM-ARCH constitute sizeable assets for the effectiveness and relevance of the consultative platform, as demonstrated by the richness of the internal debates. From the outset, the ANPS and ACS ensured the effective participation of all (“every voice counts”) and to avoid the instrumentalization of “weaker” voices. This helped to avoid the power imbalances and exclusion of some stakeholders that often hamper dialogues around social policies .

Looking to the future of multisectoral dialogue

Thanks to the commitment of the various stakeholders, in particular the ANPS, and the facilitation of ACS, the consultative platform of AM-ARCH was able to be established to initiate multisectoral and inclusive dialogue around UHC in Benin. The first months of operation of this platform have allowed notable progress in the implementation of AM-ARCH. They also made it possible to draw relevant lessons to advance the dialogue around UHC in Benin and Africa. The operation and results of the consultative platform notably inspired the officials of ANPS to launch the process of setting up a more holistic consultative platform for ARCH.