District health systems: users' preferences for services in Benin

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Abstract
The function of district health systems in Benin Republic was critically assessed, and special consideration was given to the acceptability of available health services from the users' point of view. Using a representative household survey, service records, a survey amongst service users, participant observation and qualitative interviews, we obtained data on the use of different services offered by the modern public health system, as well as on reasons for non-use and preference for treatment by traditional practitioners or within the family. Although in the last 15 years accessibility to health services has improved remarkably, services are not fully accepted. Under-utilization of services seems to be due to their low quality, and users' reluctance to consult them. Users are faced with prohibitive costs, and staff attitudes have further decreased confidence. A major reason for this seems to be staff incompetence in counselling patients and clients. Health systems research studies focusing on the clients' views may provoke a critical reflection of everyday practices, provide a review of the objectives of district health systems, and lead to discussions on how to improve the performance and quality of district health teams. This paper gives an account of the positive experience with participatory workshops at different levels of the health system, which constitute a way of ensuring that study results will be discussed and used at district and national level.

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