Inefficiency and economic performance of the financial resource mobilisation system in a teaching hospital in Benin, 2023

Abstract

Background The financial performance of public hospitals remains a major challenge in sub-Saharan Africa, where health care financing largely relies on out-of-pocket payments. In Benin, where recent reforms aim to strengthen hospital economic performance, this study analyses the efficiency and performance of the financial resource mobilisation system of a reference teaching hospital. Methods An evaluative cross-sectional study was conducted using the structure–process–outcome framework. Financial, administrative and organisational data from Centre Hospitalier Universitaire de la Mère et de l’Enfant-Lagune in Cotonou, 2021-2023 were collected through interviews, observations, document review and user surveys, and triangulated. The analysis focused on collection rates, financial losses, revenue trends by service type, and structural and operational factors influencing performance. Results Overall revenue collection was 0.795, below the expected level for an autonomous hospital. Internally generated resources were inefficient (≈0.70), with particularly low performance in laboratory services (≈0.59) and a marked decline in ultrasound revenue collection (from 1.15 to 0.65). Financial losses due to unpaid bills and revenue leakage exceeded USD 18,300. The system showed strong dependence on irregular public subsidies, sometimes disbursed after more than 300 days, alongside weakly formalised processes, limited digitalisation and insufficient professionalisation of revenue collection. Low household solvency further increased the risk of non-payment in a predominantly out-of-pocket financing context. Conclusions The revenue mobilisation system is fragile, with significant technical and organisational inefficiencies undermining economic performance and financial sustainability. Strengthening financial governance, expanding digitalisation and professionalising revenue collection, together with extending financial protection mechanisms for users, are essential to improve hospital efficiency and support progress towards universal health coverage.