Abstract

The paper covers several social aspects of the underdeveloped African state of Benin. Health care system constitutes a special interest owing to regressive population statistics in the country. The work provides an overview of the key factors such as culture, social issues, and the influence of western countries on the development of the health system. Due to the national strategy of medical development and international assistance, Benin achieved certain progress, but there are still many problems as a result of the poor economy and social inequality. This calls for further cooperation with the international organizations on the part of Benin as far as the improvement of poor health care delivery system is concerned.

Healthcare System of Benin

Introduction

Usually, when people think about Africa, many of them imagine barren wasteland, wild semi-nomadic tribes, reed huts, complete lack of amenities that are usual for the modern man. In fact, Africa is a conglomerate of original cultures, each of which has its system of values and worldview as well as profound and rich history. The appearance of the first Europeans had an enormous influence on the development of the African continent . It was the beginning of this process when the world began to discover new corners of Africa, and one of these original and exciting countries is Benin. It is hard to dispute the fact that Benin does not experience problems. It is one of the least developed countries. At the same time, access to health care remains out of reach for most people. There are few doctors for the population which is approximately 10 million. The international community is trying to assist ill-developed African countries, and Benin is in dire need of help because the country is not ready to face its problems with weak economy, poor level of development, and low-quality health care. Thus, the health care system of Benin has many critical issues which cause a great concern and force the government and the international community to develop ways for improvement.

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Culture

To grasp and understand Benin national identity better, it is necessary to research the culture of the country properly. The population of Benin has a rich and varied folklore. Most of their languages have no written form, and modern literature is in the French language due to a long historical dependence. The country has more than 60 different nationalities, what complicates the research. In any case, it is possible to split the culture into several main branches.

Benin's architecture is distinctive, and it is possible to estimate it while examining the houses of the local population. Conventional dwellings of local people fall into several types. In the northern part of the country, the houses usually have a circular shape with walls braided and coated with clay and made of tree branches with cone-shaped roofs. Dwellings of rectangular form with walls covered with mud and whitewashed dominate in central Benin. In the south, there are similar square houses. The roofs of all types of homes are made of grass or straw. Such poor conditions of living indicate economic problems of population. However, in modern cities the houses are built of brick and reinforced concrete structures. Circular wooden sculptures, wood carvings, cast in bronze and polychrome ceramics represent traditional art. The National Museums of the major cities have rich collections of wooden sculptures and other crafts. Ivory carving that includes figures of people and animals as well as jewelry, pottery, carpet weaving, leather, glass goods, and the art of batik are worth noting. In addition, Beninese people, most of whom profess, have strong traditional beliefs. In the south, there is a strong influence of the Catholic Church due to the introduction of Christianity to local people by French government during its control. Today 27 percent of the population profess it, with Islam taking 24 percent ("The World Factbook. CIA ").

Outcome of Integration with Western Country

During the exploration of the history of the country, it is important to note that Europeans believed to have the right to impose its authority on the territory of Africa. They began to bring Christian missionaries, and build military forts to harden their positions. The Beninese tried to resist the European expansion, but ultimately the cities of Cotonou and Porto-Novo became French possessions. Thus, in 1894, the Benin kingdom, called "French Dahomey" was declared a French protectorate (Ronen & Law, 2016). However, there were several positive moments such as banning the slave trade in Benin, building hospitals, schools, and introducing better transport infrastructure. On the contrary, in the second half of the 20th century, the power of France over Benin began to weaken gradually. Thus, in 1960 Benin was able to proclaim the independence of the state, which very soon all UN members recognized (Eades & Allen, 1996). However, the impact of this integration and cultural influence was not in vain, and French is still a spoken language in the country. Moving forward, with the power in their hands, Benin's population could not find stability for a long time. For decades after independence, the Government changed nine times and the country has seen four military coups (Kneib, 2006). In 1989, France convinced the government to move away from the socialist principles and introduce a multiparty system in exchange for financial support for the country's leadership (Roese & Bondarenko, 2003). Thus, France's role in the political and cultural establishment of Benin is extremely high, but not enough to assert that French authority imposed their culture on Benin. Moreover, it is also unlikely due to the great multiculturalism of the country.

Social Problems

Today, society observes numerous social problems. Although the annual growth rate of the population is high, nearly three percent, the infant mortality rate, despite its decline in the last decade, is still significant and takes the 25th place in the world rank ("The World Factbook CIA "). Many people, especially in the arid northern regions of the country, suffer from chronic malnutrition. These facts confirm the most urgent challenges of Benin and the need for the development of the public health system. Furthermore, the population is placed unevenly on the territory of the country. For a long time the land suitable for oil palm cultivation and food crops, rich in fish and water resources, as well as lagoon port cities attracted people in the southern regions. On the northeast of the country, population density even falls to one individual for several square kilometers. Most of the population live in rural areas. However, the urban population is rapidly growing, constituting more than 44 percent ("The World Factbook CIA "). Although the cities in Benin have long been the centers of cultural life, the country faces many development challenges such as public education and training of national personnel, with certain schools still belonging to the church. The cultural life in the country is very intense. Since the 20s of the XX century, journalism has developed. In addition, Benin News Agency and the national radio became involved in educational activities.

It is possible to argue that the economic backwardness of Benin is a direct result of many years of colonial exploitation that led to agrarian and raw material character of the economic development of the country, the extreme technical backwardness of the infrastructure, a high dependence on the capitalist world economy, and the existence of severe imbalances. The issues of social justice are inherent to Benin. Firstly, it is a pronounced poverty of the population. It is pertinent to note that while other parts of the developing world clearly show a tendency towards the reduction of the size of disadvantaged population in the last 20 years, African countries experience a constant growth of that (Ouendo et. al., 2003). The consequences of this situation are catastrophic for the people of the region. Extreme poverty, on the one hand, and a high degree of inequality in income distribution, on the other, are the leading causes of social tension in the region, that give rise to civil and ethnic conflicts.

Unfavorable demographic trends, as well as a low level of income of both the state and most of the population indicate the extreme stress the social infrastructure of the region and,the health sector in particular, experience. The total annual expenditure on health sector reaches to 4.8 percent of GDP in Benin ("The World Factbook CIA "). However, the region still acts as the epicenter of many dangerous diseases, AIDS, tuberculosis, and malaria specifically. The number of HIV-infected, for example, reaches here 1.18 percent of the total population ("The World Factbook CIA "). AIDS, malaria, and tuberculosis are the main reasons for the high mortality of the regional population. Thus, the lack of attention to health care, a low level of economic development in Africa, and serious financial problems lead to the economic backwardness of the region.

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The Health Care Model

Regarding the health system model, it is necessary to describe several growth trends including increased medical institutions network. General Hospital in Porto-Novo is under the direct control of the Department of Health, and, as a consequence, has autonomous financing, and modern facilities (Houngbo, et. al., 2012). There are therapeutic, surgical, gynecological, children's, and maternity departments as well as offices of many individual experts. There are also big clinics in the major cities of Cotonou, Parakou, and Abomey. During the colonial period and the early years of independence, the medical facilities focused on the capital and large administrative centers exclusively. In recent years, this imbalance reduced, what led to the appearnce of many health centers where you can get first aid and buy the necessary medicines rural areas. The country has also established the National Pharmaceutical Control, which supervises the distribution of medications and other pharmaceutical products in most districts. Thus, despite general negative tendencies, it is possible to explore certain successful developments.

However, significant health changes did not occur in the first decade of the independent development of the country. After coming to power, the revolutionary democratic government viewed the development of a national health care system as one of the main areas of social policy. The national health strategies include such tasks as making health care available to every citizen, improving and expanding health services, as well as fighting infectious diseases and their consequences. Priority went to the protection of motherhood and childhood, environmental health, nutrition, and health education. The Ministry of Health, that consists of the National Department of Health and Social Welfare, headed the work concerning its implementation. Public Health Department has two branches, namely curative and preventive one. It also supervises the activities of general medical services, which operate in the six provinces of the country. The state has created several councils, committees, and associations, designed to promote the improvement of health services. There is Permanent National Committee for the rehabilitation of persons with disabilities that supervises the creation of individual schools, centers, and other institutions to help people with mental and physical problems. The National Board of Health monitors health services nationwide. Beninese Society for Social Affairs has been providing financial and medical assistance to large families, the disabled, and the elderly. Medical Society and the Association of Medical Benin Workers unite doctors, pharmacists, veterinarians, and biologists to promote health development as well as the professional growth of the national medical staff. Altogether these institutions provide health care system in Benin.

Critical Problems of Health Care

Currently, there is an urgent need in Benin to conduct preventive measures, such as vaccination of the population in the areas of malaria and other parasitic infectious diseases. The country has established the National Service of epidemic diseases to deal with that issue, in particular, to combat malaria and trypanosomiasis. It works to improve the health of the population and the provision of clean drinking water and the construction of new wells. The major towns have established veterinary points, which made preventive vaccination of the cattle, eliminating the possibility of human infection with various diseases.

The World Health Organization and the UN Children's Fund (UNICEF) provide great help to the country to conduct therapeutic and preventive measures. These organizations regularly carry out vaccination of children from the most common and dangerous diseases such as measles, diphtheria, polio, and tuberculosis. UNICEF, together with Beninese experts developed a joint action program, that provides maternity protection measures, raising awareness among the public health and sanitation knowledge against malaria and diarrheal diseases, which are also a cause of high mortality. According to the agreement, with the assistance of UNICEF they plan to cover the vaccination against the most common infectious diseases of the young Beninese. However, certain studies argue over its results ("UNICEF program failed to save children: study", 2010)Moreover, the Children's Fund introduced a program providing the rural population with clean drinking water, which contributes to reducing the spread of infectious and parasitic diseases. Despite the lack of the necessary material and financial resources and the small number of national medical personnel, health system has expanded over the years of independent development of Benin. This fact has contributed to an increase in life expectancy and the reduction of total mortality.

As in most African countries, infectious and parasitic diseases are common in Benin. These primarily include cutaneous fungal diseases and leprosy, yaws and malaria. Every year, thousands of cases fix various diseases. Some of them demonstrate local spread with high prevalence populations. For example, in the past, there were cases of yellow fever in certain areas of northern Benin. African trypanosomiasis, carried by the tsetse fly, is most prevalent in the north of Benin, in the Borgou and Atacora provinces, famous for developed cattle breeding. The lack of factual material due to the weakness of the national statistical service does not reveal a complete picture of the primary data regarding the scale and spread of diseases among the population.

As previously mentioned, AIDS presents a significant problem. France is working with Benin in this area, providing the National Center for Blood Transfusion with modern medical equipment for the detection of AIDS virus. It also contributes to the National Committee to Combat AIDS in the organization of informative work, the promotion of sanitation and hygiene, and medical training.

Regarding medical education, the primary source of the doctors is the Medical Faculty of the National University. In addition, many countries around the world support Benin and help their students in the education process, including China, Germany, and France. The Regional Health Centre trains skilled nurses, midwives, laboratory technicians, assistant pharmacists, and health workers. Association of medical personnel brings together physicians and pharmacists, giving, in particular, attention to retraining personnel and assisting young people in obtaining the medical profession. In Cotonou there also operates the Regional Institute of Public Health. Its mission consists in the training of graduates, namely doctors, pharmacists, dentists, veterinarians, biologists, economists, and sociologists. The Institute regularly reviews the program of improvement of specialists in connection with the changing trends and the emergence of new diseases. However, despite the above-noted increase in the number of health workers, the country still has an acute problem of shortage.

International Activity

Moreover, it is important to note the world's concern about the situation in African countries. For example, the hospital ship Africa Mercy, which belongs to charity Mercy Ships, is docked in the port of Cotonou for a period up to June 2017 to provide the population of the West African country's with free specialized medical care, including surgery (Keegan, 2016). Africa Mercy arrived in Benin, after two years of the activities in another poor developing country, namely Madagascar. the local population as well as the officials of the Republic greeted medical services. Multinational Africa Mercy crew consists of 400 volunteers from 40 countries. The plan is that the medical staff will also provide training of local health professionals, to enhance the Benin health system capacity.

Besides, at the present stage, the development of new technologies as well as the availability of traditional infrastructure is important in the medical sphere. In this light, approximately $ 700 million was awarded to VaxTrac company for a new project in Benin (Scarfo, 2014). The mentioned amount will cover increasing immunization campaigns of the local population, and it was allocated from the charitable foundation of Bill and Melinda Gates.

Millions of spouses Gates will go for the purchase of laptops, tablets, and smartphones, which will give a possibility to provide for Benin citizens immunization, especially for children under the age of five years. Identification of patients will be carried out on prints of their fingers; corresponding scanners will be embedded in the structure of these devices, or quickly connect to them via USB-ports. The planned approach is reasonable taking into account the fact that the vast majority of the Beninese do not have documents proving their identity. Furthermore, funds will be allocated for the development of electronic health record systems and general statistics, raising the efficiency of the immunization program management and the supply chain in the framework of these programs.

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Finally, one of the most dangerous diseases of recent years was the Ebola virus. Benin has not suffered like other African countries. However, one can note the level of cooperation with experienced Western doctors in the prevention of possible epidemic. The Expert Group on Communicable Diseases, led by WHO and including the staff of the Centers for Disease and Prevention, Institute of Public Health of Canada, and other partner organizations visited Benin (Belluck, 2015). This group has worked within the framework of the WHO initiative to strengthen preparedness for disease caused by the Ebola virus and to fight Lassa fever. Therefore, UN assists the 14 priority countries of the African region in the preparation for a possible outbreak of Ebola.

Conclusion

To sum up, the Government of Benin has to undertake serious actions due to the current state of the health care system that adversely affects the quality of life. Distinctive Benin culture remained strong under the influence of the French expansion, however, the government that received authority in an independent country faced significant economic problems. Thus, poverty and underdeveloped economy are the main reasons for the poor quality of medicine. On the other hand, there is already a fairly logical and simple health care system, which only needs further development. Therefore, it is the task of both Benin and other African countries to overcome the enormous gap between developed and developing continents. 

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