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VOL. 75 (3), 365-372, 2009 IMPLEMENTING A DISPENSARY IN A RURAL AREA IN BENIN...

1. INTRODUCTION

Hospitals in less-developed countries tend to have large numbers
of patients and limited staff or resources. Information about the
needs of patients, the burden of many diseases and the magnitude of
the health services provided are sparse or not available. Every day,
international health organisations recognise and face the fact that
new health care services are needed in Western Africa, especially in
rural areas.

The University Rey Juan Carlos (Spain) has been cooperating
with the Centre Gbemontin (Benin) for more than 10 years. The
Centre Gbemontin is a 150 bed-hospital in a rural area in inland
Benin. It serves the municipality of Zagnanado, which counts around
39.000 inhabitants, and is taking in more and more patients from
the department of Zou (1.400.000 inhabitants) and even Benin’s
border countries such as Togo or Nigeria. Patients from other
countries come especially for the treatment of Buruli Ulcer: the
World Health Organization (WHO) has acknowledged the hospital as
a pilot centre in the treatment of this illness (1).

The national health care system in Benin is structured in three
levels: the central or national level, the departmental level and the
peripheral level. The peripheral level is completely decentralised, is
formed by a net of primary health care service (2) and is represented
in Zagnanado with one Municipal Heatlh Centre (Complexe
Communal de Santé, CCS). This CCS holds just a few beds for long-
term hospitalisation and several primary health day-centres in the
different villages, and it is clearly insufficient for providing basic
health care to the local population. However, there are a significant
number of maternity and childbirth units in the area, which is the
reason why the hospital of Gbemontin does not include this service.

In Benin, the density of physicians per 1.000 inhabitants is 0.045,
far below the 0.217 density of the WHO African Region. The access to
improved sanitation in rural areas of Benin is just 12% (28% for the
WHO African Region). Moreover, one-fifth of the human health
resources is devoted to the capital city. Private expenditure on health
represents 44.4% (data of 2005) of the total expenditure on health. That
means that private investments are vital for the country’s health (3).

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