The system redesign involved a considerable investment at HZ level. Benefits were found in the reduction of transportation costs to health posts (HP) and commune health center (CHC) levels, and the strengthening of health workers professional skills at all levels in Comé. The redesigned system contributed to a decrease in funding needs at HP and CHC levels. The benefits of the investment need to be examined after the introduction of new vaccines and after a longer period.

Enrolment in a universal health coverage scheme is a way to access health care and services and to reduce the catastrophic health expenditures that plunge already vulnerable populations into extreme poverty. As part of the analysis of the availability and operational capacity of health services in Benin (SARA 2018), an analysis of recipients' satisfaction and their willingness to pay for Universal Health Coverage scheme was carried out in 2018. This is a cross-sectional study with an analytical focus that covered 475 health facilities and 956 recipients of health care and services selected at random in health care structures and in the community. The dependent variable studied was the willingness to pay for Universal Health Coverage scheme and the explanatory variables were those relating to socio-cultural and economic factors and the reception of the recipient in the care environment. The hybrid bidding game technique was used to estimate the amount to be paid for the Universal Health Coverage scheme. Univariate and multivariate analyses were carried out to analyse the data. The data showed that Beninese people do not have a culture of early care-seeking; they get care when the episode of illness induces a temporary incapacity for work. The results observed showed that the following factors significantly influenced willingness to pay: being able to talk to the doctor, the feeling of being valued and treated with respect, the individual's ability to pay, access to pain management and temporary incapacity. In conjunction with the willingness to pay for Universal Health Coverage scheme, the payment amount, determined using the contingent valuation method, was 767 FCFA or US$1.43 per month per individual. In view of these results and taking into account the socio-economic realities of the country where approximately 38.5% of the population is poor according to monetary poverty (Benin 2020), the pooling of health insurance coverage appears to be the solution to eliminate the financial barrier and the risks of catastrophic health expenditure. State subsidies for the contributions of populations in extreme poverty also appear necessary to ensure the sustainability, equity and sustainability of the health insurance scheme.