Health insurance under the ARCH program in Benin: Design, governance, and sustainability challenges

To meet the challenges relating to unequal access to healthcare and the consolidation of integrated social protection, Benin is currently implementing the “health insurance” component of the government’s ARCH program. This study analyzes challenges regarding its design, governance, and sustainability, drawing on legislative data, interviews with key players, and evaluation reports. The scheme stands out for two innovations: (1) a targeting of vulnerabilities via the Single Social Register (RSU), and (2) a differentiated contributory model (co-payment from 0 to 50 percent depending on the level of poverty) combined with public-private partnerships to extend coverage, including to informal workers. Results from the field identify areas for improvement, including a lack of awareness among most of the rural beneficiaries surveyed about the benefits covered, which points to the need for appropriate communication campaigns. Funding, still largely dependent on external aid, needs to be diversified (health taxes, targeted subsidies, etc.) to ensure the viability of the scheme in the face of its planned expansion. The study therefore recommends strengthening the capacities of local players (municipalities, CSOs) and the optimized integration of digital tools (real-time monitoring via the RSU) to improve operational efficiency. These adjustments, aligned with the 2030 Agenda objectives, could position ARCH as a replicable model of inclusive health coverage in sub-Saharan Africa, combining risk pooling, equity, and adaptation to the realities of informal economies.