Access to public health care and associated factors in rural areas: a cross-sectional community-based study in Bopa district, Southern Benin.

Introduction: despite the considerable progress made to date, access to health care in public health facilities remains a challenging public health problem in Benin. This study aimed to assess trends in access to care over five years and to identify factors associated with low access to care.

Methods: a cross-sectional community-based study was conducted in the Bopa district, a rural area of southern Benin between January and February 2020. Twenty (20) villages were randomly selected using the two-stage probabilistic clustering method. The sample consisted of 620 participants (31 per village) distributed across the seven sub-districts of the Bopa district. Mixed-effect logistic regression models, using a clustered sampling design, were used to identify the factors associated with low access to care at public health centers.

Results: less than half of the recruited sick participants (38.9%) reported having had access to care at public health facilities in the month before the visit. Using public health services proportion in the population progressively increased from 2014 (29.7%) to 2019 (47.1%). Factors associated with no access to care were lack of mutual health insurance (adjusted odds ratio (aOR: 5.3, 95% CI: 2.1-13.5, p=0.001); low household income (aOR: 3.7, 95% CI: 1.7-8.1, p=0.001); and lack of transport (aOR: 3.4, 95% CI:1.8-6.2, p<0.001).

Conclusion: this study highlights the importance of a well-implemented and sustained community-based mutual health insurance system, particularly in rural areas. In addition, improving the living standards of the population would likely increase access to care. Policy makers should take these factors into account.