Author: Benjamin Coovi DAKO, PhD
Doctor in Political Science, Public Policy Analyst
Expert in Health, Professor of Health Policy at the National School of Administration and the
and the Doctoral School of Legal, Political and Administrative Sciences from the University of Abomey-Calavi, Benin.
Health policies are multisectoral in nature and must always be conceived in a multidimensional approach and a multidimensional approach and an impulse of health democracy in order to guarantee the population the necessary optimum of protection. It is on this condition that these public health policies can effectively guarantee the prevention of collective health risks to the population and ensure populations and to ensure the conditions favorable to the promotion of their well-being and their health security.
In the Republic of Benin, several projects and programs to raise public awareness of public hygiene and sanitation have been designed and implemented, as part of the prevention diseases. But years later, the evaluation of these projects and programs reveals a rather mixed impact on the health of populations. Quite often, certain diseases resist, which prove the more or less perceived failure of the prophylactic measures recommended. It is also the proof that popular risky behaviors, targeted within the framework of said programs, persist. This phenomenon can also be explained by the fact that the health determinants targeted may seem erroneous, because they do not always make it possible to reverse the trend of incivility prejudicial to health, both at the level of rural populations than urban and peri-urban ones. Geoeconomically, Benin continues to be today cited as one of the West African platforms for the circulation of products adulterated of all kinds including counterfeit medicines and other health products. The country has indeed sheltered vast informal networks of manufacture and distribution of the aforementioned products, this which constitutes a serious factor inhibiting the efforts of the authorities to ensure the protection health to the people.
The success of the various prophylactic strategies against infectious diseases is not limited not just the effectiveness of different vaccination programs. It is also proof of relevance and evolving performance of national, subnational and international standards in terms of public health order. Sanitation of the living environment and protection of the environment are nowadays sine qua non conditions for the health promotion and food safety assurance. It is in fact of common knowledge that the living environment of the population is conducive to the circulation and transmission of pathogenic agents, vectors of various diseases, and therefore of the increase in morbidity and even mortality on a national, regional and international scale. The strategies put in place by the various successive regimes to enforce the preventive measures have sometimes been misinterpreted by the populations who see it rather, sometimes instruments of popular repression. This observation is made in an analysis of Fidèle K. AYENA (see box 2 below).
Box n°1: Assessments of disease prevention strategies by populations
“In Benin, national policies for the sanitization of public space very early consisted of the Marxist-Leninist regime of Mathieu Kérékou in the inculcation, under penalty of a fine, of good hygiene practices, especially in markets, by health workers and law enforcement audience. But the methods employed, namely, repressive force and police intimidation spectacular at discretion have undermined the effectiveness of this national public health policy insofar as the target populations are quick to associate these administrative injunctions with sanitary and hygienist nature of the public authorities, the will to repress the political regime to subjugate the people through bullying or all-out police abuse. Wim Van LERBERGHE and Vincent de BROUWERE had already underlined in their own way this general observation to African countries where the transposition of the health institution was very early associated in the unconscious collective in the very image of the administration of state power, most often a political regime totalitarian or policeman. They conceive, in fact, that in this Africa of independence: “(…) The environmental health activities of urban administrations are even further away from daily life people, and quite perceived as linked to military and/or administrative power. Also, this health and police administration of hygiene and public health services, however quickly perceived much more as an instrument of ideological oppression in the service of political power notably inspired by Marxism-Leninism to govern the people and much less as a means of eradication or prevention of infectious diseases in the social space. Hence, the regime of political terror or police and hygienist intimidation was the first cause identifiable from the failure of the transposition of the collective sanitary principles or rules of hygiene, sanitation and public health in Benin.
AYENA Fidèle Kadoukpè, Political Science, 2012, p 180.
From 1990, with the Democratic Renewal, health promotion strategies, in particular public hygiene and sanitation are regaining renewed interest and remain, at least this day, a major concern of the health authorities. They are also the subject of decentralization policies and feature prominently in related legislation. In effect, the law on decentralization n° 97-029 of January 15, 19991 in its article 93, provides: “The municipality is responsible for the supply and distribution of drinking water; of the collection and treatment of solid waste other than industrial waste; collection and processing liquid waste; the public sewage disposal network; of the drainage network rainwater; works for the development of lowlands and protection against floods; the demarcation of areas prohibited from urbanization within the perimeters considered dangerous for natural or industrial reasons…”. This 1999 legislation has was repealed by Article 562 of Law No. 2021-14 of December 20, 2021 on the Code of the territorial administration in the Republic of Benin, which insists in its articles 39 and following, and
in the same terms, on the same role of the municipality in terms of improving the framework of life, necessary for the promotion and protection of community health.
These legal provisions sufficiently show that the implementation of the necessary mechanisms the strengthening of the living environment and the promotion of public health at the level decentralized, falls under the territorial jurisdiction of the municipality. But this mission seems today difficult for local authorities whose performance in this area remains always below the expected results. The reasons cited relate, very often, to the lack of financial resources, which would be mainly linked to the non-transfer of resources from the central State to the municipalities according to municipal officials, unlike the provisions of Article 46 of Law No. 2021-14 of December 20, 2021 on the Code of territorial administration in the Republic of Benin, which reproduces in extenso art 100 of the former law 97-029 of January 15, 1999 on the organization of municipalities in the Republic Benin (see Box 2 below).
Box 2: Role of municipalities in protecting people’s health
“The municipality is responsible for building, equipping and repairing the centers public health and social promotion, public cultural infrastructures for youth, sports and leisure, at district, village or district level of town. It also ensures the maintenance of these centers and infrastructures. To this end, the state transfer the necessary resources to it”.
Article 46 of Law No. 2021-14 of December 20, 2021 on the Administration Code territory in the Republic of Benin.
According to Philippe Lecorps and Jean-Bernard Paturet2, “The logic of public health is that a desire for collective protection based on the assessment of needs, the provision techniques, including medical ones, to offer the best chance of survival or quality of life for the whole population. It is exercised in fields where private persons have no possibility of effective intervention on their own, either because they do not master information, either because they have no individual power over the mechanisms risk production groups.
This reflection by Lecorps and Paturet highlights and justifies the role and mission thus devolved to communes and municipalities in Benin as part of their active participation in the design and implementation of health policies at the decentralized level. She illustrates moreover, the shortcomings of the legal framework described above, which remains practically silent on the substantial contribution and the effective contribution of municipalities to the definition of policies national public health services. Because as much as the central government has its agenda sectoral in terms of health, as much as the municipal authorities should also have their own should be an integral part of national health policy. Indeed, according to Kingdon J, “There are agendas within agendas3”.
From a methodological point of view, the implementation of a coherent territorial policy of public hygiene and sanitation first of all integrates the meticulous evaluation and the taking into account the problems linked to the anarchic occupation of the land, the absence of plans of sanitation in urban and rural areas, to the lack of collection and treatment strategies household waste, insufficient drainage and water treatment systems waste and various human-caused degradations of the environment. Several studies monographs of the cities of Benin have demonstrated this, and it is now obvious to note that urban and peri-urban areas with high human density are, despite the recent creation the Greater Nokoué Solid Waste Management Company (SGDS) to remedy this, particularly faced with the risk of extensive environmental pollution and the accumulation rampant with litter. All this, because of a still fledgling collection system, disposal and treatment of household waste and waste water. The health risk in this case is very plausible, in this case, through multiplication, in these areas with high population growth, breeding sites and outbreak of vectors of several diseases infectious. These findings show the extent of the challenges to be met at the level of the authorities. communal and municipal authorities to ensure the protection of populations from the many threats toilets erected like the sword of Damocles on their heads.
But other major causes of the poor mastery of town planning and development territory by the municipalities exist, including the technical difficulties of implementing the territorial public health policies. These technical difficulties relate to a poor formulation of public sanitation policies at the national level, in almost total ignorance of taking into account the multisectoral dimension of health policies and insufficient financial resources, to name but a few. one. They (these difficulties) constitute real obstacles to the adoption of approaches decentralized design and implementation of relevant protection policies public health.
Moreover, despite the efforts made in recent years by the public authorities to stem it, the phenomenon of flooding continues to rage in urban agglomerations and peri-urban areas such as Cotonou, Abomey-Calavi and many others. This, due to the fact that the local waste management, or even the treatment of solid and liquid waste are not there yet sufficiently controlled. On the contrary, it presents itself as a permanent major challenge, both wild dump sites multiply exponentially with pressure galloping demographic of these cities, which, consequently, increases the risks of infection and degeneration of community health. Also, notorious acts of incivility by certain citizens, consisting in particular in the anarchic occupation of the public domain, the non-regulatory creation of garbage dumps outside authorized sites and the wild congestion of the sewage and rainwater drainage channels throughout the opportunistic dumping of household waste, are they so many determinants that challenge the responsibility of local authorities in the proper development of the territory and the definition of adequate health policies to deal with it.
Like this situation, local authorities still need to mobilize more qualified human resources and technical equipment in quantity in order to curb the damage. All this, through a systemic, holistic, prompt and adequate policy, intertwined between the strategic objectives of the government and those of the communities decentralized.
In view of all the above, a new paradigm of public health action for the health protection is necessary. It now seems imperative that this public action be incentive and largely participatory of all local communities. This constitutes moreover both a right and a constitutional duty recognized to Beninese. For this purpose, Philippe Lecorps and Jean-Bernard Paturet assert “Public health can revitalize a democratic space where the subjects are involved in the process of analyzing the problems and searching for solutions. It is a political approach of humility, openness, questioning which can reintroduce the desiring subject in his ethical responsibility, in the collective construction of the rules of living together, as responsible citizens”4. It is there, one demonstrations of the real exercise of grassroots democracy, around the design, the implementation and evaluation of public policies, in this case health policies.
In this perspective, the decentralized authorities have the opportunity to combine the efforts of all local communities around their communal action programs or plans of communal development. To this end, they integrate one of the essential dimensions of the development of public policies: consideration of interest groups5.
Taking this cardinal dimension into account, the municipal and communal authorities will have to now support the establishment of non-governmental organizations carrying out actions
disease prevention and public health in their respective territories. It is also, for these local authorities, a direct or indirect way of testing the individual social accountability of citizens in health management community, an individual social responsibility alluded to by Patrick Peretti-Watel6 in these terms: “The moral judgments passed on individuals by the body medicine are thus transposed to the field of public health. Just like the occurrence of a disease makes suspect the management that the individual has of his body, the fact of exposing himself to a health risk, or allowing their physical condition to deteriorate through the choice of a lifestyle unsuitable reflects a certain neglect of one’s own body. It appears from the policies contemporary approaches to health promotion a dominant representation: health would be the responsibility of the individual and would engage his personal responsibility”.
For Raymond Massé, “(…) Insofar as the company assumes responsibility for offering a healthy physical but also social environment, health has become eminently a project of society, even a political project”7. It is therefore appropriate, for each municipal authority or communal in Benin, to henceforth build all public policies, in particular all public health action, with the inclusive involvement of all sections of the population, taking into account in particular the proposals of interest groups, non-profit organizations government of all kinds, legitimate and recognized as being of public utility. This consideration is further amplified by Pierre Lascoumes (1995)8 and other authors of political science who postulate that approaches to the implementation of public policies in the context of decentralization are ‘constructive’ and ‘processual’. For Peter Lascoumes indeed, “environmental policies are not, as is too often believed, often, policies of “protection” but policies of “organization”: these policies focus more on defining modes of relationships, frameworks of interpretation and interaction, than to give the solution of the problems or to determine the standards to be reached”. The focus is thus placed on the procedural nature of relations between local authorities and local stakeholders in the civil society so that genuinely consensual solutions emerge in terms of protection of people against environmental risks to public health.
1 Articles 82 and 100 of Law No. 97-029 of January 15, 1999 in its Chapter III relating to the powers of the commune provide that: – Article 82: “The commune has its own powers in as a decentralized local authority. It also exercises, under the supervision of the supervisory authority, other attributions which fall within the competences of the State. It competes with the State and other communities, administration and land use planning,
2 Philippe LECORPS, Jean-Bernard PATURET, in “Public health, from biopower to democracy”, School editions National Public Health, op. cit., p. 27.
3 KINGDON J. Agendas, Alternatives and Public Policies, New York, Harper Collins (2nd ed).
4Philippe LECORPS, Jean-Bernard PATURET, Public health from biopower to democracy, Editions of the National School of Public Health, op. cit., p. 114
5According to Wilson (1991, p.6), “interest groups are organizations that have a certain autonomy vis-à-vis the government and political parties, and who seek to influence public policy”.
6Patrick PERETTI-WATEL, “Risk behavior”, in Isabelle CORPART, (dir.), Political and social problems, file n° 914, La Documentation Française, December 2005, op. cit., p. 23.
7 Raymond MASSÉ, “Public health as a political project and an individual project” pp. 41-64, in Bernard HOURS, (ed.), Health systems and policies. From public health to anthropology, Paris, Karthala, op. cit., p. 47
8 Pierre Lacoumes, in terms of the implementation of environmental policies, in 1995.
