Factors supporting the primary care physicians' performance in Benin: a multiple case study

IntroductionIn Benin, as in many African countries, the number of primary care physicians (PCPs) is gradually increasing. The literature suggests that these PCPs hold significant potential to improve the quality of care. However, this potential is not automatically realised. This study aims to understand the factors that underpin the performance of PCP practices in Benin. MethodsWe conducted a multiple case study of eight PCP practices with contrasting performance across five health districts in Benin. Both quantitative and qualitative methods were used. Quantitative data from consultation observations were used to assign performance scores, while qualitative data, gathered through 40 interviews and 16 focus group discussions with diverse stakeholders, underwent thematic analysis to identify influencing factors. A cross-case analysis was then used to determine the key factors supporting the performance of PCP practices in Benin. ResultsPCP performance scores varied, with communication scores ranging from 14.7 to 19.3 (out of 20) and technical quality scores from 68% to 88% (out of 100%). The overall performance of the PCP practices also showed substantial variation. The study identified various potential performance factors through key informant inputs and cross-case analysis. Among these, nine emerged from the cross-case analysis as factors supporting the performance of PCP practices: (i) values guiding PCP practices, (ii) preparation of PCPs for first-line practice, (iii) support from hierarchy, peers, or professional associations, (iv) leadership mandate and autonomy, (v) financing modalities, (vi) accountability mechanisms, (vii) PCPs relationship with their primary care team and their leadership style, (viii) collaboration with community leaders and public officials, and (ix) the contextual setting of each PCP practice. The study also examined causal pathways linking these factors to the performance of the PCPs practices. ConclusionThis study has identified a series of factors that could serve as levers to enhance PCP practices in Benin.