Socio-Demographic and Academic Characteristics Of Nurses Applying for Authorization To Open And Operate Private Healthcare Practices In Benin

RESEARCH ARTICLE Br J Med Health Res. 2025;12(08) ISSN: 2394 - 2967 Please cite this article as: OTTI A et al., Socio-Demographic and Academic Characteristics of Nurses Applying for Authorization to Open and Operate Private Healthcare Practices In Benin. British Journal of Medical and Health Research 20 25 . BJMHR British Journal of Medical and Health Research Journal home page: www.bjmhr.com Socio-Demographic and Academic Characteristics Of Nurses Applying for Authorization To Open And Operate Private Healthcare Practices In Benin OTTI A1, 2* ; DOSSOU A.J.E2.3 ; DJOSSOU D.B.J.1.2 ; AGBÉTÉ I 1.2 ; KOUTCHONAN D2, 4 ; ALLADAYE L.2, 5 ; BATCHO V.R2.5 ; AKPOVO S. A5 . ; SALIFOU S5 ; SOSSA Jérôme C6 1.Department of Nursing Sciences, National Medical-Sanitary Institute ( INMeS ), University of Abomey-Calavi (UAC), Benin 2.Beninese Society of Nursing Sciences (SOBÉSI), Benin 3.Department of Obstetric Sciences, National Medical-Sanitary Institute ( INMeS ), University of Abomey-Calavi (UAC), Benin 4.AÏDJÈDO Health Center, Departmental Directorate of Health of the Littoral, Ministry of Health, Benin 5.National Directorate of Public Health (DNPS), Ministry of Health, Benin . 6.Regional Institute of Public Health (IRSP) Comlan Alfred QUENUM, University of Abomey - Calavi (UAC), Benin. ABSTRACT The health reforms initiated in Benin in 2016 have allowed the reorganization of the practice of health professions in private clients, including nursing. To describe the socio-demographic and academic characteristics of nurses applying for authorization to open and operate Private Nursing Practices (CSIP) in Benin. A review of the applications for opening and operating CSIPs, submitted from 2021 to 2024 and selected by exhaustive probability sampling, was carried out. Linear relationships between certain variables were identified using the Pearson correlation test with the Stata/IC 16.0 statistical analysis software. 306 Beninese applicants, 72.55% of whom were men, were registered. Their average age was 38 years and 31 (10.1307%) were aged 60 and over. 53.9213% of the requested installation sites were located in Alibori, Atacora, Borgou and Donga. 76.4705% of the nursing diplomas presented were obtained between 2017 and 2022. 68.6274% of these diplomas came from abroad, including 55.2287% from Burkina Faso. In addition, 69.60% of the diplomas presented were the State Nursing Diploma, 73.70% of which were issued in Burkina Faso. Authorization was granted to 87.11% of the applicants. Applicants of retirement age in Benin raise the issue of sponsorship, the legal contours of which deserve to be clarified. The unequal distribution of installation sites requires the development of a private health map with the objective of Universal Health Coverage. The predominance of foreign diplomas implies the assessment of the skills of their holders. Keywords: Nurses; Private nursing practices; Authorization to open and operate; Sociodemographic and academic characteristics; Benin. *Corresponding Author Email: [email protected] Received 02 August 2025, Accepted 19 August 2025 www.bjmhr.com 27 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 INTRODUCTION In an effort to provide quality health care to the Beninese population and achieve the goal of Universal Health Coverage (UHC), the government of Benin, by decree No. 2016-514 of August 24, 20161, initiated several major reforms in the health sector. A national technical commission was tasked with analyzing the health system, proposing the basis for a mechanism for expanded and equitable access to health services, and ensuring the monitoring and implementation of reforms for a more effective and efficient health system2. Among these reforms is the reorganization of the private practice of medical and paramedical professions in a dynamic of strengthening universal access to quality health care. The private practice of the nursing profession has not remained on the sidelines of these reforms. Long regulated by Law No. 97-020 of June 17, 1997 establishing the conditions for the private practice of medical and paramedical professions in the Republic of Benin3 and Decree No. 2000-409 of August 17, 2000 implementing Law No. 97-020 of June 17, 1997 establishing the conditions for the private practice of nursing care4, the practice of the nursing profession in private practice in Benin, like other health professions, has undergone structural reforms leading to the adoption of Law No. 2025-01 of January 16, 2025 organizing the private practice of medical and paramedical human health professions in Benin5. In this new legal framework5, the private nursing practice, while remaining a care center provided by a qualified nurse within the limits of his or her skills, is now considered a private health establishment integrated into national planning, freely established, legally regulated, subject to control and quality requirements. It is designed as an autonomous framework in which the nurse fully assumes civil and criminal responsibility, without the obligation to be attached to another medical structure. Indeed, "as a profession, nursing is dedicated to upholding the right of every person to the highest attainable standard of health through a shared commitment to providing collaborative, culturally safe, human-centered care and services. Nursing acts and advocates for equitable access to health and health care, as well as safe and sustainable environments. Nursing practice embodies the philosophy and values of the profession by providing professional care in the most personal aspects of people's lives. Nursing promotes health, protects safety and continuity of care, and manages and leads health organizations and systems. Nursing practice is based on a unique combination of scientifically based disciplinary knowledge, technical abilities, ethical standards, and therapeutic relationships. Nursing is committed to compassion, social justice, and a better future for humanity"6. All this shows the place that nursing occupies in health systems because, nursing personnel, front-line agents of any health system7, form the largest www.bjmhr.com 28 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 professional group in the health sector, representing approximately 59% of health professions8; better, it constitutes the cornerstone of the reconstruction of health systems in the world9. While the role of private practice of health professions is no longer in doubt, given that the State alone cannot cover all geographical areas of a country with health care structures, private practice of the nursing profession appears more particularly as a complementary lever for national Universal Health Coverage strategies while ensuring the quality of the services offered. The World Health Organization (WHO)8 also believes that nursing staff play a central role in establishing universal health coverage and achieving sustainable development goals. The reforms initiated in the health sector in Benin1, in an effort to preserve the quality of health care and more particularly nursing care in the context of private practice of the nursing profession, have made it possible to take several major decisions, including the start of issuing new authorizations for the opening and operation of private health establishments in a joint ministerial decree instead of individual decrees in order to avoid or limit fraud. To support and strengthen this quality approach implemented since 2018 with the aim of having an increasingly healthy private health sub-sector in which the actors are more aware of their mission and more committed to ensuring quality care for the population1, It seems important to take stock of the situation, hence the interest of this study, the aim of which is to analyze the socio-demographic and academic characteristics of nurses applying for authorization to open and operate private healthcare practices in the Republic of Benin. MATERIALS AND METHOD To achieve the aim of the study, a retrospective quantitative descriptive research design was used. The documentary analysis method was adopted by examining the files of applications for the opening and operation of private nursing practices, submitted by applicants to the health regulations department of the National Directorate of Public Health (DNPS) of the Ministry of Health of Benin from 2021 to 2024, selected through exhaustive probability sampling. A documentary analysis grid made it possible to study the main variables under study presented in the following table (Table 1). www.bjmhr.com 29 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 Table 1: List of main variables under study Variables Terms and Conditions Variable Types Socio-demographic and geographic characteristics Sex o Male o Female Qualitative binary Age Exact age of applicant Discontinuous quantitative Nationality Applicant's country of origin Nominal qualitative Department requested for the installation of the private nursing practice o Alibori o Atacora o Atlantic o Borgou o Hills o Couffo o Donga o Coastline o Mono o Ouémé o Plateau o Zou Nominal qualitative Academic characteristics Types of Nursing Degrees Presented o Bachelor of Nursing (General Secondary Education Baccalaureate + 3 years of training) o State Nursing Diploma (First cycle study certificate + 3 years of training) o Medical and Health Technician Certificate (First cycle study certificate + 3 years of training) o Certified Nursing Diploma (Primary Studies Certificate + 3 years of training) o Other nursing diploma (please specify) Nominal qualitative Year of obtaining the nursing diploma presented Year of obtaining the nursing diploma presented Quantitative time Country of nursing degree presented Country of nursing degree presented Nominal qualitative The collected data were categorized and the occurrences of the variable modalities were presented in tables using descriptive statistics by calculating absolute frequencies, relative frequencies and arithmetic mean. Significant linear relationships between the following five variables : age, gender, country of nursing degree; type of nursing degree and department requested for the installation of the private nursing practice; were sought by the Pearson correlation test carried out using Stata/IC 16.0 software. Indeed, the Pearson coefficient (r) being a normalization of the covariance, therefore mathematically bounded, a linear relationship exists between two variables if −1 ≤ r ≤ 1. Specifically, the results of the statistical test were analyzed according to the following scale (Table 2) www.bjmhr.com 30 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 Table 2 : Scale for assessing the quality of the correlation between the five variables studied No. Coefficient r Interpretation 01 r = 1 Perfectly positive correlation 02 0.7 ≤ r < 1 Strong positive correlation 03 0.5 ≤ r < 0.7 Moderate positive correlation 04 0.3 ≤ r < 0.5 Weak positive correlation 05 - 0.3 < r < 0.3 Very low or no correlation 06 - 0.5 < r ≤ - 0.3 Weak negative correlation 07 - 0.7 < r ≤ - 0.5 Moderate negative correlation 08 - 1 < r ≤ - 0.7 Strong negative correlation 09 r = - 1 Perfectly negative correlation Furthermore, it should be noted that in compliance with ethical standards in scientific research, the study was authorized by the Ministry of Health of Benin by data collection authorization No. 3648/MS/DC/SGM/DFRS/SRS/SA dated July 10, 2025. RESULTS 318 applications for authorization to open and operate private nursing practices were recorded from 2021 to 2024, including 12 duplicate applications due to the rejection of the first application due to incompleteness of the required administrative documents. 306 applications were therefore retained for analysis and the applicants are all of Beninese nationality. The majority of applications (267/306 or 87.25%) had received a favorable opinion from the technical commission for the exercise in private clients of health professionals in Benin. Socio-demographic characteristics of applicants for authorization to open and operate practices private nursing care in the Republic of Benin Table 3: Distribution of nurses applying for authorization to open and operate private nursing practices by age and gender (n=306) Age class intervals Sex Total Relative frequency (%) Male Female [20 - 30[ 57 18 75 24,50980392 [30 - 40[ 109 41 150 49,01960784 [40 - 50[ 20 10 30 9,803921569 [50 - 60[ 10 10 20 6.535947712 [60 - 70[ 22 05 27 8,823529412 [70 - 80[ 3 00 03 0.980392157 [80 - 90[ 1 00 01 0.326797386 Total 222 84 306 100 Relative frequency (%) 72.55 27.45 100 The analysis of Table 3 shows that the male sex is predominant among the respondents (72.55%) and the modal age group is [30-40[ (n=150 or 49%). Furthermore, the average age www.bjmhr.com 31 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 of the respondents was 38.0392 years ≈ 38 years with extremes of 20 years and 90 years. There are 31 respondents aged 60 years and over (10.1307%). Table 4: Distribution of applications for authorization to open and operate private nursing practices by year of submission (n=306) Years of filing the application Number of applications for authorization to open and operate a private nursing practice registered Frequency relative (%) 2021 78 25.49 2022 77 25.16 2023 81 26.47 2024 70 22.88 Total 306 100 Reading Table 4, it appears that the largest number of applications for authorization to open and operate private nursing practices was recorded from 2021 to 2023 with a slight decrease in 2024. Furthermore, the average annual number of applications recorded was 76.5. Table 5: Geographical distribution of the sites where nursing practices were set up, chosen by the respondents for the practice of the nursing profession in private practice (n=306) Departments Number of private nursing practice installation sites identified Frequency relative (%) Alibori 18 5,882352941 Atacora 40 13,07189542 Atlantic 54 17,64705882 Borgou 93 30,39215686 Collines 13 4,248366013 Couffo 06 1,960784314 Donga 14 4,575163399 Littoral 07 2,287581699 Mono 05 1,633986928 Ouémé 23 7,516339869 Plateau 10 3,267973856 Zou 23 7,516339869 Total 306 100 Of the 306 files analyzed, all 12 departments of Benin were represented with numbers of private nursing practice installation sites that vary from one location to another. The Borgou department had recorded the largest number of installation sites (n = 93 files, or 30.3921%), followed by the Atlantic (n = 54 files or 17.6470%) and Atacora (40 files, or 13.0718%). It should be noted that the four northern departments of Benin (Alibori, Atacora , Borgou and Donga ) alone account for more than half (165/306 or 53.9213%) of the private nursing practice installation sites requested by applicants. www.bjmhr.com 32 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 Academic characteristics of applicants for authorization to open and operate healthcare practices nurses in private practice in the Republic of Benin Table 6: Distribution of types of nursing diploma presented according to applicants for authorization to open and operate private nursing practices (n=306) Types of Nursing Degrees Presented Number of applicants for authorization to open and operate a private nursing practice Frequency relative (%) Bachelor of Nursing (Baccalaureate + 3 years of training) 91 29.74% State Nursing Diploma (First Cycle Studies Certificate + 3 years of training) 207 67.64% First degree qualification certificate 1 0.33% Medical and Social Technician Certificate (First Cycle Studies Certificate + 3 years of training) 6 1.96% Certified Nursing Diploma (Primary School Certificate + 3 years of training) 1 0.33% Total 306 100 The majority (69.60%) of nurses applying for authorization to open and operate nursing practices for private clients in the Republic of Benin hold either the State Nursing Diploma (First Cycle Study Certificate + 3 years of training): 67.64% or the Medical-Social Technician Certificate (First Cycle Study Certificate + 3 years of training) : 1.96%; both types of diploma having the same academic levels. www.bjmhr.com 33 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 Table 7: Distribution of nurses applying for authorization to open and operate private nursing practices by country and year of obtaining nursing diploma (n=306) Year of nursing graduation Country of nursing graduation Total Frequency relative (%) Benin Burkina Faso Niger Togo 1974 1 0 0 0 1 0.326797386 1978 1 0 0 0 1 0.326797386 1984 1 0 0 0 1 0.326797386 1985 1 0 0 0 1 0.326797386 1986 1 0 0 0 1 0.326797386 1987 3 0 0 0 3 0.980392157 1988 1 0 0 0 1 0.326797386 1989 2 0 0 0 2 0.653594771 1993 2 0 0 0 2 0.653594771 1996 2 0 0 0 2 0.653594771 1997 1 0 0 0 1 0.326797386 1999 1 0 0 0 1 0.326797386 2001 1 0 0 0 1 0.326797386 2002 2 0 0 0 2 0.653594771 2003 4 0 0 0 4 1,307189542 2004 6 0 0 0 6 1,960784314 2005 7 0 1 1 9 2,941176471 2006 5 0 0 0 5 1,633986928 2007 3 0 0 0 3 0.980392157 2008 1 0 0 0 1 0.326797386 2009 1 0 0 0 1 0.326797386 2011 0 2 0 0 2 0.653594771 2012 0 1 0 0 1 0.326797386 2013 1 0 0 0 1 0.326797386 2014 1 0 0 0 1 0.326797386 2015 0 0 1 1 2 0.653594771 2016 2 1 1 2 6 1,960784314 2017 2 6 3 0 11 3,594771242 2018 7 29 1 0 37 12,09150327 2019 8 43 1 2 54 17,64705882 2020 6 57 16 1 80 26,14379085 2021 12 22 3 0 37 12,09150327 2022 6 6 3 0 15 4,901960784 2023 3 1 1 2 7 2,287581699 2024 1 1 1 0 3 0.980392157 Total 96 169 32 9 306 100 Relative frequency (%) 31,37 55,23 10,46 2,94 100 The majority (210/306 or 68.6274%) of nursing diplomas presented by applicants for authorization to open and operate nursing practices for private clients had been obtained outside Benin (abroad) with a predominance in Burkina Faso which alone accounts for more than half (169/306 or 55.2287%) of registered nursing diplomas. It is also noted that more than 3/4 www.bjmhr.com 34 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 (234/306 or 76.4705%) of nursing diplomas presented by respondents were obtained between 2017 and 2022 with a predominance in 2020 (n = 80). Table 8: Distribution by country of obtaining the types of nursing diploma presented by applicants for authorization to open and operate private nursing practices (n=306) Types of Nursing Degrees presented Country of nursing graduation Total Frequency relative (%) Benin Burkina Faso Niger Togo Bachelor of Nursing (Baccalaureate + 3 years of training) 43 12 29 07 91 29.74% State Nursing Diploma (First Cycle Studies Certificate + 3 years of training) 45 157 03 02 207 67.64% First degree qualification certificate 01 00 00 00 01 0.33% Medical-Social Technician Certificate (First Cycle Studies Certificate + 3 years of training) 06 00 00 00 06 1.96% Certified Nursing Diploma (Primary Studies Certificate + 3 years of training) 01 00 00 00 01 0.33% Total 96 169 32 09 306 100 Relative frequency (%) 31,37 55,23 10,46 2,94 100 Analysis of the data in Table 8 shows us that although the majority (n=213/306 or 69.60%) of the diplomas presented by the respondents were the State Nursing Diploma (First Cycle Studies Certificate + 3 years of training) or equivalent, a little less than 3/4 (n= 157/213 or 73.70%) of this type of diploma were issued in Burkina Faso. www.bjmhr.com 41 OTTI et. al., Br J Med Health Res. 2025;12(08) ISSN: 2394-2967 reforms in the health sector. 2. 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Nursing: From Vocation to Profession. Conference entitled “Nursing, Care Work and Women’s Power” at the University of Montreal, June 11, 2019. 25. https://nouvelles.umontreal.ca/article/2019/06/11/soins-infirmiers de-vocation-aprofession/, accessed April 23, 2025. 26. https://lefaso.net/ 27. Ministry of Higher Education, Research and Innovation of Burkina Faso (2024). Order No. 2024/344/MESRI/SG/ DGESup suspending recruitment in the Bachelor's and Master's programs in Nursing and Midwifery in Private Higher Education Institutions (IPES) dated 09/11/2024. 28. Presidency of the Republic of Benin. General Secretariat of the Government (2023). Decree No. 2023-517 of October 18, 2023 on the attributions, organization and operation of the National Commission for the Study of Diploma Equivalences. 29. Presidency of the Republic of Benin. General Secretariat of the Government (2025). Minutes of the Council of Ministers No. 06/2025/PR/SGG/CM/OJ/ORD dated February 19, 2025. 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