In-depth mapping of primary care physicians’ practices in four health districts in Benin: a mixed methods study

Background In Benin, the number of primary care physicians (PCPs) is increasing. This phenomenon challenges the current prevailing policy of task shifting from physicians to nurses adopted in Benin’s primary care system and raises a few questions. To date, information on PCPs and their practices remains scarce. This study aims to describe current PCP practices and propose a typology of these practices. Methods A fully mixed sequential equal-status design was used. Quantitative data were gathered from 155 PCPs through a survey, whereas qualitative data were obtained from in-depth interviews with 21 PCPs, 3 representatives of health authorities, and a review of policy documents. Results In our study, four types of PCPs were distinguished: first, private general practitioners (62.6%); second, public general practitioners (3.4%); third, Médecins généralistes communautaires (MGCs) (5.2%); and fourth, specialists working in primary care (28.4%). A comprehensive description of PCP practices is presented across four dimensions: professional identity, governance arrangements, roles and activities, and outputs and outcomes. Notably, only MGCs underwent structured professional identity-building. Most other PCPs perceive primary care as temporary, with low job satisfaction stemming from limited resources and inadequate incomes. Despite strong intrinsic motivation, governance challenges—such as the absence of a coherent national policy on PCPs’ practices, along with limited support to PCPs—significantly hinder their potential, leading to issues such as an excessive focus on curative care, urban concentration, and high costs. Conclusions This study is the first to provide a complete and in-depth description of PCP practices in Benin, confirming their growing presence and classifying their practices. It also highlights critical issues affecting these practices, emphasizing the need for stronger governance arrangements to improve primary care outcomes. The findings underscore the importance of developing an evidence-based policy framework to guide and support PCP practices in Benin.