Game plan: Infrastructure investment is boosting health care access

Health infrastructure in Côte d’Ivoire remains weak and unevenly distributed as a result of insufficient investment and the damage borne throughout a decade of conflict. This has had a negative impact on access to health services, making it difficult for health care agents to adequately satisfy the population’s needs. Boosting investment in health infrastructure is a key step to overcoming this situation. Public-private partnerships (PPPs) and private sector investments have recently proven useful and are likely to continue in the future given the needs of the Ivorian people and substantial room for growth.

Emerging Partnerships

To promote the goal of growing the sector, the government has partly embraced PPPs. On April 16, 2015, President Ouattara inaugurated Hospital Saint-Jean Baptiste in Bodo-Tiassalé, located 90 km north of Abidjan. The government and a major producer of fruit in Africa, the Caribbean and the Pacific regions – the Compagnie Fruitière – in tandem with its local subsidiary, Société d’Etude et de Développement de la Culture Bananière (SCB), provided the CFA5.5bn (€8.3m) funding for the project. Overall, the hospital provides a variety of services, ranging from general practice and surgery to stomatology; and while it is primarily meant to serve SCB employees, it remains open to the general population.

International Cooperation

More specifically, the maternity and paediatrics centre of the hospital benefited from CFA796m (€1.2m) in funding released under the framework of the Debt Relief and Development Contract (Contrat de Dé sendettement et Développement, C2D) managed by the French Development Agency (Agence Française de Développement, AFD). Signed in 2013, the C2D is a debt relief and development contract whereby Ivorian debt paid to France is reimbursed by means of allocation to the financing of mutually agreed upon poverty-reduction programmes in the country. The AFD is working with the government to support the development of the health sector in Côte d’Ivoire through the C2D, totalling approximately €140m that will be allocated in two phases.

Marion Martinez Valiente, AFD Project Manager, told OBG, “The Health System Strengthening Project (Projet de Renforcement du Système de Santé, PRSS), was developed for this context and originally scheduled over a two-year time period from 2013-15, and dedicates 43.15% of its budget, CFA17.6bn (€26.8m), to the support of maternal and child health in Côte d’Ivoire.”

The PRSS foresees the rehabilitation of first-contact health facilities in urban and rural areas and general hospitals located in four government selected priority regions; Lagunes, Montagnes, Bas-Sassandra, and Moyen Cavally, and it reaches over 4.5m people in the south. According to Martinez Valiente, four project studies, covering general hospitals in San Pedro, Guiglo, Dadané and Soubré, were still under way as of May 2016.

The second phase of the project, PRSS 2, which will implement changes from 2016-20, was set to allocate 68% of its budget, CFA30.5bn (€46.5m), to supporting the improvement of reproductive, maternal, neonatal and children’s health services and nutrition. This implies significant contributions to the operation of first-contact health facilities in the north and the rehabilitation of first-reference health establishments in the north and in Abidjan. “This assistance,” Martinez Valiente told OBG, “is designed to foster the decentralisation of health services, covering eight regional hospitals, including at least four to five in the north.”

Other Investments

Other international cooperation agencies are supporting the significant improvement of health infrastructure and facilities in selected areas. This includes the World Bank with its $70m 2014-20 Health Systems Strengthening and Ebola Preparedness Project, and the EU’s Directorate-General for European Civil Protection and Humanitarian Aid Operations, which manages €18m of the PRSS funds. Together, the two groups support first-contact health facilities and regional and departmental health authorities.

International financial institutions are also supporting the initiative. On April 27, 2016 the government approved a 30-year loan of $12m at a 1% interest rate with the Arab Bank for Economic Development in Africa. The loan is aimed at funding the construction and providing the medical equipment for a regional hospital in Yopougon, Abidjan. Requests for tenders were expected in the months following this decision. The overall cost of the Yopougon project is estimated at CFA19.5bn (€29.3m). The hospital, whose services are meant to cover about 3.5m people, is expected to have 14 buildings, 250 beds and the country’s first unit for kidney transplants and haemodialysis.

Private Sector

The private sector is also committed to offering quality health services and facilities in Côte d’Ivoire. In recent years the Polyclinique Internationale Sainte Anne-Marie (PISAM), a major private clinic in Côte d’Ivoire, has made efforts to cut down its hefty debt and secure substantial investment funding. In January 2016 PISAM signed a CFA10bn (€15m), 10-year preferential loan with the Société Générale de Banques en Côte d’Ivoire. With this, PISAM plans on funding the first part of development plan for the clinic, which focuses on modernising equipment and services. After successful completion, a second phase will be implemented for the construction of a cancer treatment centre and the installation of robotic surgery equipment.

Construction work on PISAM’s radiotherapy facility is set to start in January 2017 and last 18 months at an investment of about CFA3.5bn (€5.3m). Once operational, the facility will be able to give treatment to 1300-1400 patients per year. Although, this is still less than the estimated demand of 10,000 Ivorian cancer patients per year. Overall, PISAM’s development plan is expected to cost about CFA26.5bn (€40.3m) over a five-year period.

Room For Growth

The need for health services at present is such that there is still room for significant growth in infrastructure to compensate for insufficient and unevenly distributed health facilities in the country. “In Abidjan alone,” Joseph Boguifo, president of the Côte d’Ivoire Private Clinics Association told OBG, “There will soon be room for more clinics, given that not all districts have adequate health structures. The demand is coming directly out of Abidjan, namely in the west, north and east, justifying the relevance of a decentralisation effort. The fundamental goal is to ensure public-private coordination in meeting this demand for health care access and quality in all areas of the country.”