Standard of care: Latest health development plan lays out an ambitious agenda

Since the implementation of the first five-year National Health Development Plan (Plan National de Dé veloppement Sanitaire, PNDS) in 2011, the government has focused on bringing health care infrastructure up to international standards. During the first two iterations of the PNDS, covering the period 2011-20, the state built 10 general hospitals, and rehabilitated 22 regional hospitals, 78 general hospitals and 233 health clinics. Despite the Covid-19 pandemic, the construction of primary and secondary care facilities forged ahead in 2020, with 706 public and private hospitals and clinics built that year. Significant headway has also been made to plug staff shortages. Between 2016 and 2020 the government recruited 16,481 doctors, nurses and midwives, while deploying over 11,000 community health workers. The PNDS 2021-25 prioritises many similar initiatives, and other reforms to foster dynamism and competition in the sector have been laid out.

“Although the pandemic presented serious challenges, one positive point that can be highlighted is the degree of collaboration between the public and private sectors, which was strengthened thanks to government support,” Ange Désiré Yapi, general director of the Nouvelle Pharmacie de la Santé Publique, told OBG.

Ambitious Targets

In the PNDS 2021-25, the government has set ambitious targets to improve general health indicators. By 2025 it aims to reduce infant and maternal mortality rates by half and increase the average life expectancy from 57 to 62 years. The strategy focuses on improving access to health care across the board through infrastructure development, staff training and better financing options for the system.

The government aims to increase the share of the population living within a 5-km radius of a health facility from 69% in 2018 to 80% by 2025. It plans to construct 376 new health establishments at a cost of $1.3bn. This includes four university hospitals, 17 regional health centres and 45 regional hospitals. Others, including university hospitals in Cocody and Yopougon, will be rehabilitated. The PNDS 2021-25 also plans to construct specialist medical facilities in several cities, including a radiotherapy centre in Abengourou, an emergency unit in Daoukro and Séguéla, a trauma centre in Toumodi, and a surgery and emergency unit in Bouna.

Human Resources

The training of health workers remains a key priority under the PNDS 2021-25. An additional 510 doctors, other senior health managers and 2475 personnel will be recruited each year. The government will set up incentive programmes to encourage health care professionals to work in rural regions. Through this system, the government hopes to double the number of doctors working in some of the country’s most isolated areas.

While many of these measures are similar to previous plans, the PNDS 2021-25 outlines significant reforms relating to financing, industrialisation and the private sector. The government aims to increase the health budget from 4.4% to 10% of the total by 2025, with a long-term goal of 15%. It has also singled out industrialisation, including pharmaceutical industrialisation, as a strategic priority for the sector.

Management Reforms

Reforming the current organisational structure of hospital management is also high on the agenda. The government intends to develop legislation under which public hospitals will continue to be supervised by the state but will run as private businesses with a results-based management approach to increase revenue and reduce costs. It will also carry out inspections of 500 private health establishments per year to ensure compliance.

The PNDS 2021-25 recognises the financial implications of such an undertaking and is looking to international donors and investors to achieve its targets. Resource optimisation will also be key. To cut costs and encourage improved services, public health facilities will be financed based on their performance. Various overlapping health programmes will also be merged and consolidated to reduce workforce and lower costs.