Gouvernance de la santé à l’échelle locale : le district sanitaire de Bacongo (Brazzaville, République du Congo)

Abstract

Context: Since the 1990s, the Congo health authorities are implementing a reform of its health care system by: improving territorial coverage, ensuring the sustainability of health care provision, and promoting involvement of non-state stakeholders. Objectives: This study aims to identify actors and to analyze mechanisms of urban governance of health services at the local level of Bacongo municipality. Methods: Data used come from three sources: health and administrative reports, semi-structured qualitative interviews, and participative observation. Both techniques are using as they help to understand people perception, logic and practices of actors Etienne Paka 424 involved in health governance at the local level. Results: Although the state remains a key player in the management of healtxh system, several private stakeholders are involved in the urban governance of health services. Several mechanisms have been implemented at different scales to coordinate interventions. However, due to lack of decentralization, decision-making and priority-setting processes are still adopting a top-down approach, and regulations adopted to encourage the participation of the various actors are often merely frameworks for decisions validation. Usually, there is lack of view convergence between state policy and private actors and developing partners, and this does not facilitate decision-making processes. The framework and objectives of local governance need then to be reconsidered in a sustainable manner to better reflect the complexity of urban health situations