Contractualization of public health facilities in Togo: an approach likely to improve the level of access to health services?

Abstract

Administrative and structural management problems reduce the effectiveness of health policies and systems. In Togo, investments and resource mobilization of various kinds do not alleviate the difficulties faced by populations accessing health services. Despite some progress, many challenges, including the management of health facilities, remain to be addressed to improve the performance of the health sector. In the quest for better strategies to improve the health of populations, the Togolese government experimented with the contractualization of public health facilities. A few years after its launch, questions remain as to whether the implementation of this approach has brought about positive changes. Based on field data analysed using rationalisation theory, this study helps to understand that contracted public health facilities streamline their administrative and financial management and facilitate access to health care.