We are experts, researchers and economists in public health able to identify problems within healthcare systems in developing countries and to improve the access to healthcare. Adequate access to healthcare has been recognised by large international organizations and political leaders as resulting from financial, societal and institutional problems.

The priority of the WHO Director-General and the leaders of West African countries is to set up universal health coverage. Their National Health Policies and National Health Development Plans of West Africans countries have clearly defined visions to improve, strengthen and achieve the availability and quality in the supply of care. The plan of action is expressed and shared with technical and financial partners who support them according to their possibilities and their mandates.

In this context of political commitment and knowledge of the dysfunction, why does access to healthcare for most populations in the developing countries remain generally deficient?

One answer is in the poor performance of hospital systems. Despite the significant progress made over the past twenty years, the systems currently in place often fails to create favourable conditions to meet the care of populations according to the health policies expressed.

Of course, the funding is insufficient and the needs are immense. Hospitals lack technical resources and staff are poorly valued; supply chains are often discontinued for medical products, consumables and devices for technical platforms; and the basic conditions such as access to water and electricity are inadequately met. The international partners on which the health systems depend are themselves subject to budgetary constraints and the need to demonstrate the relevance of the actions funded. In addition, there is often a reluctance to support a system that does not inspire confidence and whose results are not guaranteed, rather than supporting targeted and better-controlled actions.

Dominique Cazalens