[Public hospital in French-speaking Africa].

Traditional consensus holds that hospitals are ill-suited to the healthcare priorities in Africa countries whose policies must focused mainly on promoting primary services. Indeed hospitals are generally considered as inefficient and wasteful of financial resources that could be used for more important healthcare priorities. Long excluded from major development programs, most hospital facilities have gone from crisis to crisis over the last 10 years and are now unable to provide adequate services. The sometimes dramatic state of these institutions raises serious doubt not only about the effectiveness of current healthcare policies but also about the long-term survival of the healthcare systems now being established. But this situation is not the result of fate but rather of the failure of public hospitals to adapt their organization to the realities of today's world. Indeed hospital services are provided within a purely administrative structure with total disregard for the principles of good management. A new vision for revival of healthcare systems make hospitals a key component in a network of healthcare institutions and recommends that they be included in an in-depth reform of healthcare systems that consider any healthcare act as a service in the "economic" sense of the word and its availability as the end-result of a production process. To ensure fulfillment of the public service mission of the hospital, the resulting "entrepreneurial" approach must be accompanied by appropriation of subsidies so that charges are affordable to a majority of the population, implementation of welfare programs to insure that even the poorest users have sufficient resources, and development of monitoring capabilities.