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Introduction: The western French Guiana hospital (Chog) is atypical. The creation of a public health department (PSP) is the result of a willingness of the institution to respond to public health issues on its territory. The main objective of this article is to identify the levers and impediments for the development of public health activities within this hospital, after five years of implementation.

Method: This article was based on the analysis of documents produced within the PSP, the institution and at the regional level (2013-2018), and on interviews conducted in 2017 with PSP professionals, and chiefs of other departments of the Chog (N = 16).

Results: The added value of the PSP is based on the pooling of human resources and technical skills, the coexistence of clinical activities, prevention, research, teaching and international cooperation with Suriname, and the development of multidisciplinary and evaluative approaches. The lack of a set of public health objectives in the establishment project, the lack of place for these activities in its new hospital, and the difficult mobilization of financial resources, however, limit the prospects.

Conclusion: This analysis has shown difficulties in developing public health activities within this hospital, in an overseas territory with nonetheless multiple and complex needs. The authors invite politics and health authorities to value, and develop these activities, conditions necessary for the positioning of the hospital as an actor of the "turn in prevention".