[Public hospitals in Sub-Saharan African countries and their perspectives]

Hospitals have a very important role to play within the care system of Sub-Saharan African countries, not only because they care for patients sent by other health services, but also because they participate in the training of health professionals. In spite of many reforms, they are trapped in a vicious circle, which, to be broken, means moving from too highly stratified administrative system to a system of enterprise. This system must focus on performance, while guaranteeing necessary public service. Such change requires adopting new methods and ways of thinking for providing a complete health service for the patients, that is adequate access to quality health care. This will entail hospitals being given a free hand in their management, effective measurements of quality and expenditure evaluation being devised and supervision by the state Health department. By allowing hospitals to attract more affluent members of society, they will be better able to meet their obligations towards the poor.