[Analysis of activity pole restructuring at Oran University Hospital, Algeria]

The EHUO project of reorganization of medical units into the new activity poles is a complex exercise and a challenge in relation to structural, organizational, and especially cultural barriers. The relationships between the EHUO and the Ministry of Health leave no room for autonomy. Funding continues to be provided through grants. Furthermore, no regulatory and technical support is available to the EHUO actors for development of the local project and even less for restructuring.

The authors describe and analyze the planned new organization from limited material available produced by the administration (notes and instructions) and the services projects analysis document prepared by our team.

The proposed poles are based on draft projects integrating the various units, with no reformulation in the context of a shared vision or a coherent point of view including the interactions between all parts of the project. Theoretically expected effects, such as autonomy, and management contracts for instance, are not on the agenda. The internal contract does not appear to be at the heart of the debate. Economies of scale and sharing of resources are only vaguely discussed.

Important prerequisites are necessary for this ambitious and highly structuring project. The EHUO actors must strive to reach an agreement on a common vision and values to be protected together as part of a collectively designed project to ensure good governance.