Analysis of the health decentralization policy in C��te d'Ivoire

In Côte d'Ivoire decentralization is a process that accelerated following the economic crisis of the 1980s and under pressure from donors. It is based on arguments of efficiency rationality responsiveness and its capacity to increase community participation. From the 2000s onwards devolution has been deepened by the creation of several types of local governments and the transfer and distribution of powers from the state to them. However the appropriation and implementation of these competencies are lacking resulting in the fragmentation of the planning and coordination of local health activities and a weakness in accountability mechanisms and quality of care. In short the operationalization of the deconcentration/devolution pair in the health sector is a complex process that must be implemented in an incremental participatory mixed manner combining top-down and bottom-up approaches. It must take into account the interests of the various stakeholders through a participatory planning process and consensual coordination of local activities.