THE PROVISION OF PRIVATE CHARITABLE HOSPITAL-CARE IN WEST-AFRICA - A CASE-STUDY

The Hopital Protestant de Dabou (HPD), a private charitable hospital l ocated in a rural area of the Ivory Coast, has seen its activity decre asing significantly since the beginning of the 1990s. The decrease aff ected mainly the paediatric and the general medicine specialties. An e valuation suggested that this appeared to have resulted from a combina tion of determinants including decreasing level of financial support f rom government and aid agencies, rise in the hospital price list rende ring services financially inaccessible to the local population, and ep isodes of drug shortage. The HPD is facing two options, the first bein g to evolve towards a self-sufficient organization offering expensive health care to the wealthiest part of the population, thus departing f rom the original driving principles of affordability and value for mon ey. The second option is to try to stick to these principles by active ly seeking greater financial support from government and aid agencies. External donors may find that only with their continued support can t he qualities of responsiveness, flexibility and innovation displayed b y the HPD and other comparable hospitals be preserved.