In Côte d'Ivoire, access to quality healthcare and the well-being of the population is at the heart of government priorities. In this context, the vision of a "Côte d'Ivoire in which the health and well-being of the population are as high as possible through an efficient, accessible, and resilient healthcare system" has been included in the National Health Development Plan (PNDS) 2021-2025.

This vision will be concretely translated into an improvement in the well-being of the population through:

• an increase in life expectancy from 57 years in 2020 to 60 years in 2025;
• a reduction in maternal mortality from 614 per 100,000 births in 2020 to 377 per 100,000 births in 2025;
• a reduction in infant and child mortality from 96‰ in 2020 to 60.5‰ in 2025;
• a reduction in neonatal mortality from 33‰ in 2020 to 22.5‰ in 2025.

Achieving these objectives involves implementing the three strategic axes of the PNDS 2021-2025:

• Axis 1: Improving governance and health financing;
• Axis 2: Strengthening the supply and accessibility of quality healthcare for the population;
• Axis 3: Enhancing health promotion and the fight against diseases.

The Ivorian public health system is pyramid-shaped, with an administrative or managerial side and a healthcare provision or service provider side.

The administrative or managerial side of the health system, organized into three levels, includes:

• At the central level: the Minister's Office, Central Directorates and Services, and health programs. These structures are responsible for defining policy as well as providing support and overall coordination of health;
• At the intermediate level: 33 Regional Directorates that support the 113 health districts in implementing health policy;
• At the peripheral level: 113 Departmental Health Directorates or Health Districts responsible for coordinating health actions within their territorial jurisdiction and providing operational and logistical support to health services. Furthermore, the health district, which constitutes the operational unit of the health system, is subdivided into health areas that represent the service area of a primary healthcare facility.

The healthcare provision or service provider side is also organized into three (03) levels:

• The primary or peripheral level consists of all public health facilities that provide a first point of contact for users to deliver curative, preventive, educational, and promotional services. It increased from 1,964 Public Primary Healthcare Facilities (ESPC) in 2015 to 2,490 in 2021;
• The secondary level includes all public healthcare facilities that provide first-line care for cases that cannot be handled at the primary level. These facilities have a more extensive technical capacity for diagnosis and treatment. This includes public General Hospitals (HG), Regional Hospital Centers (CHR), and Specialized Hospital Centers (psychiatric hospitals in Bingerville and Bouaké). The number of these facilities increased from 82 to 102 for HG and from 17 to 20 for CHR from 2016 to 2021.
• The tertiary level consists of all public health structures that provide second-line care for cases that cannot be handled at the secondary level and possess technical capacity for diagnosis, treatment, training, and research. It mainly consists of National Public Establishments (EPN) which are:
  • five (5) University Hospital Centers (CHU): Cocody, Treichville, Yopougon (closed since 2020 for rehabilitation), Bouaké, and Angré;
  • five (5) National Specialized Institutes: National Institute of Public Health (INSP), National Institute of Public Hygiene (INHP), Raoul Follereau Institute of Côte d'Ivoire (IRFCI), Pierre Richet Institute (IPR) for the management of trypanosomiasis, Abidjan Cardiology Institute (ICA);
  • five (5) other National Public Support Establishments: National Blood Transfusion Center (CNTS), National Public Health Laboratory (LNSP), Emergency Medical Assistance Service (SAMU), National Center for Prevention and Treatment of Kidney Failure (CNPTIR), National Center for Medical Oncology and Radiotherapy Alassane Ouattara (CNRAO).

Since 2015, the healthcare service offer has progressed, benefiting from an increase in health infrastructure, notably through the construction of new facilities, rehabilitation, equipping or re-equipping hospitals, as well as standardization and improvement of the technical platforms of health structures in accordance with the PNDS 2016-2020 and 2021-2025.

Evolution of public health infrastructure from 2015 to 2021     

Source: Ministry of Health and Public Hygiene, 2021

* The CHU of Yopougon has been under rehabilitation since 2020

Note: The decrease in the number of beds over the years is due to the non-functionality of certain beds that have either been amortized or have suffered damage. The closure of the CHU of Yopougon in 2020 would also explain the decrease.