HISTORY
The Saint-Louis hospital was one of the first to be founded by naval physicians in colonial service, for French and native soldiers and civil servants.
Alongside this population of metropolitan origin, the number of native populations increased as the empire expanded and their demographics rose. Established in 1822 as the first hospital in Black Africa, it is now a UNESCO World Heritage Site.
Saint-Louis’s hospital, now several hundred years old, existed under the name of Hôpital Militaire in colonial times. First entrusted to naval physicians, then to the Colonial Medical Corps, it was transferred to Senegal in 1960, where French military personnel served for another thirty years. It is the reference center for southern Mauritania, the Matam, Saint-Louis and Louga regions.
- Military Hospital
It is indicated that it was in 1681 that the Ordonnance Royale, in this case article 6, allowed the creation of the Hôpital de Saint-Louis. In 1822, a huge building was erected on the west façade, on the site of a former military fort. In 1829, the staff consisted of one (1) chief physician, two (2)4th class medical surgeons, one (1)1st class health officer, and one (1)2nd class pharmacist. From 1865 to 1898, development work continued under Governor FAIDHERBE. In fact, it was from this point on that most of the construction work was carried out.
- The Colonial Hospital
These hospitals were run by the Colonial Health Service, assisted by various native staff, in particular auxiliary doctors and pharmacists.
- Administrative and financial
The 1890 regulations stipulate that the director of the colony’s health service is also the hospital’s head physician. The establishment is placed under the authority of the governor. Administrative and financial responsibilities fell to the colonial commissioner, successor to the naval commissioner.
From 1895 onwards, the operation of hospitals open to civilians and natives was modified: the head physician had a manager and full authority over the staff. Soon, this was no longer possible, and the hospital’s Chief Medical Officer was separated from the Director of Health.
The most original element is certainly the financing of these establishments. A meagre income (which goes to the Treasury) comes from individuals admitted at their own expense for outpatient or inpatient treatment. But the hospital is funded by the colony. There’s no question of balancing the budget. Ninety percent of patients are cared for by the public authorities: soldiers and civil servants, Europeans and natives, as well as the mass of people receiving free assistance. Like other public services and the health service as a whole, the hospital is a free service for the user.
- In human terms
It took a long time to “tame” the population. Cultural reticence, competition with traditional medicine, the fact that patients are separated from their families, etc., were all factors that had to be gradually overcome.
In the field of training, the colonial hospitals work closely with the Pasteur Institutes, where cutting-edge research is carried out.
- Saint-Louis Hospital from 1900 onwards
In 1903, the hospital became secular, and in 1927 it merged with the civil hospice (built in 1840 on the current site of the Lycée Ameth FALL) to become the Colonial Hospital of Saint-Louis.
The hospital had undergone several renovation programs. The first program was carried out between 1927 and 1934, while the second was financed by the European Development Fund to the tune of 4 169 750 000 F CFA.
In 1960, it became a regional hospital, a status it retained until 1998. Since then, 17 directors have succeeded one another at the head of the hospital.
The hospital has been named after the physician lieutenant colonel Mamadou DIOUF since August 29, 1983 (Arrêté n° 11 .311/MSPAS).
ORGANIZATION AND OPERATION
The implementation of the reform is characterized by a context of change, with the introduction of the structuring notions of service quality, logic, performance, management autonomy, legal personality, transfer of skills and multiple institutional anchoring.
The result is a new object structure, with the public service mission remaining unchanged.
Administrative, financial and accounting measures and management tools have been developed and implemented at all sites. Their implementation leads to more transparent management practices.
Management procedures and tools have been developed by management experts who have produced :
- a hospital organization manual ;
- a management control manual ;
- an administrative, financial and accounting procedures manual ;
- a human resources procedures manual ;
- a hospital chart of accounts ;
- a medical information system ;
- an IT master plan.
Hospital projects have been drawn up. They represent a strategic development plan defined on the basis of an analysis of the existing situation. They help to project the hospital into the future, develop team spirit and motivate staff by involving them in defining the hospital’s strategy.
The reform takes account of the recent law on decentralization, which gives local authorities new prerogatives in the management of healthcare establishments. In this context, the Chairman of the Conseil Départemental is ex officio Chairman of the Board of Directors of the establishment located in his region. It also proposes the four personalities to sit on the Board.
The State and local authorities provide hospitals with the funds they need to fulfill their missions, in particular to deal with emergencies and keep charges at an acceptable level. Users contribute to hospitalization and outpatient expenses.
To drive the necessary institutional and managerial changes, a Health Establishments Department has been set up in the form of projects supported by funds ; among other tasks, it is responsible for recruiting and training management executives, who it then makes available to the PSEs.
A: Institutional and organizational aspects
New departments are created in hospitals : a nursing department and an administrative and financial department. An accounting officer is also appointed, as is a management controller.
The main bodies set up by the reform are : the Board of Directors (Conseil d’Administration – CA), the Institutional Medical Committee (Commission Médicale d’Etablissement – CME) and the Institutional Technical Committee (Comité Technique d’Etablissement – CTE).
- Board of Directors
The Board includes representatives of the administration, local authorities, the medical and pharmaceutical professions, qualified personalities and representatives of social security organizations. Staff are also represented on the board, as are representatives of the general public.
The Board approves the operating and investment budget. It deliberates on the budget, forecasts, year-end accounts and loans. It therefore sets the price of services within a price range established by the authorities.
- Medical Commission
This commission is chaired by a doctor who works closely with the Director. It is consulted on all issues relating to care and promotes the evaluation of the quality of care within the establishment. It places particular emphasis on empowering doctors.
- Plant Technical Committee
In addition to the physician representative, one member from each staff category is elected by his or her peers. The hospital director chairs the Technical Committee. The role of this consultative body is to involve technical staff in resolving problems relating to health, safety and training.
With the adoption of the hospital reform, hospitals are structured institutionally and organizationally like a company. At institutional level, hospitals have acquired management autonomy, with advisory bodies for administrative and financial organization, in order to provide a public service at lower cost. The director, appointed by decree , enjoys considerable freedom in carrying out his program. It is supervised by the Board of Directors. In this way, the Chairman of the Board carries out an a priori check on funds, before the budget is voted, and a post facto check on what has been achieved.
B: On a managerial level:
Through management, hospitals seek to achieve a precise objective by focusing on human and material resources. In addition, there is the harmonious combination of 6 well-defined elements:
- Raising skill levels across the board through a proactive policy of developing know-how focused on quality of care and management performance.
- Strengthening the organizational structure by empowering workers.
- A global communications policy initiated, planned and implemented by the staff, using a variety of communication media to get closer to the public.
In addition, users and workers can express themselves freely on issues that concern them on radio talk shows. They also serve to popularize information, promote behavioral change and raise awareness of health-related issues.
C : Financial aspects
- State and local authority budgets
The budget can be defined as a valued action plan to achieve a dated and qualified objective.
In general, the target is set for a one-year period, corresponding to the duration of the budgeted financial year.
As in many countries around the world, the Senegalese government’s health sector development policy allocates a budget to each facility, according to its category. Through this policy, the State aims to make health services accessible to all social strata. It’s a policy that lowers the cost of patient care.
Hospitals in Senegal receive annual subsidies from the State and local authorities. On average, this state subsidy represents 53% of the hospital budget. The remainder of the hospital’s budget is made up of contributions from the general public (11%), local authorities (5%) and partners (30%).
- Self-financing
Hospitals need to be able to rely on their revenues to complete the financing of their projects. Let’s not forget that the aim of the reform is to delegate powers from the State to the hospitals, so that the latter can become autonomous in institutional, organizational and, above all, financial terms, because the State was encountering many difficulties in managing its hospitals, especially financially. In principle, EPSS revenues should be used to pay for some of their staff and make up for financial shortfalls, as the budget allocated by the State is never sufficient.
3-Mission of public health institutions
Public health care institutions must ensure :
A public service mission: they ensure equitable access to quality care for all populations;
A specific mission revolving around :
- Treatment of the sick and prevention of certain diseases;
- Human resources development ;
- Research and the dissemination of its results in the health field.