After independence, West African states as a whole developed various strategies to improve their health systems and policies. In recent times, health structures in Togo have gone through enormous difficulties which impact not only the quality of care for the population but also the well-being of the providers themselves. The contractual approach was timely as a results-based management strategy. But data on the evaluation of the economic and financial performance of these health structures during this period of the contractual approach are lacking in the literature. This article fills this void by seeking to evaluate the contribution of the Results-Based Management System to the evolution of the financial and economic performance of the CHR Atakpame at the time of the contracting of the Center.
Referring to the instrumental theory of stakeholders, we took into account documentary data from 2017 to 2018 composed of financial and accounting reports, contracts and agreements between all stakeholders (government, staff, populations, contracting organization) during the contractual approach period. This made possible an analysis of textual data inspired by the linguistic analysis model of discourse and especially analyzes of textual data. The analysis of performance is from the angle of relevance (the different axes of the project), effectiveness (comparative turnover, comparative payment) and efficiency (allocation of resources to different expenses).
The results show that financial management is orthodox and the functioning of services is improved by the acquisition of materials and equipment, improved salary conditions, better care of the indigent and good management of the pharmacy. It appears important in terms of conclusion that the national health policy takes full ownership of this approach by duplicating this management strategy to other health facilities.
Keywords: Contractual approach, financial performance, GAR, CHR Atakpame.
