Despite some improvements, Niger's healthcare system remains fragile, characterized by "unwelcoming medical practices." Reform policies, often funded by international aid, struggle to adapt to the local realities of healthcare services. However, some facilities are providing better quality care thanks to "local reformers" who develop innovative solutions adapted to daily challenges, despite precarious working conditions. This article analyzes these local innovations using ethnographic data and proposes to explore "bottom-up" approaches to reforming the healthcare system, in addition to current strategies.

Governance, Public Administration, Health, Politique publique, Healthcare system

The article highlights the shortcomings of Senegal's healthcare system, exacerbated by floods that affected hospitals such as the regional hospital of Kolda and the Aristide Le Dantec hospital in Dakar in July 2022. These incidents raise questions about the funding and efficiency of resources allocated to health. Despite international commitments, Senegal has not yet reached the goal of allocating 15% of its budget to health, with only 10% in 2019. The article calls for reflection on sector governance, staff training, and adaptation to technological advances, including artificial intelligence, to improve the quality of care and meet the needs of the population.

Governance, Healthcare system