Gouvernance hospitalière à Madagascar

Toky Lalaina Ranaivosaona
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Toky Lalaina Ranaivosaona: University of Antanarivo, Madagascar

Les Cahiers du CEDIMES, 2025, vol. 20, issue 3, 26-37

Abstract: Our bureaucratic model of director governance is based on the ideas of Max Weber. It is then combined with professional bureaucracy with characteristics of an organic structure and a duality of hierarchical power between the legal-rational power of administrators and the charismatic power of doctors. However, this tension eases during the negotiation of the budget for the hospital by the Director. The principal agent model is a pragmatic way to manage the needs of a hospital when the supervising Ministry cannot determine these needs precisely. On the other hand, this lack of knowledge of statistical information on payments in hospitals increases the risks of management inflating the organization's budget. The hospital administration and coordination programs arise from the Annual Work Plan (PTA), in accordance with the finance law and provided for by the Medium-Term Expenditure Framework (CDMT). The Ministry of Public Health develops the Health Sector Development Plan (PDSS), evaluated by the legislature according to the principle of separation of powers.

Date: 2025
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DOI: 10.69611/cahiers20-3-02

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