French Overseas Local Authorities
French overseas local authorities enjoy an enviable situation compared with the subregions with their respective statuses, making them a driving force in subregional health development, but there are however lags compared with Metropolitan France in terms of population health and medical and sociomedical care.
Issues in French overseas local authorities
An unfinished catching-up process
The gap with Metropolitan France in the health sector may be closing but healthcare delivery must be completed and modernized. Considerable efforts must also be made in coming years in the sociomedical sector with the demographic structure of some local authorities becoming parallel to that of Metropolitan France.
Such gaps can be illustrated by:
- poorer health indicators: lower life expectancy at birth, relative overmortality, higher maternal mortality, higher perinatal mortality;
- specific epidemiological profiles: infectious and tropical pathologies (such as malaria, dengue fever, filariasis); pathologies more frequent overseas (such as drepanocytosis, diabetes, arterial hypertension, chronic renal insufficiency, alcoholism, HIV/AIDS,
hepatitus B); psychiatric pathologies and addictions etc. - lower healthcare and lower rates of hospital users;
- population ageing, which on average remains lower than in Metropolitan France: INSEE, the French National Institute of Statistics, forecasts that the percentage of people who are 60 or older will reach 33% of Guadeloupe’s population by 2030 (compared with 14.4% today in Guadeloupe and 21% in Metropolitan France). The number of people aged 75 or over will reach 130 000 in the French Antilles compared with 40 000 today;
- a markedly lower supply of establishments for the old or disabled: the equipment rate for accommodation beds is 13.6 for 1 000 people aged 75 and over in Guadeloupe and 130 for 1 000 in Metropolitan France.
Catching up will therefore imply a global approach integrating health and sociomedical issues with the participation of public and private stakeholders and associations.
Different needs in expertise
The hospital sector in French overseas departments (DOM) benefits from the same regulatory and technical framework as other French departments. Planning and system regulation in particular are managed by Regional Hospitalization Agencies (ARH). This is not the case in the other French overseas local authorities which only depend on local government services and do not have specialized and/or devolved State bodies. In some cases additional sectoral expertise can therefore provide valuable inputs.
In the sociomedical sector weaknesses stem from the lack of a single specialized authority, but are also due to the diversity of actors, the lack of policy visibility and the fragmentation and size of some operators. This sector can therefore require expertise and help in programming and support.
The issue is to provide targeted answers tailored to the needs of each authority and sector in terms of population care.
French overseas local authorities: regional integration
The geographical situation of French overseas local authorities means they are particularly exposed to emerging and reemerging pathologies. At the same time many are located in regions facing significant social and economic imbalances and are confronted with uncontrolled migratory flows.
Regional cooperation actions exist in the health sector but are often limited and fragmented and are not always within a coherent framework for strengthening health systems. French overseas local authorities have material and human resources and could make a greater contribution to developing healthcare in the region.
AFD interventions in French overseas local authorities have two goals: (i) to contribute to upgrading and modernizing hospital supply and support the development of sociomedical care; and (ii) to strengthen synergies between neighbouring States in terms of health development.
Modernizing hospital supply and developing sociomedical care
AFD, in line with its mission to support public policy and decentralized authorities, contributes to the process of catching up and modernization of healthcare as well as to the development of sociomedical care in French overseas local authorities.
a. Support to the hospital sector
In order to improve the quality of the projects submitted to it, and participate in enlightening specific, little known problematics, AFD develops a technical dialogue with all stakeholders and initiates studies whenever necessary.
In the DOM regulatory and expert authorities exist in the health sector (ARH for instance) as well as strategic orientation documents for establishments(SROS). In addition, AFD support has been proposed in sectoral reflection and in technical and financial investment planning. This support, without being systematic, may be envisaged in particular in the areas of (i) financial analysis, (ii) legal expertise in public-private collaboration (public-private partnerships) and (iii) New Information and Communication Technologies, particularly telemedicine.
Outside the DOM and Mayotte AFD support can be enhanced through participating in strategic framework design as some local authorities lack ad hoc expert structures for such design; AFD can, for instance, support local authorities in designing healthcare organization programmes and systems for old people and/or the disabled.
AFD currently has limited activity with private establishments in French overseas local authorities, whereas such actors also participate in the implementation of public policy: their interventions are regulated, their systems require authorizations from public authorities and patient expenditure is at least partly collectivized. Upgrading is therefore an issue for private establishments whether they may be associations (non-profit making) or commercial; moreover, there can be geographical areas with a majority of private sector coverage which therefore gives it a public service mission; AFD has proposed to examine ways and means to operate with private establishments.
b.Support to care for the dependent
Sociomedical establishments and services have the mission of caring for “fragile” people (old people, the disabled, people suffering from precariousness or exclusion); French overseas local authorities have considerable lags in this area. The sector is marked by
a wide range of actors, whether financial or regulators, which leads to difficulty in policy design and implementation. Operators are often small scaled with a lack of skilled human resources in management and administration and meet considerable difficulties in project implementation. Moreover, the law does invite actors to develop consultation in policy design and supervision. On the basis of identified needs and requests AFD could make an effective contribution in supporting public authorities in pluriannual programme design for sociomedical establishments and services which would need to be created or transformed.
Developing synergies with neighbouring States
In line with the orientations of the June 2006 inter-ministerial committee for international co-operation and development (CICID) which underlined the specific role of French overseas local authorities in the implementation of regional cooperation policy and their considerable leverage effect thanks to means they have at their disposal (regional cooperation fund, Pacific fund, INTERREG European fund), AFD aims to foster and support regional cooperation actions within the framework of its projects.
Indeed, French overseas local authorities can contribute to developing quality healthcare in the countries of their respective subregions. In return, strengthening regional synergies must contribute to the creation of favourable conditions to support health security thanks to joint monitoring of epidemic risk. They can also contribute to improving the balance of migratory flows. Finally, such actions can contribute to making French overseas local authorities hubs for expertise and regional support.
AFD’s main activities within this framework are:
- to support the design of a coherent intervention framework for regional cooperation and bilateral projects with each intervention taking place within a logic of complementarity and mutual strengthening;
- to encourage the participation of French overseas local authorities in actions to strengthen the health systems of neighbouring States by:
- mobilizing available medical, paramedical and managerial expertise during project implementation and for future supervision;
- training professionals in their respective subregions;
- initiating and supporting regional cooperation actions in partnership with local stakeholders in order to strengthen epidemic monitoring and control systems.