Community-based health facilities (ESCOMs) are facing an unprecedented financial crisis. On April 30, 2026, during a press conference in Yopougon, the National Confederation of the sector sounded the alarm: the State owes these essential structures nearly four billion CFA francs .

A pillar of the healthcare system on its last legs

Although private and non-profit, ESCOMs are the country's first line of defense in healthcare, particularly in Greater Abidjan where they provide 80% of primary care . Their mission is crucial for:

1. Targeted free access (pregnant women, children aged 0 to 5).
2. Monitoring of chronic diseases ( HIV, tuberculosis ).
3. The deployment of Universal Health Coverage (CMU) .

The paradox of a fragile economic model

Unlike public hospitals, ESCOMs do not receive a direct operating budget from the state. They depend solely on reimbursement for services rendered.

"From 2011 until the end of December 2025, we have accumulated approximately four billion CFA francs in unpaid arrears," said Ouattara Clément , president of the Confederation.

Alarming consequences

The payment delays, which sometimes stretch over six months, paralyze the daily operations of the centers:

1. Social: Chronic difficulties in paying salaries and CNPS contributions.
2. Logistics: Inability to pay suppliers and maintain medical equipment.
3. Quality of care: Risk of shortage of supplies and deterioration of equipment due to lack of replacement.

The managers' plea for help

While stakeholders welcome the growth of the CMU (22 million enrolled), they emphasize that the sustainability of this system depends on the financial health of health centers. Without urgent debt settlement by the State, access to healthcare for the most vulnerable populations is directly threatened.