Pooling of healthcare: challenges and perspectives of mugef-ci within the framework of universal health coverage in Côte d'Ivoire

In Côte d'Ivoire, Universal Health Coverage (UHC) aims to ensure equitable access to healthcare for the entire population. The General Mutual of Civil Servants and State Agents (MUGEF-CI), the main mutual health organization for civil servants, plays a key role in integrating state employees into the UHC system. However, this integration comes with several governance challenges, particularly concerning the coordination of services, the management of human and financial resources, and the quality of care. This study explores governance practices in facilities affiliated with MUGEF-CI, identifies the challenges encountered, and proposes solutions to improve healthcare management within the UHC framework. The methodology is based on a mixed approach combining 30 semi-structured interviews with MUGEF-CI officials, hospital managers, and Ministry of Health representatives, along with a quantitative survey conducted among 100 users to assess their satisfaction. The analysis relies on systems theory to understand governance dynamics. The results reveal poor coordination between MUGEF-CI and hospitals, inadequate management of human and financial resources, and limited participation in decision-making processes, which affects the quality of care. About 45% of users express dissatisfaction with the waiting times for care. Modernization initiatives, such as the digitization of hospital services and the implementation of monitoring and evaluation mechanisms, are currently underway to improve the situation.