ABSTRACT
Local authorities play an increasingly important role in the area of public health. Contracting is therefore perceived as a solution, which would enable the rationales to be reconciled by making this redefinition of the relation between the State and local authorities operational. In the context of deconcentration, the allocation of resources remains the responsibility of the central power, while their management is the responsibility of the local level authority. Administrative decentralization, which transfers responsibility from major public authorities to local authorities with jurisdiction over a specific territory, whose legitimacy is derived from the election of their representatives, enables decision-making to be brought closer to the community level. The local authority has the possibility, through a contractual relationship, to bind these private structures to ensure that they improve their provision of healthcare-related activities. Local authorities that have acquired a mission in the health sector in the context of administrative decentralization are not, however, independent; particularly in developing countries.
