The death was "preventable". This was explained by an official of the Ivorian Ministry of Health, after the death of a woman on April 15 in the commune of Abobo, north of Abidjan, following a difficult delivery. She had been treated in a clandestine clinic that has since been closed by the authorities.
This dramatic event illustrates a recurring problem that Côte d'Ivoire has been experiencing for ages: clandestine private clinics. On the Ivorian territory, they would be about 1,700, according to the Ministry of Health, to exercise without the law authorizing them. "It is a real danger to the health of the population," said Dr. Joseph Boguifo, former president of the Association of Private Clinics of Côte d'Ivoire (ACPCI). "If there's one place where you shouldn't have fun, one place where you shouldn't be light, one place where you have to be 300% rigorous, it's the health sector," he said.
Despite state measures to regulate the sector, illegal clinics continue to emerge. These establishments generally do not have legal documents to practice. Their staff is not qualified and their equipment is rarely adequate.
The Ministry of Health, Public Hygiene and Universal Health Coverage initiated, in October 2022, the operation "Zero illegal clinics by 2025". © Angel Nomenyo, France 24
On 17 March, in the town of Aboisso, 80 km from Abidjan, another pregnant woman died after undergoing a high-risk caesarean section at a private clinic in the city. Two weeks before his death, the facility had received orders from the Ivorian authorities to close the operating theatre because it was no longer functional. "The death did not occur on the operating table... It was a few days after that complications caused the tragedy, "said an official of the clinic, which has permanently closed the doors of the establishment.
Such events prompted the Ivorian authorities to act. To stop the expansion of these clandestine structures, the government launched Operation "Zero illegal clinics by 2022" in October 2025, accompanied by a two-month awareness campaign. Since then, the objective has been to close all health facilities that operate without authorization and without any respect for the standards in force. "Evolving in legality means having an order on opening and exploitation, issued by the Minister of Health. Health facilities that do not have an authorization or whose authorizations are not up to date are illegal," says Dr. Marie-Josèphe Bitty, director of private institutions and health professions at the ministry. According to her, a sanitation operation is necessary in view of the large number of private health establishments that operate illegally and endanger the health of the population.
The operation "Zero illegal clinics by 2025" began with an awareness stage, then entered the phase of repression, i.e. dismantling, from December 9, 2022. A clandestine clinic closed in Grand Lahou, southern Côte d'Ivoire. © Angel Nomenyo, France 24
Street checks have multiplied in the different regions of Côte d'Ivoire since the launch of this operation. On 3 April, France 24 followed a team of three Ministry of Health officers into the field. The forceful raid that day targeted a private clinic in the Zuénoula district, in the city of Bonoua, 60 km from Abidjan. Dr. AhoussiBozou and his two colleagues, dressed like him in orange vests, find two nurses in the facility with three hospital rooms and a delivery room. In the latter, the operating table is obviously not in good condition. At the request of the officers, one of the two women in a white coat presented documents that did not match those required. The health workers then ordered the immediate closure of the establishment: "To be in order, it would have been necessary for it to present us with a certificate of compliance signed by the Ministry of Health. Without this certificate, the clinic does not have the right to practice, "says the head of agents.
An aggravating circumstance is that the search of the establishment reveals unlisted medicines, apparently provided by a medical delegate in exchange for the payment of a sum of money by way of commission. Health workers then seize the medicines, which they consider fake. They add that medical representatives are not allowed to sell medicines to clinics and private health facilities. The substances they make available to clinics are actually samples of untested products, which can harm the health of patients. "Those who commit such practices are liable to a prison sentence of 20 years and a fine of 10 million CFA francs," said the head of health workers.
Trafficking in fake medicines is rampant in Côte d'Ivoire. The authorities are stepping up their fight against this criminal activity. © Angel Nomenyo, France 24
According to official figures, Côte d'Ivoire has about 2,000 private clinics and facilities on its territory, of which only 280 are licensed to operate. For the Ivorian sociologist Albert Yao, this problem results from the fact that the supply of medical care is quite low: "From a sociological point of view, illegal clinics fill the gap in care supply by their proximity and the costs charged, but above all, in these so-called illegal clinics, the reception of patients is immediate. These clinics are available and open all day, 24 hours a day, seven days a week, unlike public facilities. It would be wiser to bring illegal clinics to legality rather than close them," concludes the sociologist.
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Since the launch of the operation "Zero illegal clinics by 2025", a hundred establishments have been closed on the Ivorian territory. The dismantling operations, which are continuing, will now target the outlying districts of the city of Abidjan, and the Agnéby-Tiassa region in southeastern Côte d'Ivoire.
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