Mauritania’s New Health Reform
Analysis of Mauritania’s health reform, covering low coverage, doctor shortages, territorial inequalities, infrastructure modernization, governance and care financing.
In Mauritania, health is both a social emergency and a structural challenge. Low health coverage, a severe shortage of doctors, unevenly distributed infrastructure and chronic medicine shortages mean the system struggles to meet the needs of a population in which more than three quarters fear they may not be able to receive care. Faced with this crisis of trust and marked territorial inequalities, the government is launching a major reform, backed by an unprecedented budget and built around strategic levers to sustainably transform the health landscape.
A Weakened and Unequal Health System:
Mauritania’s health system faces deep structural weaknesses. The Afrobarometer study conducted between December 2024 and January 2025 highlights these fragilities. Among them, the severe shortage of qualified medical personnel, with only 26 doctors per 100,000 inhabitants, a ratio far below international standards (World Health Organization), is a major obstacle. This is compounded by the high cost of care and frequent shortages of medicines or medical equipment, which further weaken access to treatment.
These difficulties are aggravated by limited health coverage: only two Mauritanians in ten have health insurance, mainly through the state or the civil service. This low level of protection fuels concern: more than three quarters of the population fear they will not be able to obtain care or finance the necessary treatments.
Geographic accessibility is another determining factor in the fragility of the health system. While 64% of areas in the country have at least one public or private health facility, 36% have none at all, deepening territorial inequalities in access to care.
These fears are reflected in patients’ everyday experience. Nearly six citizens in ten recently used a public health center, but most encountered serious obstacles: 88% report excessive waiting times, 73% cite a lack of staff and 76% point to medicine shortages and aging infrastructure. More worryingly, three patients in ten say they had to pay a bribe or grant a favor to access care.
An Ambitious Reform Serving Public Health:
To respond to these difficulties, Mauritania’s Minister of Health has launched an ambitious reform, with particular attention to the most vulnerable populations. The 2025 budget allocates 56.5 million dollars to the sector, reflecting a significant financial commitment to improving the national health system. The objective is clear: restore citizens’ trust, which is now weakened, since 23% of the population say they have no trust at all in the Ministry of Health. To achieve this, Nouakchott is relying on several levers:
Strengthening Infrastructure
This involves building and rehabilitating numerous care centers across the country, including the modernization of the National Blood Transfusion Center (CNTS) and the Regional Blood Transfusion Center (CRTS) in Kiffa. This is accompanied by the commissioning of several regional referral hospitals and new district hospitals, as well as the planned construction of three additional hospitals.
Modernized and Improved Governance
To ensure new governance for the sector, Mauritania is conducting a permanent and active fight against corruption while promoting a real culture of transparency in the management of health facilities and programs. This also involves strengthening the regulatory framework, with specific measures governing the private sector to ensure that it complements the public sector in providing care.
Better Allocation of Human Resources
This involves recruitment and staff reinforcement. In 2024, the Ministry of Health had already integrated around 700 health workers, across all categories, to address the shortage of qualified personnel. To retain and motivate these resources, the reform provides for more equitable career management and the regular payment of bonuses and other incentives. The objective is twofold: reduce the skills shortage and strengthen health professionals’ engagement. In addition, better coordination between central, regional and local levels of governance is being introduced, ensuring more coherent and inclusive steering of human-resource allocation.
An Overhaul of Financing Mechanisms
Ideally, this overhaul would involve establishing universal health coverage and making care broadly free of charge. However, the country’s economic context makes these goals difficult to achieve, and the still embryonic network of mutual insurance schemes cannot effectively support the expansion of health insurance.
Faced with these constraints, the government has chosen an alternative: activity-based pricing (T2A), or payment per act. This mechanism consists of remunerating hospitals according to the number and type of acts actually performed. It aims to improve system efficiency, strengthen resource management and traceability, and allow the care offer to better adapt to population needs.
Conclusion:
The reform of Mauritania’s health system represents far more than a simple technical adjustment: it embodies an attempt to break with a model marked by persistent inequalities and growing citizen mistrust. By combining targeted investment, stronger governance, infrastructure modernization and optimized human resources, the country aims to lay the foundations for a more equitable and resilient system. But beyond intentions and allocated budgets, the real challenge lies in maintaining this momentum over the long term and translating promises into tangible results.