The opening of new clinics helps to combat epidemics by providing rapid prevention and treatment services, which limit the spread of diseases and reduce mortality rates (53).

The opening of new clinics would contribute to solving the accessibility gap in access to health services (52).

The opening of new clinics approved for universal health coverage will help lower healthcare costs for the most vulnerable populations.

The opening of new clinics would increase bed capacity, allowing for the treatment of more patients and reducing waiting times.

Increased medical waste and resource consumption (water, energy) from expanded healthcare services could lead to environmental degradation if not properly managed.

Poor management of medical waste (e.g., syringes, chemicals) could lead to environmental harm, such as water or soil contamination.

The growth of private clinics can drive up healthcare costs by focusing on profitable services like elective procedures over essential or preventive care, increasing expenses for Universal Health Coverage reimbursements.

Private clinics may attract skilled healthcare professionals away from public hospitals with better salaries and working conditions, leading to a shortage of qualified staff in the public sector.

If the clinics face operational issues, such as inability to recruit qualified personnel, especially if located in rural areas and far from medical schools, the impact on access to healthcare may be smaller than expected.

Poor transportation and logistics infrastructure can delay the supply of essential medical supplies, either from local manufacturing plants or through imports, affecting clinic operations and patient care.

If the establishment of clinics is limited to large cities, the effect on health inequalities could be limited.

If clinics are insufficiently covered by the Universal Health Coverage, either due to extended registration times or regulatory delays, the impact may be limited to privileged patients.

Gender inequality and/or marginalization risk: If a system of price controls or incentive mechanisms is not established, clinics may primarily service higher-income individuals or urban populations, leading to unequal access.

Expand access to health care services, covering prevention and treatment of essential and advances diseases.

The National Health Development Plan 2021-2025 outlines initiatives to improve health and reduce maternal and infant mortality. These include the construction of health facilities and increased training of healthcare workers (2).

The National Development Plan 2021-2025 outlines the government's health strategy, including increasing the number of health centers, improving service quality, and enhancing maternal and child health (11).

The National Strategic Plan for the Integration and Development of the Private Health Sector 2021-2025 (Plan Stratégique National d'Intégration et de Développement du Secteur Privé de la Santé or PSN-IDSP) aims to improve the healthcare system in Côte d'Ivoire by strengthening the governance of the private health sector, improving access to healthcare services, notably by encouraging the establishment of private clinics, and promoting public-private partnerships (22).

Financial incentives: Following the 2014 Law establishing universal health coverage, the UHC covers 70% of the insured's health expenses, which will increase demand for private clinics by allowing lower-income individuals to get treated in private institutions (44).

Other incentives: The International Finance Corporation (IFC) has been involved in structuring Public-Private Partnerships (PPP) for affordable healthcare services, including diagnostic and laboratory facilities in 14 hospitals (27).

Other incentives: Proparco, a development bank, provides loans to companies in the healthcare sector (particularly clinics and imaging centers), with a minimum amount of 10 million euros (USD 10.8 million) (49).

Other incentives: The International Finance Corporation's Medical Equipment Access Program helps healthcare SMEs in East and West Africa secure local currency loans for essential equipment. With USD 300 million in financing, it uses risk-sharing with financial institutions and manufacturers, while offering technical assistance to improve financial management and equipment acquisition (58).

Decree No. 96-877 (1996) "Concerning the classification, definition, and organization of private healthcare facilities" details the classification and regulations applicable to the establishment of private health centers (42).

Loi n° 2019-677 "guiding public health policy in Côte d'Ivoire" acts as a new public health code. Article 73 indicates that the government promotes the private health sector, and that the creation and operation of health centers is subject to regulations (41).

Decree No. 2013-792 requires public primary care establishments in Côte d'Ivoire to source all medicines through the state-controlled Nouvelle Pharmacie de Santé Publique. It aims to centralize the procurement and distribution of medicines and strategic inputs to ensure accessibility (24).

Order No. 316/MSHP/CAB was issued in December 2020 by the Ministry of Health, Public Hygiene and Universal Health Coverage to prohibit private health establishments without operating rooms from conducting deliveries (39).

Law No. 2014-131 institutes the Universal Health Coverage and outlines its terms of application (43).

Novamed, Association des Cliniques Privées de Cote d'Ivoire, Confédération Générale des Entreprises de Côte d’Ivoire (CGECI), Nouvelle Clinique Farah, Polyclinique internationale Sainte-Anne-Marie (Pisam), Clinique Notre Dame de l'Incarnation.

Centre de Promotion des Investissements en Côte d’Ivoire (CEPICI), Ministry of Health and Public Hygiene, Ministry of Economy, Ministry of the Economy, Planning and Development, Nouvelle Pharmacie de Santé Publique.

Joint United Nations Programme on HIV/AIDS (UNAIDS), International Finance Corporation (IFC).

Santé Espoir Vie – Côte d'Ivoire (SEV-CI), Proparco.

Vallée du Bandama is the second most affected district in terms of difficulties in obtaining medical care (52% of the population). Access to healthcare remains limited, with 8 healthcare professionals per 10.000 inhabitants (4, 50, 60).

The Sassandra-Marahoué district is characterized by high unmet need for family planning (24%, the third highest). Establishing facilities in western towns, such as Daloa, would contribute to alleviate the health burden on public institutions, as the health situation is considered critical in this area (4, 51).

In Bas-Sassandra, 35% of surveyed inhabitants declared having experienced difficulty in accessing healthcare over the last 12 months (either having to wait for very long period or having not received any assistance). The district also benefits from support from International Finance Corporation's programme for access to medical equipment in Africa, which benefits private clinics, hospitals and other health facilities (50, 61).

Health needs are high in the Savanes district, with 77 % of children (6 to 59 months) suffering from anaemia. Vaccination rates (DPT-HepB-Hib, OPV2, IPV) are also lower than the national average. Additional clinics would help improve the health situation in the area, which is considered critical (4, 51).