Abstract
Countries develop national health policies, strategies, and plans to overturn the global burden of disease. Managerial policy practice questions the policy share in the poor performance of public health facilities. We designed a descriptive observational study to analyze the root causes of low coverage of health services in municipal health facilities in Zio District. The study, a managerial policy analysis, covered the period of implementation of the 2012-2015 national strategic plan (NSP). Our findings showed that apart from vaccination, in which Tsévié and Agbélouvé performed well, municipal health facilities did not reach the targets of the 2012-2015 NSP. Health information system and health services delivery accounted for 51% of the dysfunctions causing the poor performance. Compliance with standards was the leading root cause (72%) of poor performance of municipal health facilities. More than two-thirds (68%) of the corrective policies were operational. The corrective policies must be enacted in 31% by the central level. The municipal health facilities also share a proportion of 31%. This study showed the important share of managerial policies, especially that of operational policies. The study adds to the previous ones to highlight the quality mindset needed in Togo health system. The next steps before the creation of a training program for quality specialists will have to resolve the questions of their number and assignment positions.