Major reforms have been undertaken since the late 1970s in order to reduce inequalities between the access to health care different segments of the population. These reforms also sought to improve the performance of health facilities in their activities. This thesis seeks to measure the levels of efficiency and equity in the health system in Senegal. The thesis is organized into three chapters. The first chapter analyzes the use of public health spending in the first two decades of post-independence. This analysis allows us to understand the root causes of inequalities in access to care. It focuses on the role played by social networks and groups in explaining underperformces within the health sector. Chapter 2 is devoted to the measurement of technical efficiency of hospitals and health centres, following the various reforms in the health sector. Chapter 3 measures inequalities in use of health care. The decomposition method of inequalities in the use of care enables the fairness of the distribution of healthcare to be judged. A simulation on the allocation of patients was then undertaken to analyze the role of addressing patient in equity research in the health care system.
