This thesis analyzes the economic and social impacts of the marketization health car system in Djibouti. Since the late 1970s, all developed countries and developing, although with health systems based on the principles and different institutional arrangements (forms of financing, degrees of decentralization, availability of resources, etc...), are faced with the same problem : finance in a period of slower growth, a highly inflationary health sector. Therefore, the majority of countries have implemented reforms to their health care system. Developed countries mainly proposed ad hoc measures, often dictated by the need to balance health accounts. However, the measures proposed by developing countries are moving towards reforms. Under pressure from international financial organizations in particular, developing countries will change their health system to a disengagement of the State. The results of this thesis clearly show that in Djibouti, even if the transfer of ownership which corresponds strictly to privatization is rare in the health sector, public ownership of health care facilities shall not relieve the people of the care expenses. The downward trend of state subsidies, for public institutions of care and greater financial autonomy granted to them often leads to intervene in the market as a business selling services products. This makes the mostly requested health services unaffordable for the majority of the people. The expected benefit of the marketization of the health system, is however, affected by Djibouti the low contributory capacity of households.
