Table 1 Definitions of some concepts [30]

Health zone

A well-delimited entity (maximum diameter 150 km) contained within the limits of a territory or an administrative commune with a population of at least 100,000 inhabitants (with similar socio-cultural characteristics). A health zone provides health services at two interdependent levels (health centers at the first echelon and a General Reference Hospital at the 2nd echelon), under the supervision of a health zone Management Team.

Health Centre (primary health care structure)

A peripheral public health care structure that is run by at least one nurse (enrolled nurse or midwife, secondary education graduate). Its mission is to provide good quality integrated health care to a population (generally 10,000 inhabitants) within a defined geographical health area (less than 5 km by airway). The health center serves as the first contact with health systems offering a minimum package of care (consultation, basic curative care, maternity, immunization activities, and laboratory). Patients or vulnerable people are referred to the General hospital of Reference for special care such as surgical interventions to ensure that a better care pathway is followed (complementary package of care).

Health area

A geographic entity of the delimited health zone, composed of a set of villages in rural areas and/or streets in urban areas, established according to socio-demographic affinity criteria, with an average population size of 10,000 inhabitants depending on the area (rural or urban). A health center covers one health area

Reference health center

Any health care structure that carries out some specific activities usually provided by the General Hospital of Reference in addition to traditional health centers’ attributions. A reference Health Center is managed by a Medical doctor or at least a qualified nurse (with an advanced diploma or a degree).