Case Study on the Local Health Contracts in France
Case Study on the Local Health Contracts in France and in the context of the SHAPE-med@Lyon project
What is the format about
A local health contract is an agreement between a local authority (city, metropolitan area, community of municipalities) and the Regional Health Agency. The objective is to adapt public health policies to the real needs of the local population, taking into account their specific characteristics. This multistakeholder governance model is central to the link between research and policy.
There are two priority objectives for local areas:
=> To reduce social and territorial health inequalities
=> To implement solutions for local healthcare provision.
The local health contracts (CLS) contribute to the development of local health dynamics. They enable the Regional Health Agency’s project to be aligned with the expectations of local authorities in order to implement actions that are as close as possible to the population.
Unlike major national strategies, local health contracts operate on the local level, aiming to reduce social and regional health inequalities and improve access to care.
How does it work
The Local Health Contract operates primarily on the basis of a shared regional diagnosis. Local stakeholders, universities (including scientists), healthcare professionals, associations, and residents participate in analyzing the health situation: the population’s state of health, living conditions, access to care, etc. This diagnosis makes it possible to define priorities for activity that is tailored to current conditions on the local level.
Once the strategy has been established, the local authority and the Regional Health Agency sign a contract that is valid for an average of five years. The contract covers several strategic areas (prevention, mental health, environmental health, youth health, etc.) and sets out a series of practical actions.
In Lyon, for example, the Local Health Contract for 2022-27 presents more than 40 actions organized around four main areas and a cross-cutting focus on environmental health.
The Local Health Contracts are managed by a steering committee that includes representatives from the city, the Regional Health Agency, and the partners involved, while scientific bodies (such as the Local Health Scientific Council in Lyon) provide independent expertise.
Challenges and how to address them
Implementing a Local Health Contract raises several challenges:
The first one is Concertation, because bringing together institutions, associations, residents, and researchers in one place requires a considerable capacity for coordination. This concertation is generally organized by the local authorities and the regional health agency.
Furthermore, priorities are not always shared, and a balance must be found between political demands and scientific realities. Researchers are essential for providing data-based expertise, helping analyze regional health determinants, and evaluating the impact of actions taken. Their key mission is to ensure methodological rigor and to provide scientific knowledge for public decision making.
Another challenge concerns knowledge of the region, as this requires a solid diagnosis. There are, of course, funding limitations, as the Local Health Contracts is based on a multiannual contract, while local authority budgets can change with political cycles.
Finally, the evaluation of the efficiency of a local health policy requires tools shared between partners.
These difficulties help to explain why the SHAPE-med@lyon project in Lyon was created, which aims to bring together research, innovation, and regional leadership. The goal is to support the Local Heath Contracts with scientific data to build a shared culture of evaluation.
Tasks and resources
The success of a Local Health Contract relies on a number of coordinated stages:
First, there is a mobilization phase in which the various stakeholders commit to working together to build the project. This dynamic partnership, particularly between researchers and policymakers, is essential to guarantee sustainability beyond political cycles.
Then, a local diagnosis is carried out by both the local authorities and the regional health agency with the researchers’ expertise, combining all types of data. Based on this diagnosis, the steering committee defines priority areas and targets for action: these will be assigned to specific managers, with dedicated resources and identified managers.
Once the contract is signed, operational implementation begins: coordination between institutions, launch of actions, etc.
Among the examples of action, we can highlight SONAR@lyon, a Nature-Based Solutions Observatory that uses a One Health Approach in the Lyon metropolitan area, a project supervised by Ms. Caillaud from Lumière University: https://greps.univ-lyon2.fr/projets/projets-nationaux/sonarlyon
Throughout the process, regular reviews allow for adjustments to be made to the measures, certain things to be corrected, and successes to be built on.
Ressources
https://www.univ-lyon2.fr/universite/shape-medlyon
https://www.ars.sante.fr/les-contrats-locaux-de-sante
https://www.lyon.fr/actions-et-projets/les-plans-daction-strategiques/le-contrat-local-de-sante







