The internationalization of competition and the globalization of markets characterize the new business environment. In addition, the evolution of information and communication technologies has brought distances closer and eliminated borders, reducing the world into a large market in which information, capital and goods move easily and quickly. These changes certainly bring new perspectives, but especially new challenges because of the new constraints (AMBA, 2009).

To overcome the complexity and dominate the impacts of the environment, organizations must relearn how to manage the present in order to master the uncertainty of the future. Indeed, management control, insofar as it is based on notions relating to future events, such as management by objectives; is particularly confronted with this turbulence of the environment.

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Long regarded as a strategic value because of its importance, management control has become the cornerstone of the fact that it is a source of potential improvement progress for all types of companies. It is a function that aims to motivate those responsible, and to motivate them to perform activities that help to achieve the objectives of the organization (Brigham and Houston, 2004). It is therefore an answer to a certain number of business problems for which the search for solutions is essential: the increase of costs, and the disorganization of services within the company.

Nowadays, with the globalization of the economy and the opening of borders, companies are competing very aggressively for the sale of their products in a market where only well-organized companies can afford a large share of the market. Conversely, companies of weak organization are likely to be marginalized, or even to disappear.

The survival of such a company necessarily involves improving their performance. Thus management control can be perceived as an improvement of the economic performance of the company, it constitutes a tool allowing the efficiency, when the objectives traced are reached and the efficiency, when the quantities obtained are maximized starting from a quantity of means.

The company today, acts in an increasingly complex and dynamic environment, it is an institutional unit in which several systems in perpetual interdependence (operation, information, and piloting) interact. This interdependence of systems affects the level of process satisfaction, which requires more and more controls requiring ever more numerous and adapted steering tools.

In any organization, the management control is used for the deployment of the strategy as well as its execution by all its members. Influenced by behavioral currents, modern management control has expanded beyond its traditional functions described as instrumental, to become a global tool for steering organizations. Several authors share this reflection (Bouquin, 2010, Guy and Rouby, 2003, Lorino, 2001, Simons, 1994).

Bouquin (2010) described organizational control as the set of mechanisms on which managers rely to control the decision-action-results process. In this context, one of the goals of control is to model this process, in order to better define and understand the general objectives. In this sense, management control is an organizational control whose missions are as follows:
Ensure that the construction of the action plans is in line with the operational plan;
Help managers to choose the assumptions necessary to implement action plans;
Consolidate plans to prepare budget negotiations;
Prepare budgets based on the selected plans;
Select criteria for performance measurement of managers that will be consistent with those of management. (Bouquin, 2010).

The human dimension, highly valued recently within organizations, has given management control the role of “a system of regulation of human behavior in the exercise of its profession, when it is exercised within the framework of an organization: company, public service, non-profit association, etc. ” (Burlaud and Simon, 1997, 8)
Du Puy (2009) and Kaplan and Norton (2004) agree on the idea that management control is a tacit vector or a catalyst for organizational sustainability, by sharing throughall the actors belonging to the organization controlled the elements of the performance that underpin this durability.

Management Control is not always well understood and its definition has changed over the years. The definition used in this research is that of SCHWEITZER in 2000: “Management control reduces uncertainty by defining the mechanisms for identifying, assessing and managing the risks of present activities and projected from the company so that they are integrated into the definition processes; devise control standards, rules and procedures that ensure the effectiveness of the actions decided by the management of the company to achieve the objectives under the accepted risk conditions; provide management bodies with tools to monitor action programs and adjust them to changing circumstances; to ensure a common language between the various stakeholders of the company: shareholders, employees and the public. “16 This last definition is interesting because it highlights the vocabulary of the company with specific terms (company, shareholders) when all the stake of this study is to demonstrate that the management control can be a guarantee of performance in a social and medico-social establishment. It is important to note the description of Management Control as an instrument of evaluation and decision support to achieve achievable and adjustable objectives. SCHWEITZER also pays special attention to risk management and communication, themes that will be included in this study.

In a public context, management control is a very recent discipline that is gradually being established within these institutions. In the last decade, control in the public services was a control by regulation and procedures, which corresponds to a mechanical control. (Burlaud and Simon 1997, Bouquin and Pesqueux 1999).

Demeestère (2005) mentions, among the reasons for management control in the public sector, the constraint of the optimal use of allocated resources, the question of the quality of service rendered and the evaluation of the management of this quality, the coordination and coherence of actions with the objectives pursued, responding to the organization’s need to adapt to changes in the environment and, lastly, strengthening organizational learning (collective experience feedback). He adds that the understanding of the functioning of the public company goes through the understanding of its structure. Demeestère (2005) explained how the introduction of the “customer” orientation has changed the traditional bureaucratic organization specialized by function.

In service companies, the management control function appeared in the mid-1970s, whereas industrial companies had been using it since the 1950s (ROUAH ; al., 2000: 17). Moreover, its introduction has been characterized by fierce competition and an unstable environment, the pursuit of which is of paramount importance for these companies.Indeed, the service sector is an area where the performance is very delicate because of the taste of the consumer; this makes it all the more difficult to develop effective tools for decision support and management monitoring. In addition, the rise of start-ups in the field of internalization of major groups has put pressure on the players in the sector. It is therefore in this environment in full excitement that we witness the rise of the management control function of financial activities in general and in service companies in particular to reach today the standards of industrial companies.

In most developing countries, and particularly in sub-Saharan African countries, the phenomenon described above did not appear until a few years ago. This has allowed state-owned enterprises to benefit from management autonomy in general and in particular from health institutions. A wind of liberation thus blew leaving a requirement of adoption to the modern standards of the company. This has resulted in the multiplication of health institutions.Africa, despite this progress, has always been the subject of many concerns about the ability of each of its countries, whatever their ideological reference, to put in place an effective health policy. The hospital, public institution in essence, is the place par excellence that best reflects the health policy of a country, its primary purpose being to provide quality care and humanitarian.

The medical organization of the hospital, according to the analysis of PORTER, consists of various specialty functions that bring together various specific skills needed to achieve this public service mission. For these specialists, economic rationality is second only to technical service. However, the hospital, “a living organization with a strong collective identity, has a real autonomy that many other public entities can not benefit from” (KITOUS, 1994). This autonomy brings it closer in some respects to the management of private enterprise, thus constituting a privileged ground for developing the logic of objectives and results.

Today, the concern of hospitals is twofold: firstly, to improve the quality of care provided to populations in charge (their effectiveness is at stake), secondly, to focus on controlling or even reducing their costs, or constant costs, increase their activity, reflecting the fact that the population concerned is enlarged and that the response times are lower. Therefore, the effectiveness of the action, combined with the optimization of resources, contribute to hospital efficiency. However, public health establishments are not, by definition, subject to the requirements of the private sector, namely, profit seeking and return on capital; the issue of profitability of the hospital is still absurd insofar as a hospital can only cost, what it brings back to the community (It is above all a human investment). On the other hand, hospitals should not be exempt from the search for efficiency and effectiveness because they concern any organization that works with limited resources. The concepts of efficiency and effectiveness are integrated into hospital performance, which is understood in two ways: financial performance, but even more, social performance.

This search for performance must necessarily involve the establishment of a stable and operational administrative system within the hospital. This system, even basic, requires the presence of a management control function. The purpose of the latter is to ensure that the organization’s resources are used effectively and efficiently to achieve the objectives of the organization (ANTHONY, 1965). However, the context of application of this management control depends on the country where we are, and the specificity of its economic environment.

In France, since 1990, a new paradigm in the management of public services is at work. The public authorities are committed to replacing the traditional logic of means with logic of objectives and results based on the trust and accountability of managers. For this, it integrates management by objectives and contracting into the management of its public hospitals.

A study conducted by EHESP (2015) in Paris revealed that 67.4% of social and medico-social institutions included in the survey found it difficult to have a performance. Compared to 44.6% in 2014, the accentuated growth in costs is at the root of this apparent situation. It is argued that one of the main reasons for the failure to achieve organizational performance is the reluctance of managers to revise the management control approach. A total of 29% of companies reported falling into performance, making it difficult to meet employee demands as the cost was higher than production. Companies that intend to transfer their activities from France to other countries are 53% to reduce expenses and reduce the cost of production operations.

In DRC, EUP FASS survey (2017) revealed that, public hospitals as complex organizations are going through a decisive phase of their existence. The actors of the public hospital system decision makers, professionals, funders and users deplore all the discomfort that weighs on the performance of the public hospital today. Shortage of professionals, obsolescence of equipment, inadequate budgets, clientelism, corruption, demotivation of staff, inefficiency, poor quality of care and dissatisfaction of patients are the key words in all discussions both in the hospitals themselves than at the central administration level.
In these conditions, the recovery of management tools by hospital organizations has become a necessity. The aim of this research is to try to model the link between the design of the management control system of Congolese health facilities and their performance, in light of the context variables.

The term of the management control system must be understood in the sense of not only the attributes of the tools that make it up (the same tool can be implemented in different ways and have several roles), but also the context of use of these tools. , that is, the level of development of the management techniques that are being implemented in the hospital (delegation, decentralization, formalization of information and communication systems and the existence of an organizational culture).

So far, different perspectives show that organizational performance can not be overlooked in any organization that uses management control. This forced the researcher to undertake this study which aims to determine the determinant of organizational performance.


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