🚨The ARS are being departmentalised: what the decree of 1 August changes for your territory
🔍🏛️ Local health governance: each department now has a dedicated ARS director and a healthcare access committee co-chaired with elected officials. New entry points for your prevention and local projects.
📌This decree reshapes the local health interlocutor: each department now has a departmental ARS director with expanded missions (prevention, medico-social services, local health contracts, combating medical deserts) and a primary care access committee co-chaired with elected officials. In practical terms, a project leader can better identify whom to approach locally, in which forum their territorial needs will be discussed, and on which regulatory levers (CLS, single window, France Santé network) to rely. Useful for anticipating the new articulations between the prefect / departmental council / ARS in which prevention projects are situated.
Source :📒 Decree No. 2026-722 of 1 August 2026 relating to the departmental delegations of regional health agencies✍️ Official Journal of the French Republic — Ministry of Health, Families, Autonomy and Disabled Persons. Text 24 of 85, published on 2 August 2026📜🔗LINK to the source
The decree 2026-722 (1 August) creates and defines the departmental director of the ARS and its missions. The decree 2026-649 (22 July) gives it a financial role : the departmental allocations of the FIR are determined by the director general of the ARS on the proposal of the departmental directors (art. R. 1435-28-1). In other words, the second decree entrusts a budgetary lever to the figure that the first establishes. You cannot read one well without the other.
1️⃣ ANALYTICAL SUMMARY
A departmentalisation by regulatory means
The decree complements the public health code to consolidate the departmental level of the ARS (p. 1-2). It defines the status and missions of the departmental director, placed under the hierarchical authority of the director general of the ARS and appointed by ministerial order after the advice of the prefect (p. 1). The context is one of persistent tensions regarding access to care: the text explicitly targets the fight against medical deserts and access to local care (p. 2). Concerned parties: ARS, health insurance funds, local authorities, health and social care establishments, professionals, associations, and users (p. 1). This is an organisational response, not a funding mechanism or an action programme.
An expanded territorial governance and a consultation body with elected officials
The departmental director leads the regional health policy at the departmental level across eight axes: health democracy, delineation of territories, local health contracts, access to care projects, health prevention and promotion, city-hospital-medico-social coordination, management of health crises (p. 2). The decree also establishes, in each department, a primary care access committee co-chaired by the prefect, the president of the departmental council, and the departmental director (p. 2). This committee identifies needs, manages the departmental single point of contact for supporting professionals, and relies on the "France Santé" network (p. 2). A specific regime is provided for Saint-Barthélemy and Saint-Martin (p. 3).
2️⃣ KEY POINTS OF THE DOCUMENT
1️⃣ A departmental director with expanded missions. He represents the general director of the ARS to the prefect, local authorities, health insurance schemes, health and medico-social establishments, associations, and user representatives, and leads the departmental health policy (Art. D. 1432-53-3, I and III, p. 1-2).
2️⃣ Prevention and promotion of health included in his mandate. Among his eight missions, the implementation of health prevention and promotion actions (6°) and environmental health are explicitly included, in line with the regional health project and the regional health environment plan (Art. D. 1432-53-3, II and III-6°, p. 2).
3️⃣ Creation of the primary care access committee. New instance, co-chaired by the prefect, president of the departmental council and departmental director, meeting at least once a year, composed of the elected officials concerned and a representative of each health insurance scheme (Art. D. 1434-45, p. 2).
4️⃣ Anchoring on existing tools for access to care. The committee pilots the single departmental gateway for supporting healthcare professionals and mobilises the network of "France Santé" structures (Art. D. 1434-45, p. 2; Art. D. 1432-53-3, III-4° and 5°, p. 2).
5️⃣ A derogatory scheme overseas. A unique territorial delegation operates in Saint-Barthélemy and Saint-Martin, under the authority of the general director of the health agency of Guadeloupe, Saint-Barthélemy and Saint-Martin, with substitution of departmental references (Art. D. 1442-1-1, p. 3).
3️⃣ ACTION PATHS FOR LOCAL ACTORS
1️⃣ Identify the departmental director as the privileged contact for any prevention, environmental health or medico-social project, as he now leads health policy at this level (p. 2).
2️⃣ Identify and solicit the primary care access committee to relay ground needs: it contributes to identifying needs and determining the offer adapted to the territory (p. 2).
3️⃣ Position projects within local health contracts (CLS), which the departmental director coordinates the preparation and negotiation with local authorities (Art. D. 1432-53-3, III-4°, p. 2).
4️⃣ Mobilise the departmental single window for supporting the installation of professionals, now led by the committee (p. 2). Point of caution: the decree refers to a system currently being generalised, the effective deployment of which remains to be confirmed locally.
5️⃣ Rely on the network "France Santé" (Art. L. 6330-1) to structure or label a local healthcare offer (MSP, health centres, primary care teams) (p. 2).
6️⃣ Use the annual report presented to the departmental council as an entry point into local dialogue: the departmental director reports each year on the agency's actions to the prefect and then, in consultation, to the departmental council (Art. D. 1432-53-3, IV, p. 2). This is an opportune moment to make known its actions and needs.
4️⃣ ADDITIONAL REFERENCES
- Decree
no. 2026-649 of 22 July 2026 relating to the intervention of the prefect in
the payment of the regional intervention fund of the regional health agencies
- Installation of healthcare professionals: mission to generalise the departmental single windows (inter-ministerial press release, 17 April 2026) — Ministries of Land Use Planning / Ecological Transition. Clarifies the single window and the deployment of France Santé mentioned in the decree. Verified URL: https://www.ecologie.gouv.fr/presse/installation-professionnels-sante-lancement-dune-mission-generaliser-guichets-uniques
- Proposed law aimed at combating medical deserts — "the law in plain language" — Senate. Places the regulatory reform in its legislative context (access to care, regulation of installation). Verified URL: https://www.senat.fr/travaux-parlementaires/textes-legislatifs/la-loi-en-clair/proposition-de-loi-visant-a-lutter-contre-les-deserts-medicaux-dinitiative-transpartisane.html
5️⃣ FREQUENTLY ASKED QUESTIONS (FAQ)
1️⃣ Who appoints the departmental director and to whom is he accountable?
He is appointed by decree of the ministers responsible for health, health insurance, the elderly and disabled persons, on the proposal of the general director of the ARS and after consultation with the prefect. He is placed under the hierarchical authority of the general director of the ARS (p. 1).
2️⃣ Does this director replace the regional ARS?
No. He represents the general director of the ARS at the departmental level and drives the regional health policy in the department; he does not replace the regional level (p. 1-2).
3️⃣ What is the committee for access to primary care?
An instance established in each department, co-chaired by the prefect, the president of the departmental council and the departmental director. It identifies the needs for primary care and determines the appropriate offer (Art. D. 1434-45, p. 2).
4️⃣ How often does this committee meet?
At least once a year, at the invitation of its chairs (p. 2).
5️⃣ Is prevention adequately taken into account?
Yes. Among the missions of the departmental director is explicitly the implementation of prevention and health promotion actions, as well as environmental health (Art. D. 1432-53-3, III-6° and II, p. 2).
6️⃣ Does the text provide for a specific system for overseas territories?
Yes, for Saint-Barthélemy and Saint-Martin: a unique territorial delegation, under the authority of the general director of the health agency of Guadeloupe, Saint-Barthélemy and Saint-Martin, with substitution of departmental references (Art. D. 1442-1-1, p. 3).
7️⃣ When does the decree come into force?
The day after its publication, namely 3 August 2026 (publication in the Official Journal on 2 August 2026, p. 1).
6️⃣ REWRITING IN FALC
What this text says
This text is a decree. A decree is a rule written by the government.
It concerns the Regional Health Agencies. They are called ARS.
The ARS are responsible for health in each region.
A head in each department
Each department now has an ARS director.
This director works under the orders of the head of the ARS of the region.
The director is responsible for health in their department.
They help to find doctors where there are shortages.
They implement prevention actions.
Prevention helps people stay healthy.
They also take care of places for the elderly and disabled.
A new working group
The text creates a new group in each department.
This group is called the access to care committee.
Three people lead this group together:
- the prefect,
- the president of the departmental council,
- the ARS director of the department.
This group meets at least once a year.
The group looks at what people need to care for themselves.
The group helps doctors to settle in.
A special case for the islands
The text provides for a special rule.
This rule is for Saint-Barthélemy and Saint-Martin.
These two islands have a separate organisation.
7️⃣ CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES
- Literacy : no suitable comprehension tool is provided; it is a technical legal text, without a pedagogical dimension (structural limit of this type of document).
- Empowerment : users do not intervene in the design; they are among the concerned public and are represented indirectly via user representatives to the departmental director (p. 1).
- Participation : co-construction relies on consultation with elected officials (access to care committee, territorial health councils) rather than on the direct participation of residents (Art. D. 1434-45; Art. D. 1432-53-3, III-2°, p. 2).
- Community health : the collective dimension is present through the facilitation of health democracy and territorial health councils, but the approach remains institutional (p. 2).
- Ethics : the decree does not address cultural or social biases; its object is organisational.
- Human rights : territorial equity of access to care is an implicit objective (fighting medical deserts), without a formal statement of inclusion principles (Art. D. 1432-53-3, III-5°, p. 2).
- Intersectorality : strong — articulation prefect, departmental council, ARS, health insurance, local authorities, health and medico-social sectors (Art. D. 1434-45, p. 2).
- Partnership : a model of collaboration is formalised by the tripartite co-presidency of the access to care committee (p. 2).
- Fight against discrimination : not addressed in the text.
8️⃣ EVALUATION OF RESOURCE RELIABILITY
Operational relevance : high for understanding the new mapping of interlocutors and bodies, but indirect for field action: the decree establishes a governance architecture, it does not provide any tools, methods, or directly mobilisable funding. Its concrete usefulness will depend on the appointment orders and the effective establishment of committees department by department.
9️⃣ STRATEGIC HASHTAGS
#HealthPractices #AccessToCare #ARS #MedicalDeserts #ProximityHealth #HealthDemocracy #FranceHealth #PublicPolicy
🔍➕ For more information, see the articles referenced by "Health Practices" on the theme of health and work ➡️🔗