Estimates indicate that 16% of the population applied for the service of doctors in 2011 in Togo. From 2008 to 2012, it was noted an average increase of patient deaths by 10%. The present study is aimed at looking at the issue of efficiency of public hospitals in Togo. We used the directional distance functions to analyze the technical efficiency of 139 public hospitals in Togo. The data were extracted from the annual reports of health activities of each hospital. These data were supplemented by visits and interviews with hospital officials. On average, 60.71% of large size public hospitals are technically inefficient. In these hospitals, only 41.45% of the beds were occupied in 2010. Furthermore, on average, 48.83% and 63.47% of paramedical and administrative staffs were actually employed in these hospitals. Nevertheless, outputs could be increased by 94.24% while maintaining inputs levels in Pediatrics services. The removal of the evaluation of agents funded from the autonomous budget and the lack of department heads in many health centers contribute to the increase of the technical inefficiency. The lack of qualified personnel and technical equipment, the dilapidated health infrastructures and the low financial affordability may explain these inefficiencies. The governance factors such as the effective management of human and technical resources should occupy a prominent place in the health development policies.