Universal health coverage, health systems strengthening, and. Sep 18, 2008 the inability of the phc and bamako initiative and other international initiatives to improve access and quality of healthcare in subsaharan africa and other development regions in the late 1980s and early 1990s led to search for alternatives to health policy making. Former head of the bamako initiative management unit, unicef, new york. Unicef is also in the process of launching the bamako initiative which aims, by introducing drugtreatment charges and settingup revolving drug funds at. Sp otlight on the bamako initiative 77 ed with the quality of care, although 48 percent were not fully satis ed. Under the bamako initiative unicef will provide free drugs to participating countries for the 1st few years. The bamako initiative was launched in 1987 by the ministers of health of the african states against a background of deteriorating socioeconomic conditions, fragmented primary health care programmes and stagnating or even increasing infant mortality rates. Mali malaria is the primary cause of morbidity and mortality in mali, particularly among children under five years of age.
Since the advent of health user fees in low and middleincome countries in the 1980s, the discourse of global health actors ghas has changed to the disadvantage of this type of healthcare financing mechanism. Universal health coverage, health systems strengthening. Throughout 1 the analysis has been primarily informed by the personal experience of the three main contributors to this chapter sara bennett, julio frenk. The bamako initiative, sponsored by unicef and who and adopted by african ministers of health in 1987, was based on the realization that, despite accepting in princi ple the core tenets of comprehensive primary health care, by the late 1980s many countries especially in subsaharan africa were burdened by a lack of resources and practical implementation strategies.
The bamako initiative was designed as a strategy for strengthening primary health care. Mahler 41620 3 commentaires the next interview of our series on community participation and the bamako initiative is with dr. Bamako, malis capital, is a regional trade center located on the niger river, in the countrys southwest and has an approximate population of 2,270,000. Sokari hellen adoxokujagu department of primary education, ignatius ajuru university of education, port harcourt.
The aim of the study was to identify and analyze the stance of ghas in the debate on user fees. As far as accountability was concerned, the approach was twofold. One of the most controversial elements of this initiative has been the prominent role given to community nancing through user fees. The application of user fees to poor households and the principles of cost recovery drew strong criticism. Bamako initiative, meant to improve communities access to pharmaceuticals.
Development goals mdgs, the gambia national development strategy 20122015 and investment program the program for accelerated growth and employment page which will lead to achievement of all the millennium development goals, especially those related to health. This work is licensed under a creative commons attribution. In 19921993, burkina faso implemented the bamako initiative, a health sector reform in subsaharan africa that included several strategies, one of which was the implementation of user charges to. Reflections on the impact of the bamako initiative and the. Schistosomiasis assessing progress toward the 2020 and 2025. The bamako initiative was a formal statement adopted by african health ministers in 1987 in. The profits from these sales would be used to buy more drugs in a selfsustaining way. To compare the level of availability and rational use of drugs in primary health care phc facilities where the bamako initiative bi drug revolving fund programme has been operational, with phc centres where the bitype of drug revolving fund programme is not yet operational. All told, some 35 countries have implemented the eight basic principles of the bamako initiative for use in nationwide programmes programmes that involve such major components as immunisation, vitamin a supplementation, safe motherhood, guineaworm eradication and community participation activities. Second, health committees were created to comanage the user fees collected by the. The unit worked closely with african countries that had shown interest in the principles of the bamako initiative. Development goals mdgs, the gambia national development strategy 20122015 and investment program the program for accelerated growth.
You already touched the first two issues, could you say a word about the regular supply of drugs. Effect of the bamakoinitiative drug revolving fund on. Bamako initiative knippenberg et al 1997 describe the cases of guinea and benin in the mid 1980s, where the bamako initiative strategies were refined quality of care was low. The bamako initiative was not without its limitations. Review history and milestones in evolution of primary health care phc. Bamako mali initiative 1987 set goals for phc in subsaharan africa. Universal health coverage, health systems strengthening, and the world bank in the second article of the series, marlee tichenor and devi sridhar discuss how the world bank is promoting better access to healthcaret he sustainable development goals sdgs formally promote universal health coverage as a key objective for the global health community.
Ten best readings in the bamako initiative health policy. In essence, implementing the bamako initiative was a political process that involved changing the prevailing patterns of. Health care users found the availability of drugs to be high over 80 percent said drugs were av ailable and the overall quality of care to be good 91 percent. The bamako initiative millennium development goals health.
Agostino paganini has an extensive experience of primary health care and emergency health care in africa, an. The bamako initiative bi was launched following a conference in 1987, on the subject of strategic policies on primary health care, and it is, in and by itself, an innovation supporting the work of the various actors within health systems. Bamako initiative 1987 decentralize health care to the district level, essential drugs supported by the world bank through 1980s this is the basic system to pay for health care services and dominates developing countries. The multidimensional nature of poverty reducing income poverty table 1. Timeline of essential medicines and health systems milestones. Bamako initiative employed some form of phased scaling up, and several countries most notably benin, mali and rwanda achieved significant results. Get a printable copy pdf file of the complete article 505k, or click on a page image below to browse page by page. The bamako initiative aimed to increase access to primary health care by raising the effectiveness, efficiency, financial viability and equity of health services. We conducted documentary research using public documents published by and officially. The bamako initiative was a formal statement adopted by african health ministers in 1987 in bamako, mali, to implement strategies designed to increase the availability of essential drugs and other healthcare services for subsaharan africans the idea as proposed by unicefs executive director, james p. In essence, implementing the bamako initiative was a political process that involved changing the prevailing patterns of authority and power. These strategies were launched as the bamako initiative by the world health organizations regional assembly in 1987.
Bamako initiative was adopted to bring health care closer to the population. The organization of phc systems was not specifically clarified and it was up to each country to establish strategies taking into account its geographical, sociocultural and economic realities. The bamako initiative, implemented in varying degrees in half of the countries of. In the first part of the interview we publish today, he shares his analysis of the setup of the bamako initiative. Global health actors no longer in favor of user fees. The idea as proposed by unicefs executive director, james p. In most african countries where the bamako initiative has been deemed a success, poor people viewed price as a barrier. Mali, with maternal and child mortality rates among the six highest in the world, is at the epicenter of. Bamako a new presidential initiative announced today in the west african nation of mali aims to halt two of the worlds oldest health crises.
To compare the level of availability and rational use of drugs in primary health care phc facilities where the bamako initiative bi drug revolving fund programme has been operational, with phc centres where the bitype of drug revolving fund programme is not yet operational methods. While there are many aspects to this initiative, the introduction of user fees to improve the sustainability of primary health care in africa has been identi ed as a key component. Bamako health centres implemented an integrated minimumhealthcare package in order to meet basic community health needs, focusing on access to drugs and regular. Bfci baby friendly community initiative bi bamako initiative bts blood transfusion services cbo community based organisation. Apr 16, 20 he was the manager of the bamako initiative support unit at the unicef hq. User fees are a fragile nancing tool that requires careful design and implementation. Links to pubmed are also available for selected references. The study was undertaken in 21 phc centres with bi drug revolving funds and. From the early stages of the initiative it became clear that, while underfinancing was a major obstacle, one of the main causes of poor quality, poor mix of curative and preventive. From the early stages of the initiative it became clear that, while underfinancing was a major obstacle, one of the main causes.
To make matters worse, there is little public participation in the decisionmaking process, and a tendency to launch programmes with shortterm goals which do not. The state of dietrelated ncd policies in afghanistan, bangladesh, nepal, pakistan, tunisia and vietnam. The success of the bamako initiative can be traced directly to three major factors. The declaration of almaata was adopted at the international conference on primary health care phc, almaty formerly almaata, kazakhstan formerly kazakh soviet socialist republic, 612 september 1978. The harare declaration and bamako initiative spearheaded efforts to improve primary health care systems in africa through decentralization i. In the bamako initiative, a joint who united nations childrens fund unicef initiative aimed at solving the problems in the financing of primary health care in sub saharan africa was launched. The bamako initiative suggested a revolving drug fund to pay for future drug supplies and the use of excess fund left over for the maintenance and improvement of primary health care services. Grant, was for unicef and other donors to supply drugs to countries which would be sold a. Despite these efforts, who estimates that roughly 270 million people in africa nearly half the populationlack regular access to even the most essential medicines. In 1992, phc implementation started with the commencement of phc programmes in the local government areas lgas. According to a 2015 household survey, the prevalence of malaria among children under five years of age was 36 percent.
Past, present and future cynthia haq university of wisconsinmadison. The aims are to establish a revolving drug fund to pay for future drug supplies and to use leftover money to maintain and improve primary health. An alternative is the concept of the user fee, cost sharing, costrecovery or copayment. The bamako initiative millennium development goals. Facility management committee operational guidelines.
The bamako initiative has aroused considerable debate amongst. Schistosomiasis assessing progress toward the 2020 and. The bamako initiative on child survival, development and universal immunization in. The bamako initiative could be described as having three pillars. Following the bamako initiative, rwanda decentralized management and districtlevel care strategy with the development of provinciallevel health offices for health system management. Full text full text is available as a scanned copy of the original print version. Review of the implementation of the bamako initiative. Oct 27, 2017 the bamako initiative was not without its limitations. Rising infant mortality rate from 64 per 1,000 live births in 1993 to 72 in 1998, 74 in 2000 and 77 in 2003 kdhs 2003. This is the first in a series of five articles on the bamako initiative in benin and guinea. Past, present and future cynthia haq university of wisconsinmadison thomas hall university of californiasan francisco david thompson university of minnesotaminneapolis john bryant aga khan university and the tropical institute of community health february 2009 prepared as part of an education project of the. The bamako initiative bi was a pragmatic strategy to implement primary health care phc in. Nhssp ii goals of equity, effectiveness and efficiency. Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day.
Grant, was for unicef and other donors to supply drugs to countries which would be sold a little above cost. Three conditions were initially seen as necessary for success. Although countries followed different paths in implement ing the bamako initiative, in practice they had a common core objective. Consequently, a large share did not use essential health. In cooperation with the private sector, make available the benefits of new technologies, especially information and communications.
Reflections on the impact of the bamako initiative and therole of user fees in 1987, unicef launched the bamako initiative. The bamako initiative and development of communitybased information systems the challenge presented by the goals of the 1990s is to capitalize on the substantial progress made during the last decade in the pursuit of universal child immunization and shift from specific coverage goals to. Fmcs were created to manage the costrecovery agenda of the bamako initiative and its role in facility infrastructure and operations management, and revitalize it to ensure access to the free health care initiative by its intended beneficiaries. Rapid urbanization, exacerbated by a volatile refugee flow from neighboring cote divoire and from malis own north, has led to severely degraded living and sanitation conditions in. During the 1987 world health organizations regional assembly, the ministers of health of the african states launched the bamako initiative, an effort aimed at reorganizing the health system to ensure universal, permanent accessibility of maternal and child health services. Nigeria therefore, became one of the few countries in the developing world to have systematically decentralized the. Community engagement is critical for the achievement and sustainability of sierra. The strategies implemented in these two countries are discussed.
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