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Lancet. 1989 Jan 21; 1(8630):162.This letter was written in defense of a November 19, 1988 editorial discussing the Bamako Initiative. The writer, who works for UNICEF, has been working, with WHO, on the Initiative for the past year. In addition, he taught and practiced pediatrics in Ghana for 25 years. He claims the idea of "free" health services has undermined traditional African practice and confused the debate about fairness and community responsibility. UNICEF and WHO feel that increased community involvement and contribution to costs will strengthen Primary Health Care and maternal and child health systems. Acknowledged difficulties of the program, such as equity, management, foreign currency, and drug orientation are being addressed. Research and experience in community financing for health in Africa is felt to provide a solid basis for proceeding with the Bamako Initiative.