Health: building on the success of PHC in Africa.
The author from UNICEF's Bamako Initiative management unit provides an overview of child and maternal health in Africa in terms of survival, primary health care, and immunization. There is a summary of the Bamako Initiative of 1987 by African Health Ministers. 172 out of 1000 children born will die by the age of 5 versus 120 out of 1000 for all developing countries. Maternal mortality is 30-200 times greater than in the industrialized world, and poor maternal health leads to low birth weight babies and neonatal illness. Malnutrition is an exacerbating factor. AIDs among the 25% of females of reproductive age means that approximately 1 out of every 10 urban children is born with the AIDs virus. Drug shortages abound. The African government support at the Alma Ata Conference in 1978 shifted primary health care (PHC) into the community. The approach which is based on trained health workers aims to address preventive and curative care by also improving sanitation and water access, nutrition, and education. UNICEF has doubled it funding for Africa, and provided training, drugs and medical supplies, and efficient service systems based on situational analysis. The African Health Ministers Lusaka Resolution of 1986 marked the increase in immunization from 5% to 50% of children <1 in 1988. UNICEF and WHO have helped promote oral rehydration therapy; treatment for diarrhea has increased from 4% in 1984 to 12% in 1986. AIDs education is gaining a foothold in Tanzania and Uganda as examples. Teacher training has involved 2500 primary teachers and 2400 secondary teachers through the end of 1988. The Bamako Initiative strengthened child and maternal services within PHC by asking for UNICEF and WHO funding for basic drugs. The approach is part of a long term strategy to strengthen primary health care through self supported financing. There is confidence that progress has been made and determination to build for the future. The Bamako Initiative targeted the year 2000 for distributing good quality essential drugs to the community which upon sale has helped pay for 85% of operating costs and supplies. Generic supplies purchased in bulk would be sold at low cost, which is far less that what is currently paid. 100 million is needed for this effort alone.