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Ten best readings in ... the Bamako initiative.

Hardon A
HEALTH POLICY AND PLANNING. 1990 Jun; 5(2):186-9.

WHO and UNICEF joined forces to support the Bamako Initiative agreed upon by African ministers of health at a 1987 meeting. Primary health care (PHC) should be advanced by identifying and introducing self-financing mechanisms at the district level (specifically, revenue from drug sales), securing a constant supply of drugs, and promoting social mobilization. UNICEF has produced several policy papers on recurrent costs and the sales of drugs. The 1988 UNICEF policy paper Problems and Priorities Regarding Current Costs reviews UNICEF practices of financing programs and proposes recommendations. For example, about 40% of program expenditure goes to recurrent costs, especially the financing of drugs and vaccines. Another 1988 UNICEF working paper is Community Financing Experiences for Local Health Services in Africa, which reviews 3 case studies on community financing. Today, however, UNICEF no longer considers drug cost recovery as essential to the Bamako Initiative. In July 1989, the WHO Regional Office for Africa published Guidelines for the Implementation of the Bamako Initiative. Charging for Drugs in Africa: UNICEF's 'Bamako Initiative' (1989) critiques UNICEF's policy in the context of the IMF and the World Bank adjustment programs. Availability of Pharmaceuticals in sub-Saharan Africa: Roles of Public, Private and Church Mission Sectors (1989) highlights the success of cost recovery in church mission health care and the efficiency of distribution through the commercial sector. Its authors consider the Bamako Initiative to be unrealistic. One of the first shots at reviewing community financing experiences is the 1982 article, Community Financing of PHC. Other works are Financing PHC Programmes (Christian Medical Commission), Financing PHC: Experiences in Pharmaceutical Cost Recovery (PRITECH), WHO's Financing Essential Drugs, and A Price to Pay: The Impact of User Charges in Ashanti-Akim District, Ghana.

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