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Improving Access to Essential Drugs for Rural Communities in Nigeria: the Bamako Initiative Re-Visited

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Abstract

One of the major indices of the performance of the primary healthcare delivery remains improved access to essential drugs. The Bamako Initiative (BI) was introduced by WHO/UNICEF in the late 1980’s to improve access to essential drugs for the most vulnerable in the society and thus improve the health outcomes. However, almost 20 years post-inception, the outcomes and/or impact of the BI on the health indices of many implementing African countries remains varied, with not so significant improvement in health status being registered in a majority of countries. A review of literature suggests that the poor outcomes may be attributable to issues more fundamental than just the absence of adequate funding. Although the current Nigeria Drug Policy (NDP) clearly enunciates and provides policy direction for the core objective of the Bamako Initiative (BI), which is “EQUITABLE ACESS TO ESSENTIAL DRUGS at the community level”, it appears the implementation guidelines may not have drawn on the NDP policy guidelines to provide an adequate framework/tools to ensure efficient realization of the core objectives of the BI. This paper appraises the implementation of the BI in Nigeria within the context of the NDP. It reviews the current status of the BI in the country and attempts to proffer solutions for improvement and/or functionality. The paper seeks:

1. To provoke thoughts and direct attention to an aspect of Public Health Pharmacy, which had been hitherto neglected by Pharmacists and Programme Planners.

2. To get pharmacists more involved in ensuring the efficiency and safety of drug supply at the community level.

3. To engender more research by pharmacists and stakeholders for improved outcomes in this service area.

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References

  1. Chukwuani CM, Olugboji A, Akuto EE, Odebunmi A, Ezeilo E, Ugbene E. A baseline survey of the primary healthcare system in south-eastern Nigeria. Health Policy (in press), e-pub available on line at http://www.sciencedirect.com, August 2005

  2. Gilson L, Kalyalya D, Kuchler F, Lake S, Oranga H, Ouendo M. The equity impacts of community financing activities in three African countries. Int J Health Plann Manage 2000;15(4):291–317

    Article  PubMed  CAS  Google Scholar 

  3. Condamine JL, Atigues S, Midol S, Asi-Burkina KB. Support programme for the implementation of the Bamako Initiative: analysis of the creation of eight health districts, in Gnagna province. Sante 1999; 9(5):305–311

    PubMed  CAS  Google Scholar 

  4. Soucat A, Levy-Bruhl D, De Bethune X, Gbedenou P, Larmarque JP, Bangoura O, et al. Affordability, cost-effectiveness and efficiency of primary healthcare: the BI experience in Benin and Guinea. Int J Health Plann Manage 1997; 12 Suppl 1:S81–S108

    Article  PubMed  Google Scholar 

  5. Godin C. Cameroon and Chad: cost recovery. Ann Trop Med Parasitol 1998; 92 Suppl 1:S163–S164

    PubMed  Google Scholar 

  6. Diallo I, Sarr LC, Borghese G, Wone I. Evaluation of the financial participation of the users of 102 health services in 3 districts of Senegal. Dakar Med 1995; 40(2):167–174

    PubMed  CAS  Google Scholar 

  7. Salako LA. Drug supply in Nigeria. J Clin Epidemiol 1991; 44 Suppl 2: 15s–19s

    Article  PubMed  Google Scholar 

  8. Fiedler JL, Wright JB. Financing healthcare at the local level: the community drug funds of Honduras. Int J Health Plan Manage 2000; 15(4):319–340

    Article  CAS  Google Scholar 

  9. Tran TT, Nguyen TN, Le T, Truong CH, Morgensen K, Andersen E. Establishment of drug chests in commune health stations in Vietnam, Bamako Initiative. Southeast Asian J Trop Med Pub Health 1998; 29(3):628–635

    CAS  Google Scholar 

  10. Litvack JL, Bodart C. User fees plus quality equals improved access to healthcare: results of a field experiment in Cameroon. Soc Sci Med 1993; 37:369–383

    Article  PubMed  CAS  Google Scholar 

  11. Soucat A, Gendaho T, Levy-Bruhl D, de Bethune X, Alihonou E, Ortiz C, et al. Health seeking behaviour and household health expenditures in Benin and Guinea: the equity implications of the Bamako Initiative. Int J Health Plann Manage 1997; 12 (Suppl 1): S137–S163

    Article  PubMed  Google Scholar 

  12. Haddad S, Fournier P. Quality, cost and utilization of health services in developing countries: a longitudinal study in Zaire. Soc Sci Med 1995; 40(6):743–753

    Article  PubMed  CAS  Google Scholar 

  13. Ridde V, Girard JE. Twelve years after the Bamako Initiative: facts and political implications for equity in health services accessibility for indigent Africans. Sante Publique 2004; 16(1):37–51

    PubMed  CAS  Google Scholar 

  14. Coll AM. Health and structural adjustment.Vie Sante 1990; 2:13–5

    PubMed  Google Scholar 

  15. Federal Ministry of Health, Nigeria: National Primary Health Development Agency, Guidelines on the Bamako Initiative Programme, 1998

  16. Federal Ministry of Health, Nigeria: National Drug Policy, 2003

  17. Zachariah R, Lange L, D’Altilia P. Financing advances on salaries of health workers in Chad: an example of a feasible strategy to sustain the Bamako Initiative. Health Policy Plann 2001; 16(3):332–333

    Article  CAS  Google Scholar 

  18. Uzochukwu BSC, Onwujekwe OE. Socio-economic differences and health seeking behaviour for the diagnosis and treatment of malaria: a case study of four local government areas operating the Bamako Initiative programme in south-east Nigeria. Int. J Equity Health 2004; 3:6

    Article  PubMed  Google Scholar 

  19. McPake B, Hanson K, Mills A. Community financing of healthcare in Africa: an evaluation of the Bamako Initiative. Soc Sci Med 1993; 36(11):1383–1395

    Article  PubMed  CAS  Google Scholar 

  20. Uzochukwu BS, Onwujekwe OE, Akpala CO. Effect of the Bamako Initiative on availability and rational use of essential drugs in PHC facilities in south east Nigeria. Health Policy Plan 2002; 17(4):378–383

    Article  PubMed  Google Scholar 

  21. Gilson L, Kalyalya D, Kuchler F, Lake S, Oranga H, Ouendo M. Strategies for promoting equity: experience with community financing in three African countries. Health Policy 2001; 58(1):37–67

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Chinyere M. Chukwuani.

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Chukwuani, C.M., Olugboji, A. & Ugbene, E. Improving Access to Essential Drugs for Rural Communities in Nigeria: the Bamako Initiative Re-Visited. Pharm World Sci 28, 91–95 (2006). https://doi.org/10.1007/s11096-006-9010-1

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  • DOI: https://doi.org/10.1007/s11096-006-9010-1

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