Strengthening health services for MCH in Africa: the first four years of the 'Bamako Initiative'
Jarrett, S.W.; Ofosu Amaah, S.
Health Policy and Planning 7(2): 164-176
1992
ISSN/ISBN: 0268-1080 DOI: 10.1093/heapol/7.2.164Document Number: 326672
The Bamako Initiative is an African movement formed to refocus and strengthen primary health care, with an emphasis on maternal and child health (MCH) in peripheral rural areas. More than four years have passed since its adoption by African Ministers of Health. It has evolved into a movement to revive and extend peripheral health services, with a district-level strengthening of health care delivery systems. It places responsibility for health care management at the local level, but with continuing national Ministry of Health (MOH) technical supervision and support. This provides the basis on which prime mother and child health care interventions, such as immunization, prevention and control of common diseases and pre- and postnatal care, can be made accessible to the majority of the population, and on which HIV/AIDS-related action can be accelerated. Community action in the management and financing of peripheral health services is seen as the most critical element for improving service quality and ensuring long-term sustainability. Whilst many countries in Africa have initiated action, difficult issues remain: access for the very poor who cannot afford to pay; the rational use of drugs given a more continuous supply of essential drugs in the delivery system; the ability of governments to maintain their support in the face of declining economies; and the role of women in community action. More than 4 years have passed since the adoption of the 'Bamako Initiative' by African Ministers of Health. It has evolved into a movement to revive and extend peripheral health services within a district-level strengthening of health care delivery systems, placing responsibility for health care management at the local level, but with continuing national Ministry of Health (MOH) technical supervision and support. This will provide the basis on which prime mother and child health care interventions, such as immunization, prevention and control of common diseases and pre- and postnatal care, can be made accessible to the majority of the population, and on which HIV/AIDS-related action can be accelerated. Community action in the management and financing of peripheral health services is seen as the most critical element for improving service quality and ensuring long-term sustainability. Whilst many countries in Africa have initiated action, difficult issues remain: access for the very poor who cannot afford to pay; the rational use of drugs given a more continuous supply of essential drugs in the delivery system; the ability of governments to maintain their support in the face of declining economies; the role of women in community action.AS.