International Study Conference on Community Health Financing in Primary Health Care, Freetown, Sierra Leone, 27-30 September, 1989. Essential Drugs Monitor No. 009 (1990)
(1990; 3 pages)


The Bamako Initiative was developed during a meeting in Bamako, Mali in September 1987. Health Ministers from throughout Africa resolved to raise additional resources for primary health care services via community managed drug funds. Two years after the adoption of the Bamako Initiative, Health Action International and UNICEF organized a meeting in Freetown, Sierra Leone to address concerns surrounding the sustainability of community health financing for primary health care. The main issues discussed at the conference include the implementation of the Bamako Initiative, equity, alternative forms of health care financing, community participation, the need for foreign exchange and financial resources, and rational drug use. Dr. Patricia K. Nickson from the Liverpool School of Tropical Medicine summarizes the discussion on each issue in her report. Key conclusions drawn from the conference were that the Bamako Initiative should be seen as a programme to revitalize primary health care and that the emphasis put on drugs in the Initiative may lead to overconsumption and psychological dependence on medication. There were also concerns raised about individuals’ inability to pay for medications and the high inflation that could result from a long-term supply of drugs from UNICEF. There have been several formal and informal meetings since the Freetown conference to discuss the outcome of the meeting and add further suggestions. Nickson concludes that although the Bamako Initiative was developed to meet a particular need, the cause of that need has not been adequately addressed. A detailed description of the Guiding Principles for the Implementation of Bamako-Type Projects, drafted at the Freetown conference, is also included. (Abstract by Flannery Bowman, 2013)

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