From Bamako to Kolda: a case study of medicines and the financing of district health services

In 1987 the United Nations Children's Fund and the World Health Organization promoted the Bamako Initiative whose principal objective was to raise funds for primary health care (PHC) at community level through charging for drug treatment. Although the $US 180 million requested from donors by UNICEF has not been forthcoming, nevertheless about 15 countries in sub-Saharan Africa are at present implementing Bamako-type projects. The management of these projects may perhaps benefit from experience in the district of Kolda in Senegal, a country in which the principle of the self-management of receipts by health service structures has been established since 1981. In 1985, in the rural district (departement) of Kolda, Senegal, situated 450 km from Dakar, the health service was not being used by the population. The district management team attempted to change the pattern of under-utilization by rationalizing the mechanisms for financing services and supplies of pharmaceuticals. After the introduction of new forms of management and control, the hospital issue of prescriptions for the purchase of drugs at private pharmacies was stopped. The result was an increase in the utilization of services and in receipts, which made it possible to increase the stocks held by the pharmacy. It is planned to make the services of the pharmacy available to satellite dispensaries, giving priority to those which under take to rationalize their prescribing of medicines and to alter their methods of financing.