E-drug: Bamako Initiative (cont'd)
---------------------------------------------
Dear Richard,
You seem to make a fundamental difference between a) a community
managed revolving drug fund with a mark-up to finance some extra
"primary care" activities (RD: according to the BI approach, these
primary care activities were meant to be MCH: this would get more
attention by making more financial resources available), and b) a
cost-recovery program for rural health facilities. I don't see that
difference. At present, several west-African countries adopted a
national strategy of installing drug revolving funds at the health centre
level, co-managed by the communities. Usually, other services
(curative consultation, etc.) are charged as well through fixed fees.
These revenues are supposed to cover part of the recurrent
expenditure of the health centres, including the real cost of the
essential drugs. In Mali, the communities have organised themselves
in formal associations: "Association de Sant� Communautaire"
(ASACO), and play an active role in decision making and in managing
the revenues of the health centre: Centre de Sant� Communautaire.
There is enough evidence - at least in the better 'gray' literature - to
show that in many cases service utilisation improved after these
schemes. I don't agree that in these countries 'there was nothing
else'. What do you mean by that?
Last comment: drug revolving funds and other user fee schemes have
been established in several west-African countries well before the
devaluation of the FCFA. In fact, the devaluation became a threat to
some of the schemes as prices in local currency had to increase.
Anyway, I am very curious to know what will be the results of the
conference. I agree with you that it is important to clearly define the
various concepts, so that we do not compare apples and pears.
Ren� Dubbeldam
ETC/Crystal, Leusden, Netherlands
e-mail: DubSlob@compuserve.com
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.