The Bamako Initiative in Benin and Guinea: improving the effectiveness of primary health care

✍ Scribed by Daniel Levy-Bruhl; Agnes Soucat; Raimi Osseni; Jean-Michel Ndiaye; Boubacar Dieng; Xavier de Bethune; Alpha Telli Diallo; Mamadou Conde; Mohamed Cisse; Yarou Moussa; Kandjoura Drame; Rudolf Knippenbery

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 420 KB
• Volume: 12
• Category: Article
• ISSN: 0749-6753
• DOI: 10.1002/(sici)1099-1751(199706)12:1+<s49::aid-hpm466>3.0.co;2-p

✦ Synopsis

The objective of the health system revitalization undergone in Benin and Guinea since 1986 is to improve the eectiveness of primary health care at the periphery. Second in a series of ®ve, this article presents the results of an analysis of data from the health centres involved in the Bamako Initiative in Benin and Guinea since 1988. Data for the expanded programme of immunization, antenatal care and curative care, form the core of the analysis which con®rms the improved eectiveness of primary health care at the peripheral level over a period of six years. The last available national data show a DPT3 immunization coverage of 80% in 1996 in Benin and 73% in 1995 in Guinea. In the Bamako Initiative health centres included in our analysis, the average immunization coverage, as measured by the adequate coverage indicator, increased from 19% to 58% in Benin and from less than 5% to 63% in Guinea between 1989 to 1993. Average antenatal care coverage has increased from 5% in Benin and 3% in Guinea to 43% in Benin and 51% Guinea. Utilization of coverage with curative care has increased from less than 0.05 visit per capita per year to 0.34 in Guinea and from 0.09 visit per capita per year to 0.24 in Benin. Further analysis attempts to uncover the reasons which underlie the dierent levels of eectiveness obtained in individual health centres. Monitoring and microplanning through a problem-solving approach permit a dynamic process of adaptation of strategies leading to a step by step increase of coverage over time. However, the geographical location of centres represents a constraint in that certain districts in both countries face accessibility problems. Outreach activities are shown to play an especially positive role in Guinea, in improving both immunization and antenatal care coverage. &1997 by John Wiley & Sons, Ltd.