The Bamako Initiative - Research Paper Example

Bamako Initiative Massive resources shortages have been reported in the government health systems in the less developed nations in Africa due to recession and economic adjustment policies. United Nations Children’s Fund (UNICEF) is currently various initiatives like the adjustment of the human face and the Bamako Initiative (BI). BI was started to aiming at increasing the access to primary healthcare by raising the efficiency, effectiveness, financial viability, and equity of health services (Johnson, Carleen, & Stoskopf, 2010). BI is tasked with introducing treatment charges, setting up revolving drugs at the community level, financing the costs of drugs and the salary of the community workers at the primary level. The BI was initiated in Nigeria to promote self-reliance in the supply of essential drugs through the introduction of self-help projects as cost recovery systems, utilizing funds from the programs to replenish the drug supplies, developing and promoting capacity of health management at village and district levels, and finally establishment and development of equitable methods of service delivery (Omululu, Okunola, & Salami, 2012) The BI program ensured the purpose of community financing was to capture the portion of household funds that was already being spent in the informal sector combined with donor and government funding helped to revitalize the health service and improve their quality in Nigeria. BI came up because of in response to the increasing poverty levels and reducing resources for healthcare in Africa in this case Nigeria due to the falling prices of commodities and the strain in the repayment of loans. According to Riddle (2011) asserts that the weak health systems in are the bottlenecks to the achievement of millennium development goals. Ultimately, the Nigerian health system is still being faced with the problem of inequality. The BI initiative was launched in Nigeria in April 1990 and by 2001 it had covered 11 million Nigerians. The BI had its problems because equity was at risk in the distribution of drugs. Although UNICEF agreed that provision of free service of indigents was necessary, the identification of these people proved a challenge as it required that discretionary powers likely rested with the health staff (Akpala, Onwuejekwe, & Uzochukwu, 2004). By the initiative financing the healthcare in Nigeria, community financing has been hard to implement as the managerial skills were rare and also the local supervision was poor. In addition, there have been mismanagement and misappropriation of funds. As result, the financing of BI initiative in Nigeria has continually been dependent on the supply of drugs from donors. The limitation of the BI was application of user fees to the poor households and cost recovery. The issue of abolishment of the user fees of the BI program showed that the health care system would increase in the short term and later stabilize after several months. But this initiative required that: there should be leadership and political will; the intervention should be prepared and planned carefully; the health staff, stakeholders, and the population should be informed; organizing a simple and consistent administrative system; finally installing a monitoring and evaluation system (Riddle, 2011). Another problem during the implementation of the BI in Nigeria was poor policy formulation or utilization and inadequate validation and modeling (Chukwani, Olugboji, & Ugbene, 2006). According Gardner (1999) argues that the community management of the revolving drugs has been dealt with provision of initial training courses but there have been no commitment to the continued support from the locals. people behaviors on illness has been a major hindrance to successful delivery of medical services as the resources are scarce in Nigeria and are also wasted in the duplication of duties by the personnel. In many parts of Nigeria the question of willingness to pay, cost, and the ability to pay are the major determinants of utilization and access to healthcare. The BI in 1987 was as a result of the economic and political crisis that struck the Sub-Saharan Africa culminating into the child mortality rate exceeding 200/100 births and yet the national budget for health was declining despite the rapidly budging population. It has been found out that the BI facilities have better availability of the essential drugs both in stock and average number. Conversely, the BI has given rise to more drugs prescription which could be irrational. According to Akpala, Onwuejekwe, and Uzochukwu (2004) reported on study conducted on the utilization of the child and maternal healthcare services in the health centers before and after the introduction of BI in the south-east Nigeria found out that the usage of antenatal, immunization, and delivery services improved, whilst curative services worsened. Additionally, the exclusion of some socio-economic groups from using these services as result of financial reasons, distance, and the non-availability of medical doctors are the main factors that are militated against the utilization of these services. However, people were willing to pay for the health service. BI was modeled so as to empower the communities so that they move towards equitable and sustainable health care system. By design the BI is tasked with ensuring quality and improving accessibility at the higher levels. Moreover, community empowerment through decentralization of decision making and community management should be policy backing. Consequently, by harnessing the local voices through the participation of the community, experience, and evidence from research to the public and private sector policy processes, it is quite possible to inform the debates and shaping of better policies and the institutions of health. In Nigeria the health Bill of 2008 expressed without any bias that all the Nigerians are to be entitled to a guaranteed minimum package of services (Omululu, Okunola, & Salami, 2012). The BI program tried to alleviate the situation where poverty is keeping more and more people in the bracket poor health, just as the poor health of an increasing number of Nigerians is retaining them in abject poverty. BI has further structural arrangements to make sure that the poor also have quality health care services available (Uzochukwu, Onwujekwe, & Eriksson, 2011). In addition, to the BI program, the existing traditional welfare structures should be providing channels for taking care of the indigent. They are to be incorporated into the health care delivery systems as many communities have embraced the challenges associated thus need to motivate and encourage them. Reference List Akpala, Onwuejekwe, E., & Uzochukwu, B. (2004). Bamako Initiative program and the Utilization of Maternal and Child Healthcare services in Nigeria. Journal of Health Population in Developing Countries , 7 (2), 345-398. Chukwani, C., Olugboji, A., & Ugbene, E. (2006). Improving Access to Essential Drugs for Rural Communities in Nigeria: the Bamako Initiative. Pharmacy World abd Science , 28 (2), 91-95. Gardner, P. (1999). Evaluation and Planning Center for Health Care. London: London School of Hygiene and Tropical Medicine. Johnson, J., Carleen, C., & Stoskopf, H. (2010). Comparative health systems:. Sudbury: Jones & Bartlett Learning. Omululu, F., Okunola, R., & Salami, K. (2012). Equity and access to Healthcare Sercices: Experience of the Bamako Initiative program in Nigeria. Journal of Medicine and Medical Sciences , 6 (3), 434-442. Riddle, V. (2011). Is the Bamako Initiative still relevant for the West African Health Systems. International Journal of Health Services , 41 (1), 175-184. Uzochukwu, B., Onwujekwe, O., & Eriksson, B. (2011). Inequity in the Bamako Initiative programme--implications for the treatment of malaria in south-east Nigeria. International Journal Health Planning Management , 113-135. Read More