Bamako Initiative revitalizes primary health care in
Community involvement in primary health care in Benin
has helped reduce child death rates, boost immunization coverage,
and increase access to antenatal care.
In the early 1980s in Benin, a child had a slim chance
of survival and good health. At the time, Benin had one of the highest
under-five death rates in the world: 203 deaths for every 1000 live
births. And only one-third of women had access to antenatal care.
Less than 30% of the population had access to functioning
primary health care (PHC) services and the government spent only about
US$ 1.50 per capita a year on health.
What changed the situation dramatically was the introduction
of a series of community-based health system reform strategies, which
helped make primary health care more effective and equitable. Innovations
included the reliable supply of affordable essential drugs combined
with community co-management, cost-sharing and community-based monitoring
of an integrated minimum package of PHC services. These include immunization,
health and hygiene education, treatment of minor illnesses, and maternal
and child health care.
When UNICEF provided substantial funding for the Expanded
Programme on Immunization (EPI) in 1985 to help achieve the objective
of Universal Child Immunization by 1990, Benin used the funds not
only to improve immunization but also to revitalize their PHC systems.
The health system reform strategies were subsequently
formally adopted in 1987 in Bamako by African Ministers of Health,
UNICEF and WHO, as the Bamako Initiative. By 1990, the strategies
had helped revitalize the entire existing primary health care network
in Benin and the country achieved the objective of reaching 75% of
children through the national immunization programme.
When a combined economic and political crisis hit West
Africa in the early 1990s and undermined the gains made in EPI, Benin
-- thanks to the Bamako community-based initiative -- continued to
achieve high immunization rates and significant reductions in death
rates among the under-fives.
As a result, by 1998, death rates among infants and
children under five were down by nearly 20%, immunization coverage
was being sustained at around 80%, and about 65% of women were using
Within a few years of its inception, the Bamako Initiative
was adopted widely throughout West and Central Africa, but not always
as successfully as in Benin. The remaining challenge in Benin is to
build on the Bamako Initiative experience in order to accelerate large
scale implementation of other health initiatives such as Roll Back
Malaria, Stop TB, and the International Partnership Against AIDS in
A recent analysis of the results achieved through
the Bamako Initiative highlights the key conditions for success: