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World Health Forum. 1993;14(4):349-55.

Primary health care: from aspiration to achievement.

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1
Division of Primary Health Care, Ministry of Public Health and Social Action, Dakar, Senegal.

Abstract

A review is presented of Senegal's response to the Bamako Initiative, aimed at strengthening primary health care. The experience gained is of broad interest since the basic principles involved are the same everywhere. Of particular importance are users' financial contributions and improved organization and management.

PIP:

The 1987 Bamako Initiative tries to rectify the major gaps and inadequacies in implementing primary health care (PHC). In Senegal, people living near health units elect health committees which collect and manage health facilities and their income. Each patient contributes some money each time he/she uses a health service. The proportion of funding allocated to priority health care activities is very inadequate. Problems of public health services in Senegal range from chronic shortages of essential drugs to the people having lost faith and having abandoned public health services. Medical personnel in the public sector question the PHC strategy. So Senegal has developed a medium-term plan for social and health development for each health district and medical region. It has also redefined district and regional level management structures and their roles and responsibilities. Private pharmacies sell most of the 3000 medicines authorized to treat infectious diseases, deficiency diseases, and congenital diseases. They sell the more expensive brand name drugs. They controlled the sale of 13-14,000 million CFA francs worth of drugs out of the 15,000 million CFA francs worth of drugs sold in Senegal in 1991. An expert committee on essential drugs of the Ministry of Public Health and Social Action's Human Resources Development Project has revised essential drug lists to include generic names. It has distributed different lists to health huts, health posts, health centers, and regional hospitals. Another committee has determined the initial amount of money needed for essential drugs for each level of the health system. It has identified various sources of funding with Switzerland contributing enough money to cover drugs for health posts and health centers. Senegal has reorganized the supply and distribution system by decentralizing the National Supply Pharmacy. New management tools are registers of incomes and outgoings, stock cards, inventory cards, order books, and receipt books. Private pharmacists objected to full implementation of the Initiative. Physicians also resisted it.

PMID:
8185783
[Indexed for MEDLINE]
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