Affordability, cost‐effectiveness and efficiency of primary health care: the Bamako Initiative experience in Benin and Guinea

Abstract

Since 1986 two West African countries, Benin and Guinea, have been actively reorganizing their peripheral health systems according to strategies subsequently called the “Bamako Initiative”. Two preceding articles described the strategies implemented and the increased effectiveness of primary health care (PHC) witnessed over a period of six years. This article presents an analysis of cost and coverage data from biannual monitoring sessions between 1988 and 1993 in approximately 200 health centres in Benin and 214 in Guinea. In order to assess affordability, the total and per capita recurrent costs for operational health centres are analysed and then compared. The cost analysis reveals a mean total cost per health centre per year of slightly over US$11,000 in Benin and nearly US$9,000 in Guinea. The median cost per capita per year is approximately US$1.0 in Benin and between US$0.60 and US$0.80 in Guinea. Comparisons of these costs between regions, health centres and over time (as coverage levels evolved) show very little variation in either country. Cost‐effectiveness is estimated by allocating these costs to immunization, antenatal and curative care and comparing them to the coverage achieved with these interventions. First, the cost‐effectiveness of the Bamako Initiative (BI) system as a whole is analysed. The cost per fully vaccinated child is calculated at US$10.9 in Benin and US$8.8 in Guinea. The cost per woman receiving at least three antenatal visits is US$7 in Benin and US$4.7 in Guinea. For curative care, cost per full treatment is US$1.6 in Benin and half this amount in Guinea. Cost‐effectiveness is variable between regions, health centres and over time. An analysis of the characteristics of the most and least cost‐effective centres reveals that these differences in cost‐effectiveness are mainly caused by the coverage levels achieved, since total costs are relatively stable. Finally the efficiency of drug management and prescriptions as well as of outreach for the expanded programme of immunizations (EPI) is estimated by relating specific drug and outreach costs to the number of beneficiaries. The average cost of drugs per treatment is around US$0.5 in Benin and around US$0.3 in Guinea. Cost analysis of outreach activities undertaken for EPI in Guinea revealed a similar average cost per child completely vaccinated for health centres with different intensities of outreach (approximately US$10) and an additional cost per child vaccinated attributable to outreach of US$1–2. © 1997 by John Wiley & Sons, Ltd.

Some pharmacological studies on the methanolic extract of <i>Inula graveolense</i> L.

“…These fevers are often accompanied by aches and pain which all lead to morbidity and mortality. Herbal medicines are often used as remedies in these conditions since as a result of poverty orthodox medicines may be unaffordable [4]. It is known that a large number of plant species contain various bioactive compounds that may have health-beneficial properties, anti-inflammatory, anti-oxidant and antimicrobial effects, and their preventive and therapeutic use is increasing [5].…”

Antipyretic and Analgesic Effects of the Aqueous Extract of the Fruit Pulp of Hunteria umbellata K Schum (Apocynaceae)

“…These fevers are often accompanied by aches and pains which all lead to morbidity and mortality. Herbal medicines are often used as remedies in these conditions since as a result of poverty orthodox medicines may be unaffordable 2 . It is a well known fact that herbal medicines may be sources of substances with better therapeutic potentials than some currently used orthodox medicines 3 .…”

Discussion

“…8 -10 This is because high-level host community involvement and ownership are strongly linked to sustainability and bode better for the success of health aid programs. [11][12][13][14][15][16] In reviewing the literature, there is evidence that surgical capacity building led by volunteer organizations has yielded the benefits of sustainability and successful independent surgical care delivery in developing countries. [17][18][19][20] In addition, academic institutions in partnership with volunteer organizations have also demonstrated successes in surgical capacity-building efforts.…”

“…13 It is widely believed that the initiative improved availability, use, and affordability of many health services. [12][13][14][15][16] The successes of implementing the Bamako Initiative are in large part attributed to building the capacity of local communities to address the objectives it outlined in partnership with intergovernmental and nongovernmental organizations. [12][13][14][15][16] If one criticism remains of the several successful surgical capacity-building efforts, it is reporting the details of implementation of capacity-building models.…”