Sustaining the Bamako Initiative in the Gambia--some management implications.
There is increasing pressure in developing countries to improve the social, political and economic status of their people. For former colonies such as the Gambia, pre-independence promises of equity in health, education, water supply and sanitation were vaguely presented in political manifestos. Some of these promises were not translated into concrete plans because of the economic difficulties that the countries experienced. The Alma Ata Declaration on Primary Health Care in 1978 was seen as a strategy to improve the deteriorating health status in developing countries. The economic crisis however, which these countries were facing forced them into implementing Structural Adjustment Programmes (SAP). This resulted in a search for alternative methods of financing health care including that of the Bamako Initiative in 1987 to strengthen the implementation of PHC. The Gambia adopted The Bamako Initiative in 1993 to help in strengthening its already well-developed PHC infrastructure. The Bamako Initiative, like any other form of financing health services, is however not without shortcomings. This paper assesses the structural bottlenecks likely to affect the sustainability of the programme in the Gambia. It examines the political and operational management issues such as political stability, donor commitment and support, effective community management, health sector support and the availability of financial resources.
Ministry of Health, The Gambia.
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Ceesay
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Kalliecharan
D018672:Community Health Planning / Q000191:economics; D003906:Developing Countries; D005381:Financing, Organized; D005714:Gambia; D006289:Health Planning Support; D011320:Primary Health Care / Q000191:economics*; D014944:World Health Organization