title: [Improve the accessibility of essential drugs for the populations of one medical region in Burkina Faso].
abstract: Despite the formulation of the Bamako initiative in 1992 in Burkina Faso, not until 2001 and the launching of a project by a nongovernmental organization was the policy really implemented in a region of the country. One of the goals of this policy is to improve access to health care by using generic essential drugs. The objective of this article is to summarize the results of the evaluation of the project's ability to improve the population's access to drugs. The project lasted three years (2001-2003) and the interventions took place in 41 basic health centres of three districts. According to WHO, improving access to drugs requires consideration of four essential factors: rational use, affordable prices, financial viability, and effectiveness of the distribution. The average number of drugs prescribed per prescription sheet (n = 1061) was 2.4; 93% of the drugs were prescribed by their generic name (international non-proprietary names); 44% of infant diarrheas were treated with oral rehydration salt. National drug prices were respected but not the directives aiming at exempting from payment or subsidizing certain population sub-groups (children, indigents). The average annual cash flow of the basic health centres was 1.2 million F CFA and it increased by 854% compared to the beginning of the project. The cost-recovery scheme for administrative expenses was 106%. The average annual availability of the 10 essential drugs was 89%. Utilization rates increased (0.13 in 1999 to 0.21 in 2003) but not significantly differently than in other basic health centres of the area not supported by the project (p = 0.084). The project succeeded in improving access to these drugs for the overall population but not for the worst-off. The drugs are now geographically available for all and financially accessible for those who can afford to pay. The intervention strategy supported the sustainability of the project's activities but much remains to be done to provide the poorest with access to drugs.
authors.affiliation: Université Laval, Département de médecine sociale et préventive, Québec, G1K 7P4 Canada. valery.ridde.1@ulaval.ca
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.forename: Abdoulaye P
authors.initials: AP
authors.lastname: Nitièma
authors.forename: Moussa
authors.initials: M
authors.lastname: Dadjoari
mesh_terms: D002050:Burkina Faso; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D003968:Diarrhea, Infantile / Q000188:drug therapy; D016527:Drug Costs; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D016568:Drugs, Generic / Q000145:classification / Q000191:economics / Q000600:supply & distribution*; D005252:Fees, Pharmaceutical; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015397:Program Evaluation; D015532:Rehydration Solutions / Q000627:therapeutic use; D040841:Resource Allocation; D017664:Uncompensated Care / Q000706:statistics & numerical data
chemical_list: D016568:Drugs, Generic; D015532:Rehydration Solutions