Is the Bamako Initiative still relevant for West African health systems?

Int J Health Serv. 2011;41(1):175-84. doi: 10.2190/HS.41.1.l.


Faced with the difficulty of implementing primary health care services as proposed at Alma-Ata, UNICEF and the World Health Organization launched a new public health policy in 1987, the Bamako Initiative, to improve access to health care by revitalizing primary health care. The key principle was to decentralize retention of user fees to the local level in health centers managed by a committee of community representatives. Initially, measures were envisioned to exempt the worst-off who were unable to pay; however, these measures were never applied. Today, with most funding agencies in favor of abolishing user fees and some African countries already starting to do so, the relevance of this public policy is being reconsidered for West African countries.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa, Western
  • Decision Making, Organizational
  • Fees, Medical*
  • Financing, Personal*
  • Health Policy
  • Healthcare Disparities*
  • Humans
  • Primary Health Care / economics*
  • Primary Health Care / organization & administration
  • Universal Health Insurance / economics*
  • Universal Health Insurance / organization & administration