THE BAMAKO INITIATIVE IN BENIN AND GUINEA - IMPROVING THE EFFECTIVENESS OF PRIMARY HEALTH-CARE

The objective of the health system revitalization undergone in Benin a nd Guinea since 1986 is to improve the effectiveness of primary health care at the periphery. Second in a series of five, this article prese nts the results of an analysis of data from the health centres involve d in the Bamako Initiative in Benin and Guinea since 1988. Data for th e expanded programme of immunization, antenatal care and curative care , form the core of the analysis which confirms the improved effectiven ess of primary health care at the peripheral level over a period of si x years. The last available national data show a DPT3 immunization cov erage of 80% in 1996 in Benin and 73% in 1995 in Guinea. Tn the Bamako Initiative health centres included in our analysis, the average immun ization coverage, as measured by the adequate coverage indicator, incr eased from 19% to 58% in Benin and from less than 5% to 63% in Guinea between 1989 to 1993. Average antenatal care coverage has increased fr om 5% in Benin and 3% in Guinea to 43% in Benin and 51% Guinea. Utiliz ation of coverage with curative care has increased from less than 0.05 visit per capita per year to 0.34 in Guinea and from 0.09 visit per c apita per year to 0.24 in Benin. Further analysis attempts to uncover the reasons which underlie the different levels of effectiveness obtai ned in individual health centres. Monitoring and microplanning through a problem-solving approach permit a dynamic process of adaptation of strategies leading to a step by step increase of coverage over time. H owever, the geographical location of centres represents a constraint i n that certain districts in both countries face accessibility problems . Outreach activities are shown to play an especially positive role in Guinea, in improving both immunization and antenatal care coverage. ( C) 1997 by John Wiley & Sons, Ltd.