Paper short abstract:

Based on data collected in 2011, this presentation aims to evaluate the implementation of the Bamako Initiative in general, but in particular in Guinea-Bissau. The question posed is: Can universal health coverage be realized, as currently advocated by global institutions?

Paper long abstract:

UNICEF and WHO jointly formulated a statement that became known as the Bamako Initiative after its adoption by the African Ministers of Health in 1987. The aim was to rescue primary health care from privatization with user fees and selling of drugs. Later, the World Bank embraced the approach, and its list of assumed benefits included additional revenues, improved quality of services, efficiency, privatization, transfer of revenues from richer urban areas to poorer rural ones, decentralization, and sustainability. The ability to pay was found adequate, or at least be cheaper than the traditional system. The Initiative was assumed to improve access to services, and those unable to pay should be exempted through solidarity fund.

This presentation aims to evaluate the implementation of the Bamako Initiative generally, and in particular in Guinea-Bissau. It is based on data collected in the country in 2011. The benefits attributed to the approach have rarely been realized. Thanks to user fees and informal payments, the Bissau-Guinean nurses may have kept their health centers open during turbulent times. Nonetheless, the poorest part of the population has been excluded from the services, reflected in the low level of attendance and limited revenues. Due to general poverty and consequent difficulties in deciding whom to exempt from payment, no solidarity funds were established. Policy changes are needed to address inequality in access to health care and increase its quality. Will the implementation of universal health coverage, as currently advocated by donors, become more successful than the Bamako Initiative?