A few weeks later, UNICEF organized another regional meeting in Bamako. It went down in history as the Bamako Initiative. Its content is better known: it marked the introduction (or formalization) of user fees and that of community participation in resource management, including essential drugs now sold to users.
Like the vast majority of policies, these proposals were based on pilot experiments or similar approaches already in place in some countries, for example, the "health shops" of Mali (cost recovery) or the experience of health zones in Zaire (health district strategy).
25 years have passed. Globalization and new information technologies have profoundly changed the environment. The structural adjustments of the 80s are long gone. Today the continent is experiencing the strongest economic growth. Some countries have been able to exploit this new phenomenon for major changes in their health system and its financing. Rwanda has shown that the goal of universal coverage is not insane. But the continent is far from being homogeneous. HIV / AIDS is ravaging southern Africa. For the Horn of Africa to Central Africa and a fraction of West Africa, these 25 years have been plagued by armed conflicts. These shocks, coupled with the effects of the global economic crisis of the 80s, have been particularly harmful to health care systems. Many would argue that the potions that were administered to patients (structural adjustment programs, privatization, introduction of user charges...) have not helped, moreover, had long-term side-effects on health systems.
In the coming months, several communities of practice affiliated with “Harmonization for Health in Africa” (in 25 years, agencies have also realized the need to coordinate better!) will collaborate to develop a collective reflection on the Harare Declaration and Bamako Initiative. Several organizations have already indicated their willingness to be partners in this endeavor (if you work for an agency or an international organization and would like to help, please contact us). Like us, they believe that the issues identified in Harare and Bamako 25 years ago are still valid, although some updating is required.
We hope that this process can lead to a regional event in 2013. In the meantime, our intention is to tap our different technology platforms, especially this blog and our online discussion groups, to progress in the reflection.
This text is more than just an announcement of things that we will be producing. It is primarily a call for your contribution and input. They can be modest, such as helping us to widely spread our debates and discussions to people you know, or more ambitious, such as writing an article or a blog post or conducting an interview.
We count on your enthusiasm!