Twelve years after the Bamako initiative: facts and political implications for equity in health services accessibility for indigent Africans

Launched in 1988, the Bamako Initiative was considered as a policy aimed at revitalizing the primary health care strategy while strengthening equity in access to health care. A decade later, two research initiatives conducted in Mali and Uganda, and later in Burkina Faso, concluded that a) this policy did very little to improve or increase access to health care among the most deprived and excluded vulnerable population groups, b) this policy only served to marginalize certain population groups already disenfranchised due to the emphasis on financial sustainability and viability of health care organisations, and c) the exemption mechanisms for alleviating the burden of payment and financial barriers for the poorest represent a technically feasible solution, while one not socially advocated. The current state of affairs requires that in order to give impetus to the principles of equity and the initial goals of the Bamako Initiative, African states should implement incentives, NGOs should consider planning as a tool for social change and donors need to ensure investments which are centred upon and prioritize principles of equity.