Evaluation of the Bamako Initiative in Ekiti State
The Bamako Initiative (BI) was established at the 36th African Ministers' meeting in Bamako, Mali in 1987 to help accelerate Primary Health Care (PHC) implementation at the district and community levels. Nigeria has implemented the BI for decades but it has rarely been evaluated. This study was aimed at evaluating the level of implementation of the programme in Ekiti State of Nigeria. The specific objectives were to assess the extent of achievement of the BI national priority objectives in the State and ascertain factors contributing to the achievement of these objectives. The study employed a descriptive design using a structured questionnaire. The study population included 180 implementers (Primary Health Care Management Committee members and members of the PHC Technical Committee) and 240 beneficiaries who were community members. The level of implementation was measured by the extent of attainment of the national priority objectives of the initiative since its inception. Equally, the activities with the highest and the lowest frequency under each of the key implementation subject areas were taken as the factors contributing to the level of achievement of the respective national objective. Results were presented using simple descriptive statistics. The results showed that 60% of the implementers and beneficiaries were in support of the cost-recovery programme, just meeting the national target of 60%, while 35% of communities had Drug Revolving Funds (DRF) still running in their facilities, this being much lower than the national target of 100%. Only 12% of health workers reported using standing orders to treat patients, compared with the national target of 90%, while 31% received supervisory visits (with the supervisors using a checklist) in the month preceding the study, also much lower than the national target of 100%. Equally, 35% of health workers (compared with the national target of 100%) reported that the health facilities had a continuous supply of essential drugs and 40% of them (instead of the 1000 recommended) had attended update trainings in the year preceding the study. Factors reported to contribute to the prevailing level of implementation included the non-translation of the B.I. manual into local language (79%), non use of the Standing Order while treating patients (30%), poor supervision of the scheme by LGA authorities (50%), poor coverage of pro-poor schemes such as exemption and deferrals (42%) and poor financial commitments of LGA authorities to the health facilities (42%). The study concluded that the level of implementation of, the Bamako Initiative in the State was poor, grossly falling short of the national targets. Factors responsible for this included non-translation of the B.I. manual into local language, poor support of pro-poor schemes by the LGAs and poor financial commitment of the LGAs to the BI programme.