The Bamako initiative

The Bamako initiative was sponsored by UNICEF, WHO and was adopted by African ministers of health in 1987. It aimed to increase access to primary healthcare.

With UNICEF support, 34 countries (Benin, Burkina Faso, Chad, Guinea, Niger and Sudan being examples) are developing their primary health care systems.

Links are established between hospitals, rural social services, schools, religious groups, women's groups and youth groups to encourage, develop and strengthen health care and health education initiatives.

For example, in Benin, West Africa:

  • 200 health centres, covering 58 per cent of the population, spread their costs among the local communities
  • a vaccination programme for BCG, polio and DPT (diphtheria, polio and tetanus) was introduced in 1993
  • infant mortality rates were tackled by a programme of pre and post-natal health education

Effectiveness

In Benin in 1993:

  • 86 per cent of the population received a BCG immunisation
  • 71 per cent of the population received a polio/DPT immunisation
  • 75 per cent of pregnant women obtained medical consultations
  • 63 per cent of births were attended by skilled medical staff
  • costs to the community were kept down to £0.50 per visit

Life expectancy has improved and is now 60 years for men and women (2012 figures). Infant mortality rate has also decreased from 83 per 1000 live births in 1993 to 42 per 1000 in 2011.

Maternal mortality remains high at 350 per 100,000 live births in 2012. This is down from 497 per 100,000 in 1996. This is despite an increasing number of births attended by skilled health workers - 84 per cent in 2012.

Doorstep delivery in Bangladesh

Female family planning advisors travel to visit women, many of them unable to leave their homes without a male.

They encourage women to use contraception and to have smaller families. This improves maternal health and encourages sustainable development.