Benin: from the Bamako initiative to eradication of the Guinea worm...]

Benin a pioneer in applying the Bamako initiative has based its health policy on primary health care and community financing in order to respond in a decentralized manner to the priority health concerns of the population. The focus has been on preventive medicine maternal-child health care control of major endemic diseases infrastructure development improved quality of care continuous supply of essential drugs and rational management of resources. The sale of essential drugs in the health facilities assures a regular flow of income that can be used to finance resupplies of drugs and recurrent expenses. In 1993 the five principal reasons for health consultations were malaria (32%) acute respiratory infections (15%) diarrheal diseases (8%) traumas (5.5%) and anemia (5%). The use of funds is controlled by the community represented by management committees. This article describes the activities of 15 communities to illustrate the working of the health policy at the local level and the major public health problems of Benin. Local achievements have included improving immunization coverage providing a permanent stock of supplies for treatment of recurring outbreaks of cholera renovating hospitals (with international assistance) and organizing the central purchasing facility for drugs which assures availability of quality medications throughout the national territory at a price affordable for most of the population. Provision of health care to Togolese refugees and treatment of leprosy and tuberculosis are other achievements. The national tuberculosis control program has used a short course of treatment since 1983 achieving an 80% cure rate. 6.6% of tuberculosis patients are HIV positive. A national survey was begun in 1994 to estimate the average annual risk of infection. The national system of health information and statistics has been improved and decentralized assuring effective epidemiologic surveillance. 20 sentinel surveillance centers for HIV infection have been established. Dental examinations and treatment of school children organization of a pilot project to consolidate health resources and efforts to curb annual outbreaks of cerebrospinal meningitis are other activities. The national program to eradicate guinea worm has produced a decline in cases with hopes for future eradication.