Many developing countries, particularly in Africa, have recently introduced payment schemes based on the selling of essential drugs.
This is one of the main elements of the Bamako Initiative according to which the income generated would ensure a reliable supply of drugs and would improve other aspects of the quality of the services offered.
Thus, quality improvements would compensate for the financial barrier and as a result the utilization of public health services would be increased or at least maintained.
These hypotheses have proven to be partially valid, since there have been cases where the utilization of health services has increased and others where it has decreased ; these inconclusive results have fuelled criticisms concerning the inequitable nature of these measures.
This longitudinal study in a rural community of Zaïre shows that the utilization of health services had diminished by close to 40% over 5 yr (1987-1991) and that 18-32% of this decrease is explained by cost.
The regular supply of drugs and the improvement in the technical quality of the services-technical qualification of the star, allocation of microscopes, and renovation of the infrastructures-was not enough to compensate for the additional financial barriers created by the increased cost of services.
Mots-clés Pascal : Utilisation, Service santé, Qualité, Coût, Economie santé, Zaïre, Milieu rural, Etude longitudinale, Homme, Financement, Système santé, Afrique
Mots-clés Pascal anglais : Use, Health service, Quality, Costs, Health economy, Zaire, Rural environment, Follow up study, Human, Financing, Health system, Africa
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0139985
Code Inist : 002B30A01B. Création : 09/06/1995.