[e-drug] Sachs' unfashionable Rx for third world aid (4)

["Murtada Sesay" <msesay@unicef.org>]

E-DRUG: Sachs' unfashionable Rx for third world aid (4)
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As Sierra Leone, my home country, has been correctly referred to as one of
those "amongst the last 20 of the UN Human Development Index category.."
and as I was directly involved as Health Project Officer with
implementation of the "Bamako Initiative" for many years, before the civil
war hustled everybody away, I can say the following:
   Although admittedly with no hard evidence, it was often claimed in
   statements by community leaders at programme launching ceremonies that
   communities generally believed that "free" can never be "best".
   User fee or no user fee, was often not  the issue, but whether supplies
   will be available when required. Unfortunately, in communities where
   government capacity could not be relied on, it is true that collection
   and good management of user fees did, at least in the Sierra Leone case,
   result in better assurance of supplies. Briefly, UNICEF Sierra Leone
   had, in view of foreign exchange difficulties the country faced, a
   special concession with government whereby collected local currency from
   districts, through user fees, were used in their in-country programme
   implementation, and the equivalent foreign currency provided to finance
   import of essential medicines for districts who paid. It was as
   hard-nosed as "no money, no medicine" in this programme. There was at
   least qualitative evidence that health facilities in districts where the
   Bamako Initiative was not yet launched were worse off in a number of
   indicators. This hopefully may have translated into better health
   indicators. However, it must also be said that the government did not
   renege on its commitment to provide free medicines to all its peoples.
   Translating commitment to reality boiled down to resource availability
   and good governance.
   Even where user fees are felt to be helpful, it should never be
   overlooked that there has to be safety nets on which some/many members
   of the community can fall. The problem would be how to identify and
   provide safety to those vulnerable.
   It is important to emphasise that it is not entirely what and how much
   resources are available, through user fees or otherwise,  but how well
   they are managed.

Murtada M. Sesay
Technical Officer (Pharmaceuticals)
UNICEF Supply Division

Tel: +45 3527 3098
Mobile: +45 28 23 28 07
E-mail: msesay@unicef.org
Web: www.unicef.org/supply