RESUMO
The implementation of the Bamako initiative is a central pillar of the health policy of Burkina Faso. The NGO, ASI, working with the health authorities, has set up a program involving the creation of eight health districts in the province of Gnagna. The program covers a population of 115,000 inhabitants in 134 villages and was progressively established between 1994 and 1997. The health districts were set up in phases (2 in the first year and 3 in each of the following two years). The method used to select the members of the village management committees is one of the key aspects of the program. It required a large amount of effort to increase the awareness of villages, and much activity because each committee is elected by the various villages of the district. The training of the managers of these committees and of the managers of the pharmaceutical warehouses in each district is also a key element. In our initial assessment, we noted balance in the accounting of the pharmaceutical warehouses of each district, adhesion of the population to the program, dynamics in the management committees and, above all, the autonomy of the committees. The first results in terms of health are very fragmentary and difficult to interpret because the program has been running for such a short time. We considered the long-term elements of the program, the necessity to set up a system for monitoring activities and the quality of care. An initial assessment showed a clear improvement in the availability of drugs in the 8 districts. Health promotion activities have not yet been developed in these districts. This type of program requires the follow up and support of the management committees, and will be the object of the second phase, begun in 1998.